Laparoscopic hepatic lobectomy in the porcine model

Background: To date, there have been only a few anecdotal reports of laparoscopic hepatectomy, most of which are limited to wedge resections. The aim of this study was to assess the feasibility of laparoscopic hepatic lobectomy in a porcine model. Methods: Eight pigs were anesthetized before placement of an abdominal wail lift device and five laparoscopic ports. With the porta hepatis clamped, the left lateral hepatic lobe was divided with an ultrasonic dissector. Small vessels and ducts were clipped, larger vascular structures were transected with staplers, and surface hemorrhage was controlled with an argon beam coagulator. Serum liver enzymes (LFTs) and blood counts were drawn pre- and postoperatively. All animals were killed after 1 week. Results: Mean +/- SEM operating and clamp times were 131 +/- 8 and 39 +/- 2 min, respectively. There were four intraoperative complications in three animals (three lacerations of the hepatic vein and one lear of the splenic capsule), all of which were controlled at surgery. Mean blood loss was 189 +/- 52 ml, and the mass of the resected specimen was 139 +/- 11 g. There were no postoperative complications or deaths. White blood cell count, hematocrit, and LFTs did not change postoperatively, except for aspartate aminotransferase (AST), which was elevated transiently. There were no bile leaks or intraabdominal abscesses. Conclusions: Laparoscopic left hepatic lobectomy was technically feasible in the porcine model using an abdominal wall lift device for exposure. Clinical trials are needed to assess its feasibility and limitations before laparoscopic hepatic lobectomy is deemed safe for human use.