This video shows a case of laparoscopic left ectomy for Carly disease limited to segment two and three of the liver. A 53-year-old male patient was admitted to the hospital for recurrent right-sided abdominal pain associated with fever. Abdominal CT scan demonstrated a segmented dilatation of the repath ducts limited to those segment two and three of the liver as in left sided cly disease.3D.
Reconstruction of the eria blood flow demonstrated the presence of the RightPath artery of originating directive from the orta. While no abnormalities were revealed in the portal system, A laparoscopic Left ectomy was then implanted. Patient was placed in supine position.
The operating surgeon stands between patient legs and five toker have used. The position of the toker can be seen in this scheme. The procedure starts with Exploration of the abdominal cavity and after the placement of the remaining four toker, a laparoscopic vascular clamp is placed on the liver ilum in order to reduce the bleeding during division of the liver parenchyma.
We currently do not use this sort of ingal maneuver anymore, although a tape is always placed around the ilum and tight neck In case of bleeding. The division of the liver parenchyma is performed using a combination of bipolar electro cordery and monic scalpel along the falciform ligament between segment three and four. This maneuver allows to expose the segment three main pedicle.
When the segment three pedicle is fully dissected, it can be divided using a 45 millimeter in the GIA with a vascular cartridge. The procedure Carries on with further division of the parenchyma till the main P hole to segment two is reached, isolated, and then finally divided using a further cartridge of 45 millimeter in the GIA At this point, The left lower of the liver is attached to the remaining parenchyma only by the left, so particle vein and the left triangle or ligament who is now divided using a later Tery using an in partic approach. The left partic vein is isolated and then divided Using a vascular staple due to the deep location Of the vein.
More than one cartridge is usually required at this point. The left ectomy is completed. The liver of phase is checked for bleeding and argon beam is applied on the levels of face.
The vascular clump is Then removed at this point. Fing glue is applied in order to reduce the risk of postoperative bio leaks. Specimen is placed into an endo bag and remove alar one of the axis.
A 24 French silicone drain is left in place for 48 hours. The patient is usually discharged on postoperative day three.
