Laparoscopic right hepatectomy after radioembolization using yttrium-90 resin microspheres
Background: Liver surgery after selective internal radiation therapy (SIRT) has been scarcely reported. The combination of laparoscopic approach in post-SIRT major liver surgery is a complex scenario to our knowledge not reported so far. Method: From July' 2007-July' 2016, 40 patients underwent post-SIRT R0 resections in our center: 30 resections and 10 liver transplants. From March'2011, 5 (out of those 30) were full-laparoscopic resections: Three patients underwent laparoscopic right hepatectomy (LRH) after previous right hemiliver radiation lobectomy: two cirrhotic patients with HCC and one with colorectal cancer liver metastasis; one segment-VI resection in a cirrhotic patient, due to HCC and finally, a patient with a Budd-Chiari Syndrome and an infiltrating HCC in segment-III underwent left lateral seccionectomy. In all cases, the procedure was uneventfully completed full-laparoscopic and none required transfusion. Hospital stay was 3, 2, 5, 3 and 3 days respectively. We herein present a LRH in a 71 year-old patient after right hemiliver radiation lobectomy (due to a 7 cm unresectable HCC in a HCV cirrhotic liver). Case presentation, surgical findings and technique are detailed in this video, which also demonstrates the comparative hypoperfusion of the treated hemiliver revealed with ICG fluorescence, a hitherto undescribed finding. Results: Hospital stay was 3 days. No early or late morbidity occurred. At this writing, 18 months after the resection and 43 months after the initial diagnosis the patient is alive and free of disease. Conclusion: This experience suggests that laparoscopic liver resection after SIRT is feasible and safe, even in major hepatectomies. (C) 2017 Elsevier Ltd. All rights reserved.