Laparoscopic Left Lateral Segmentectomy for Symptomatic Hepatic Cysts: A Case Series.

Abstract

Large hepatic cysts can cause abdominal pain, pressure symptoms, or liver dysfunction. Although laparoscopic fenestration is the standard surgical approach, recurrence remains a concern. As laparoscopic hepatectomy techniques have advanced, we have adopted laparoscopic left lateral segmentectomy as a curative treatment for symptomatic cysts located in the left lateral segment. Between 2018 and 2023, 4 patients underwent laparoscopic left lateral segmentectomy for symptomatic hepatic cysts at our institution. All procedures were performed using five ports. Cystic fluid was aspirated as much as possible, and hepatic transection was conducted under the total Pringle maneuver using ultrasonic dissectors. Small vessels were sealed, while larger vessels and Glissonean pedicles were clipped or divided with linear staplers. Resected specimens were retrieved via an extended umbilical incision. Surgical and postoperative parameters were analyzed to evaluate the safety and efficacy of the procedure. The cohort included 1 male and 3 female patients, with a mean age of 63 years. Presenting symptoms included abdominal pressure (3 cases) and epigastric pain (1 case). The mean maximum cyst diameter was 16.3 cm, and the average aspirated volume was 950 mL. The mean operative time was 232 minutes, and the mean blood loss was 48 g. No postoperative complications were observed. The average postoperative hospital stay was 6 days. All patients experienced symptom resolution without delayed complications during follow-up. Laparoscopic left lateral segmentectomy might be a safe and curative surgical option for symptomatic hepatic cysts located in the left lateral segment.