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better visualization and a more precise procedure than does movement of the transection point to the appropriate
open surgery. position, and creation of good tension for parenchymal
transection at the transection point. The original hanging
Liver mobilization itself may result in postoperative refractory maneuver can only be applied in right hemihepatectomy and
ascites, considering the destruction of collateral blood and extended posterior sectionectomy; however, HARNESS can
lymphatic flow. In laparoscopic surgery, depending on the be applied to various kinds of laparoscopic hepatectomies,
[13]
location of the tumor, liver rotation by gravity and gentle even those without a natural hook for the tape, such as
manipulation often enables liver resection without liver posterior sectionectomy, anterior sectionectomy, and partial
mobilization. hepatectomy.

LAPAROSCOPIC LIVER TRANSECTION TECHNIQUE The described techniques have resulted in good clinical
(SUPERFICIAL PRE-COAGULATION, SEALING, AND outcomes, as described in our previous reports. [12,15] These
TRANSECTION METHOD) less-invasive and systematic procedures have the potential to
prevent postoperative hepatic failure. Keeping these points
Liver transection is the most challenging aspect of in mind ensures that laparoscopic hepatectomy becomes a
hepatectomy in terms of bleeding. Pre-coagulation of the simple and safe procedure, even for cirrhotic patients with
superficial parenchyma using a radiofrequency ablation HCC. Furthermore, laparoscopic hepatectomy is associated
device is useful for controlling intraoperative bleeding. with fewer postoperative adhesions than conventional open
[14]
We introduced an original laparoscopic liver transection hepatectomy. For the cirrhotic liver, which is a well-known
technique, the superficial pre-coagulation, sealing, and precancerous condition requiring multimodal treatment,
transection method. This method consists of four steps: this benefit could enable any future surgical treatments to
[15]
Superficial pre-coagulation from the liver surface using a be performed much more easily in case of recurrence. For
needle-type electrode with the VIO 300 D soft-coagulation tumors on the liver surface, the procedure also carries a lower
system (ERBE Elektromedizin, Tübingen, Germany); exposure risk of peritoneal dissemination than radiofrequency ablation.
of vessels and bile ducts with an ultrasonic aspirator; sealing With regard to both surgical and oncological aspects, these
of the vessels and bile ducts with energy devices; and advantages make laparoscopic hepatectomy ideal as a
transection of the liver parenchyma. In this method, bleeding bridging therapy for curative liver transplantation. [6,16]
can be well controlled even during transection, which enables
bloodless transection without inflow and outflow vascular REFERENCES
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