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BACKGROUND: Laparoscopic distal pancreatectomy (LDP) is the preferred approach for resection of tumors in the distal pancreas because of its many advantages over the open approach. AIM: To analyse and compare short and long-term outcomes from LDP performed through two different techniques: with splenectomy vs. spleen preservation and splenic vessel preservation. METHOD: Fifty-eight patients were operated and subsequently divided between two groups: Group 1, LDP with splenectomy (LDPS); and Group 2, LDP with spleen preservation and preservation of splenic vessels (LDPSPPSV). RESULTS: The epidemiological characteristics were statistically similar between the two groups (age, gender, BMI and lesion size). Both the mean of operative time (p=0.04) and the mean of intra-operative blood loss (p=0,03) were higher in Group 1. The mean of resected lymph nodes was also higher in Group 1 (p<0.000). There were no statistic differences between the groups in relation to open conversion, morbidity or early postoperative mortality. The mean hospital stay was similar between groups. Pancreatic fistula (grade B and C) was similar between the groups. The mean of overall follow-up was 37.6 months (5-96). Late complications were similar between the groups. CONCLUSION: Both techniques were superimposable; however, LDPS presented, respectively, higher intra-operative bleeding, longer duration of the operation and higher number of lymph nodes resected. No differences were observed in the studied period in relation to the appearance of infections or neoplasm related to splenectomy during follow-up. Maintenance of the spleen avoided periodic immunizations in patients in LDPSPSV. It is indicated in small pancreatic lesions with indolent course.

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BACKGROUND: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. AIM: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. METHODS: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). RESULTS: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. CONCLUSION: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.

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BACKGROUND: Laparoscopic distal pancreatectomy has been the choice for resection of distal pancreas lesions due many advantages over open approach. Spleen preservation technique seems minimizes infectious complications in long-term outcome. AIM: To present the results of laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique (preservation of spleen blood vessels) performed by single surgical team. METHODS: Retrospective case series aiming to evaluate both short and long-term outcomes of laparoscopic distal pancreatectomies with spleen preservation. RESULTS: A total of 54 laparoscopic distal pancreatectomies were performed, in which 26 were laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique. Mean age was 47.9 years-old (21-75) where 61.5% were female. Mean BMI was 28.5 kg/m² (18-38.8). Mean diameter of lesion was 4.3 cm (1.8-7.5). Mean operative time was 144.1 min (90-200). Intraoperative bleeding was 119.2 ml (50-600). Conversion to laparotomy 3% (n=1). Postoperative morbidity was 11.5%. Postoperative mortality was null. Mean of hospital stay was 4.8 days (2-14). Mean time of follow-up period was 19.7 months (2-60). There was no neoplasm recurrence or mortality on evaluated period. There was no infectious complication. CONCLUSION: Laparoscopic distal pancreatectomy with spleen and splenic vessels preservation is feasible, safe, and effective procedure. This technique presented both low morbidity and null mortality on this sample. There were neither infectious complications nor neoplasm recurrence on long-term follow-up period.

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ABSTRACT Background: Percutaneous drainage for pyogenic liver abscess has been considered the gold-standard approach for the treatment on almost of the cases. However, when percutaneous drainage fails or even in some especial situations, as multiloculate abscess, lobe or segment surgical resection can solve infectious clinical condition. Aim: To report a series of patients who underwent hepatectomy for pyogenic liver abscess performed by a single surgical team. Methods: Eleven patients were operated with ages ranging from 45-73 years (mean and median 66 years). There were eight men and three women. The etiologies were: idiopathic (n=4), biliary (n=2), radiofrequency (n=2), direct extension (n=1), portal (n=1), and arterial (n=1). The mean lesion diameter was 9.27 cm (6-20 cm). Results: The mean operation length was 180 min (120-300). The mean intra-operative blood loss was 448 ml (50-1500). Surgical approaches were: right hepatectomy (n=4), left hepatectomy (n=3), left lateral sectioniectomy (n=1), right posterior sectioniectomy (n=2), resection of S8 (n=1), and S1 (n=1). Postoperative morbidity rate was 30%, while mortality was null. Median hospital stay was 18 days (5-45). The median follow-up period was 49 months (13-78). There was single lesion recurrence. Conclusion: Hepatectomy can be done as exception approach for pyogenic hepatic abscess treatment; it is a good therapeutic option in special situations.

RESUMO Racional: A drenagem percutânea do abscesso hepático piogênico tem sido considerada padrão-ouro para o tratamento na maioria dos casos. Mais raramente, quando essa abordagem falha ou em casos de abscessos multiloculados, a ressecção daquele segmento ou lobo destruído pode resolver o contexto infeccioso. Objetivo: Relatar uma série de doentes com abscesso hepático que foram submetidos a hepatectomia. Método: Onze doentes foram operados. A idade variou de 45-73 anos (média e mediana 66). Foram oito homens e três mulheres. As causas foram: idiopática (n=4), biliar (n=2), radiofrequência (n=2), portal (n=1), arterial (n=1), e extensão direta (n=1). A média do tamanho das lesões foi 9,27 cm (6-20). Resultados A média de tempo cirúrgico foi de 180 min (120-300). A média de sangramento intra-operatório foi de 448 ml (50-1500 ml). Os procedimentos cirúrgicos foram: hepatectomia D (n=4), hepatectomia E (n=3), setorectomia lateral E (n=1), setorectomia posterior D (n=2), ressecção do S8 (n=1) e S1 (n=1). A morbidade pós-operatória foi 30%, enquanto a mortalidade foi nula. Mediana de internação foi de 18 dias (5-45). A mediana de seguimento foi 49 meses (13-78). Houve uma única recidiva de lesão. Conclusão: Embora a hepatectomia possa ser considerada conduta de exceção para tratamento do abscesso hepático piogênico, ela deve ser boa opção terapêutica em situações especiais.

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ABSTRACT Background: Laparoscopic distal pancreatectomy has been the choice for resection of distal pancreas lesions due many advantages over open approach. Spleen preservation technique seems minimizes infectious complications in long-term outcome. Aim: To present the results of laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique (preservation of spleen blood vessels) performed by single surgical team. Methods: Retrospective case series aiming to evaluate both short and long-term outcomes of laparoscopic distal pancreatectomies with spleen preservation. Results: A total of 54 laparoscopic distal pancreatectomies were performed, in which 26 were laparoscopic distal pancreatectomies with spleen preservation by Kimura´s technique. Mean age was 47.9 years-old (21-75) where 61.5% were female. Mean BMI was 28.5 kg/m² (18-38.8). Mean diameter of lesion was 4.3 cm (1.8-7.5). Mean operative time was 144.1 min (90-200). Intraoperative bleeding was 119.2 ml (50-600). Conversion to laparotomy 3% (n=1). Postoperative morbidity was 11.5%. Postoperative mortality was null. Mean of hospital stay was 4.8 days (2-14). Mean time of follow-up period was 19.7 months (2-60). There was no neoplasm recurrence or mortality on evaluated period. There was no infectious complication. Conclusion: Laparoscopic distal pancreatectomy with spleen and splenic vessels preservation is feasible, safe, and effective procedure. This technique presented both low morbidity and null mortality on this sample. There were neither infectious complications nor neoplasm recurrence on long-term follow-up period.

RESUMO Racional: A pancreatectomia distal laparoscópica tem sido a abordagem de escolha para ressecção de tumores em pâncreas distal devido a muitas vantagens sobre a abordagem laparotômica. A técnica com preservação esplênica parece minimizar complicações infecciosas em longo prazo. Objetivo: Analisar os resultados das pancreatectomias distais laparoscópicas com preservação esplênica e dos vasos esplênicos. Método: Série de casos com 26 doentes operados para avaliar os resultados em curto e longo prazo. Resultados: Cinquenta e quatro pancreatectomias distais laparoscópicas foram realizadas nesse período, onde 26 foram pancreatectomias distais laparoscópicas com preservação esplênica pela técnica de Kimura. A média de idade foi 47,9 anos (21-75), onde 61,5% eram mulheres. A média do IMC foi 28,5 kg/m² (18-38,8). O diâmetro médio das lesões foi 4,3 cm (1,8-7,5). O tempo cirúrgico médio foi 144,1 min (90-200). A média de sangramento intra-operatório foi 119,2 ml (50-600). O índice de conversão foi 3% (n=1). A morbidade pós-operatória foi 11,5%, e a mortalidade nula. A média de internação hospitalar foi 4,8 dias (2-14). A média de seguimento foi 19,7 meses (2-60). Não houve recorrência de neoplasias e nem mortalidade durante esse período e também não houve complicações infecciosas em longo prazo. Conclusão: A pancreatectomia distal laparoscópica com preservação esplênica e dos vasos esplênicos é procedimento factível, seguro e eficaz no tratamento de neoplasias pancreáticas. Esta técnica apresentou baixa morbidade e mortalidade. Não houve complicações infecciosas e nem recidiva neoplásica em longo prazo.

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BACKGROUND: Laparoscopic hepatectomy has presented great importance for treating malignant hepatic lesions. AIM: To evaluate its impact in relation to overall survival or disease free of the patients operated due different hepatic malignant tumors. METHODS: Thirty-four laparoscopic hepatectomies were performed in 31 patients with malignant neoplasm. Patients were distributed as: Group 1 - colorectal metastases (n=14); Group 2 - hepatocellular carcinoma (n=8); and Group 3 - non-colorectal metastases and intrahepatic cholangiocarcinoma (n=9). The conversion rate, morbidity, mortality and tumor recurrence were also evaluated. RESULTS: Conversion to open surgery was 6%; morbidity 22%; postoperative mortality 3%. There was tumor recurrence in 11 cases. Medians of overall survival and disease free survival were respectively 60 and 46 m; however, there was no difference among studied groups (p>0,05). CONCLUSION: Long-term outcomes of laparoscopic hepatectomy for treating hepatic malignant tumors are satisfactory. There is no statistical difference in relation of both overall and disease free survival among different groups of hepatic neoplasms.

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ABSTRACT Background: Laparoscopic hepatectomy has presented great importance for treating malignant hepatic lesions. Aim: To evaluate its impact in relation to overall survival or disease free of the patients operated due different hepatic malignant tumors. Methods: Thirty-four laparoscopic hepatectomies were performed in 31 patients with malignant neoplasm. Patients were distributed as: Group 1 - colorectal metastases (n=14); Group 2 - hepatocellular carcinoma (n=8); and Group 3 - non-colorectal metastases and intrahepatic cholangiocarcinoma (n=9). The conversion rate, morbidity, mortality and tumor recurrence were also evaluated. Results: Conversion to open surgery was 6%; morbidity 22%; postoperative mortality 3%. There was tumor recurrence in 11 cases. Medians of overall survival and disease free survival were respectively 60 and 46 m; however, there was no difference among studied groups (p>0,05). Conclusion: Long-term outcomes of laparoscopic hepatectomy for treating hepatic malignant tumors are satisfactory. There is no statistical difference in relation of both overall and disease free survival among different groups of hepatic neoplasms.

RESUMO Racional: A hepatectomia laparoscópica tem apresentado grande importância no tratamento das lesões hepáticas malignas. Objetivo: Avaliar o impacto dela realizada por uma única equipe em relação à sobrevida global e tempo livre de doença nos diferentes tumores malignos hepáticos. Métodos: Foram realizadas 34 hepatectomias laparoscópicas em 31 pacientes com neoplasia maligna. Os doentes foram distribuídos em: Grupo 1 - metástases colorretais (n=14); Grupo 2 - carcinoma hepatocelular (n=8) e Grupo 3 - metástases não-colorretais e colangiocarcinoma intra-hepático (n=9). As curvas de sobrevida e sobrevida livre de doença foram estimadas. Foram avaliadas também a taxa de conversão, morbidade, mortalidade e recorrência tumoral. Resultados: A taxa de conversão foi de 6%; a morbidade de 22%; a mortalidade pós-operatória de 3%; recorrência tumoral em 11 casos. As medianas de sobrevida global e de sobrevida livre de doença foram respectivamente de 60 e 46 m, contudo não houve diferença entre os grupos estudados (p>0,05). Conclusão: Os resultados em longo prazo da hepatectomia laparoscópica para o tratamento de tumores malignos hepáticos são satisfatórios. Não houve diferença estatisticamente significante quanto às sobrevidas global e livre de doença nos diferentes grupos de neoplasia tratada.

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Com a evolução da cirurgia minimamente invasiva, as hepatectomias laparoscópicas têm se mostrado uma alternativa interessante para o cirurgião hepático. Hepatectomia por via laparoscópica apresenta muitas vantagens sobre a abordagem aberta.

With the advances in minimally invasive surgery, laparoscopic hepatectomy has shown to be an interesting alternative in liver surgery. Laparoscopic liver resection presents many advantages over an open surgery approach.

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câncer de ovário é geralmente doença assintomática, quase sempre diagnosticada em estádios avançados e geralmente resulta em morte. Mais raramente, o diagnóstico é realizado em estádio inicial (câncer de ovário precoce)por ultrassonografia pélvica. O tratamento curativo clássico tanto para casos precoces quanto avançados tem sidoa cirurgia citorredutora por laparotomia. Entretanto, o papel da abordagem laparoscópica no tratamento de tumores malignos está aumentando em virtude dos seus muitos benefícios. Os autores apresentam um caso de câncer de ovário precoce que foi estadiado e tratado por meio de citorredução laparoscópica ótima com boa evolução pós-operatóriae sem sinais de recorrência aos quatorze meses de seguimento. Em suma, o acesso laparoscópico para realização de citorredução ótima no câncer de ovário precoce representa excelente escolha. Boa experiência da equipe cirúrgica pode permitir que o acesso laparoscópico seja uma opção factível, segura e eficaz no manejo do câncer de ovárioprecoce sem comprometer a radicalidade oncológica.

Ovarian cancer is usually an asymptomatic disease, mostly diagnosed in advanced stages chance and that generally results in death. More rarely, the diagnosis is accomplished in initial stage (early ovarian cancer) by pelvic ultra-sonography. The classical curative treatment either initial or advanced cases has been cytoreductive surgery by laparotomy. However, the role of laparoscopic approach in treating malignant masses is increasing due to its many benefits. The authors present a case of an early ovarian cancer which was both stated and treated by means of anoptimal laparoscopic cytoreduction, with a good post-operative course and no signs of recurrence at fourteen months follow up. Laparoscopic approach to perform an optimal cytoreduction for early ovarian cancer presents an excellent choice of treatment. Good expertise of surgical teams may allow laparoscopic approach to be a feasible, safe andeffective option to the management of early ovarian cancer without comprises the oncologic radicality.

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Hepatectomy has been the standard treatment for metachronic metastases of non-colorectal (NCR) origin, mainly when the disease-free interval is more than two years. Laparoscopic hepatectomy has become the golden standard mainly for left side resections, due to lower morbidity, shorter hospital stay, early recovery and good cosmetic outcome. The authors report the case of a female patient with two metachronic metastases (ten years of disease-free survival), of non-colorectal origin (adenocarcinoma of small intestine), treated by laparoscopic left lateral segmentectomy (left hepatic lobectomy) with success. The postoperative progress was satisfactory. To date, the patient has presented no tumoral recurrence (six months of follow-up period). Laparoscopic left lateral segmentectomy can be satisfactorily performed in selected cases of hepatic metastasis. This approach presents low morbidity and good cosmetic result. The lack of alternative treatments and the poor prognosis of untreated cases have justified surgical resection in order to increase overall survival. Nevertheless, this approach should be performed by hepatic surgery expertise teams trained on advanced laparoscopic procedures. (AU)

A hepatectomia tem sido o tratamento padrão para metástase de origem não colorretal (NCR) metacrônica, principalmente quando o intervalo livre de doença é maior do que dois anos. A hepatectomia por laparoscopia tem se tornado padrão principalmente para as ressecções à esquerda, haja vista a menor morbidade, menor tempo de internação, reabilitação precoce e melhor resultado estético. Os autores relatam um caso de paciente com duas metástases metacrônicas (10 anos de sobrevida livre de doença), de etiologia não colorretal (adenocarcinoma de intestino delgado), tratada com segmentectomia lateral esquerda (lobectomia hepática esquerda) laparoscópica. Paciente apresentou boa evolução pós-operatória sem recidiva (seis meses de seguimento). Segmentectomia lateral esquerda laparoscópica pode ser satisfatoriamente realizada em casos selecionados de metástases hepáticas, acarretando menor morbidade e melhor resultado estético. A falta de tratamentos alternativos e o prognóstico reservado nos casos de metástases NCR não operadas justificam a ressecção com o objetivo de prolongar a sobrevida. No entanto, essa abordagem deve ser realizada por equipe especializada em cirurgia hepática com treinamento em procedimentos laparoscópicos avançados. (AU)

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A colecistite xantogranulomatosa é uma doença rara caracterizada for intensa fibrose que pode ser uma causa de dificuldade técnica na realização de colecistectomia tanto por cirurgia laparoscópica quanto aberta. Casos de colecistite xantogranulomatosa podem ser frequentemente confundidos com carcinoma de vesícula biliar localmente avançado na avaliação intra-operatória fato esse que pode acarretar em uma resseção alargada. Os autores relatam um caso de paciente com colecistite xantogranulomatosa que simulou adenocarcinoma de vesícula biliar localmente avançado tanto a avaliação intraoperatória quanto a biópsia de congelação. O doente foi submetido a ressecção estendida (bissegmentectomia IV+V) com linfadenectomia hilar e não houve intercorrências. À análise histológica definitiva, observou-se tratar de colecistite xantogranulomatosa.

Xanthogranulomatous cholecystitis is a rare disease characterized by severe fibrosis that can be a cause of technical difficulty in performing cholecistectomy (either laparoscopic or open surgery). Patients with xanthogranulomatous cholecystitis can be frequently confounded at intraoperative evaluation with gallbladder carcinoma, this fact can lead to an extended resection. The authors report one case of xanthogranulomatous cholecystitis that mimicked gallbladder adenocarcinoma at intraoperative evaluation by frozen-section. The patient was submitted to an extended resection (bisegmentectomy IV+V) with hilar lymphadenectomy. He carried out without postoperative complications. Definitive histological analysis revealed xanthogranulomatous cholecystitis.

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Objective: To evaluate the early and late results from laparoscopic hepatectomy procedures at a tertiary hospital in Brasília (DF), Brazil. Methods: The authors report on a series of 18 patients (11 women) who underwent laparoscopic hepatectomy performed by a single surgical team at Santa Lúcia Hospital, in Brasília, between June 2007 and December 2010. Age ranged from 21 to 71 years (median = 43 years). There were eleven women and seven men. Nine patients had benign diseases and nine had malignant lesions. The lesion diameter ranged from 1.8 to 12 cm (mean: 4.96 cm). Results: Six major hepatectomy procedures and 12 minor hepatectomy procedures were performed. The mean duration of the operation was 205 minutes (range: 90 to 360 minutes). The mean intraoperative blood loss was 300 mL (range: 100 to 1,500 mL). Two patients received a transfusion (11%). There was one conversion to open surgery. There was no death and no patient underwent reoperation. The postoperative morbidity rate was 11% (n = 2). One patient presented with a minor complication (lobar pneumonia) while other presented with two major complications (intraoperative bleeding and incisional hernia). The median length of hospital stay was 4 days (range: 2 to 11 days). The median time to return to normal activities was 13 days (range: 7 to 40 days). Conclusion: Laparoscopic hepatectomy is a safe surgical approach for treating both benign and malignant hepatic lesions. This small series showed no mortality, low morbidity and good cosmetic results.

Objetivo: Avaliar os resultados precoces e tardios das hepatectomias laparoscópicas realizadas em um hospital terciário, em Brasília (DF). Métodos: Os autores relatam uma série de 18 pacientes (11 mulheres) submetidos à hepatectomia laparoscópica, realizada por uma única equipe cirúrgica do Hospital Santa Lúcia, em Brasília, entre Junho de 2007 e Dezembro de 2010. A idade variou de 21 a 71 anos com mediana de 43 anos. Havia onze mulheres e sete homens. Nove casos apresentavam lesão benigna e nove, lesão maligna. O diâmetro da lesão variou de 1,8 a 12 cm (média: 4,96 cm). Resultados: Seis hepatectomias maiores e 12 hepatectomias menores foram realizadas. O tempo cirúrgico médio foi de 205 minutos (variação de 90 a 360 minutos). A média de sangramento intraoperatório foi de 300 mL (variação de 100 a 1.500 mL). Dois pacientes foram transfundidos. Houve uma conversão para cirurgia aberta. Não houve óbitos e nenhum paciente foi reoperado. A morbidade pós-operatória foi de 11% (n = 2). Um indivíduo apresentou uma complicação menor (pneumonia lobar), e outro teve duas complicações maiores (sangramento intraoperatório e hérnia incisional). A duraçãomediana de internação foi de 4 dias (variação de 2 a 11 dias). O tempo mediano de retorno às atividades diárias foi de 13 dias (variação de 7 a 40 dias). Conclusão: A hepatectomia laparoscópica é um método cirúrgico seguro para tratamento de lesões hepáticas benignas e malignas. Nesta pequena série, não houve óbitos, a taxa de morbidade foi baixa, e o resultado estético foi bom.

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O cistoadenoma biliar intra-hepático é neoplasia benigna rara, que se apresenta como lesão cística multisseptada. Essa afecção é considerada lesão pré-maligna. O tratamento tem sido ressecção completa. Atualmente, a hepatectomia maior laparoscópica é aceita como preferencial em afecções hepáticas benignas devido à baixa morbidade e ao melhor resultado estético. Relata-se o caso de um doente com cistoadenoma biliar intra-hepático, tratado com hemi-hepatectomia direita laparoscópica. Houve bom curso pós-operatório sem recidiva do tumor nos doze mesesde seguimento. O tratamento do cistoadenoma biliar intra-hepático por hemi-hepatectomia direita laparoscópica apresenta baixa morbidade e bom resultado estético.

Intra-hepatic biliary cystadenoma is a rare benign neoplasm presented as multisepted cystic lesion. This affection has been considered a premalignant lesion. Treatment has been complete resection. Nowadays, laparoscopic major hepatectomy has been accepted as preferential treatment for benign hepatic diseases due to both low morbidity andbest aesthetic result. The authors present a case of intra-hepatic biliary cystadenoma treated with laparoscopic right hemi-hepatectomy. The patient presented good postoperative course without tumor recurrence after a twelve month follow-up period. Intra-hepatic biliary cystadenoma treatment with laparoscopic right hemi-hepatectomy presentsboth low morbidity and good aesthetic result

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OBJECTIVE: To evaluate the early and late results from laparoscopic hepatectomy procedures at a tertiary hospital in Brasília (DF), Brazil. METHODS: The authors report on a series of 18 patients (11 women) who underwent laparoscopic hepatectomy performed by a single surgical team at Santa Lúcia Hospital, in Brasília, between June 2007 and December 2010. Age ranged from 21 to 71 years (median = 43 years). There were eleven women and seven men. Nine patients had benign diseases and nine had malignant lesions. The lesion diameter ranged from 1.8 to 12 cm (mean: 4.96 cm). RESULTS: Six major hepatectomy procedures and 12 minor hepatectomy procedures were performed. The mean duration of the operation was 205 minutes (range: 90 to 360 minutes). The mean intraoperative blood loss was 300 mL (range: 100 to 1,500 mL). Two patients received a transfusion (11%). There was one conversion to open surgery. There was no death and no patient underwent reoperation. The postoperative morbidity rate was 11% (n = 2). One patient presented with a minor complication (lobar pneumonia) while other presented with two major complications (intraoperative bleeding and incisional hernia). The median length of hospital stay was 4 days (range: 2 to 11 days). The median time to return to normal activities was 13 days (range: 7 to 40 days). CONCLUSION: Laparoscopic hepatectomy is a safe surgical approach for treating both benign and malignant hepatic lesions. This small series showed no mortality, low morbidity and good cosmetic results.

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O adenoma hepático é uma neoplasia benigna rara, que pode ser de difícil distinção entre outros tumores hepáticos tanto benignos quanto malignos. Apresenta possibilidade de transformação maligna e grande tendência a hemorragia. A ressecção hepática tem sido a principal opção terapêutica. Como neoplasia benigna, porém, ressecção com a conservação do parênquima é desejável. A bissegmentectomia VI-VII por laparoscopia representa um grande desafio técnico por evitar a morbidade da incisão abdominal ampla e ser boa alternativa estética. Relata-se o caso de umamulher jovem com três adenomas de 1,7, 1,9 e 2,8 cm nos segmentos VI-VII, submetida a bissegmentectomia VI-VII e com boa evolução. A ressecção hepática laparoscópica oferece baixa morbidade e bom resultado estético, sendo excelente opção para o tratamento dos tumores hepáticos benignos.

Hepatic adenoma represents a rare benign hepatic neoplasm that eventually may be difficult to differ as a benign or a malignant hepatic tumor. It presents a high chance of malign transformation and a great hemorrhagic tendency. Surgical resection has been the main therapeutic choice. In a case of benign neoplasm, a resection that spares adjacent hepatic tissue has been desirable. Laparoscopic VI-VII bisegmentectomy represents a technical challenge that avoids the morbidity of a large abdominal incision and is still a good aesthetic alternative. The authors present a case of three hepatic adenomas (1.7, 1.9 and 2.8 cm) in VI-VII hepatic segments that were treated by means of laparoscopic VI-VII bisegmentectomy. Patient presented good postoperative course. Laparoscopic hepatic resection offers both low morbidity and good aesthetic result. This approach presents as an excellent choice for treating benign hepatic tumors.

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INTRODUÇÃO: A ressecção de neoplasias no setor posterior direito costuma ser um desafio técnico pela dificuldade de sua abordagem. Adicionalmente, as hepatectomias laparoscópicas tem se tornado alternativa interessante em virtude de muitas vantagens (baixa morbidade, curto tempo de internação, retorno precoce as atividades laborais e bons resultados cosméticos). OBJETIVO: Relatar experiência em doentes submetidos à setorectomia posterior direita laparoscópica por uma única equipe. MÉTODOS: Cinco doentes foram operados entre novembro de 2008 a agosto de 2010. A idade variou de 21 a 63 anos com mediana de 43 anos. Foram quatro mulheres e um homem. A causa das neoplasias foi: adenoma (n=2), hepatocarcinoma (n=1) e metástases (n=2). A lesão foi solitária em três casos (60 por cento). A média do tamanho das lesões foi 3,3 cm (1,8-5). Foram analisados: tempo cirúrgico, sangramento operatório, morbimortalidade, tempo de internação e tempo de retorno à atividade habitual. RESULTADOS: A média de tempo cirúrgico foi de 160 minutos (90-260). A de sangramento intra-operatório foi de 200 ml (0-500). Nenhum doente foi transfundido. Não houve mortalidade e a morbidade foi nula. A mediana de internação foi de três dias (2-5). A mediana de retorno às atividades cotidianas foi de 12 dias (7-20). A mediana de seguimento foi de 13 meses (1-20). Não houve recidiva de lesão. CONCLUSÃO: A setorectomia posterior direita laparoscópica representa boa opção tática para o tratamento dos tumores hepáticos situados no setor posterior do lobo direito. É opção segura que evita grandes incisões com morbimortalidade. Também apresenta bom resultado cosmético e retorno precoce ao trabalho.

BACKGROUND: Resection of neoplasms arising in the posterior right sector is usually a technical challenge due to approach difficulties. Additionally, laparoscopic hepatectomy has become an interesting alternative with several advantages (low morbidity, short hospital stay, early return work activities and good cosmetic results). AIM: To report a series of patients who underwent laparoscopic right posterior sectioniectomy performed by a single surgical team. METHODS: Five patients were operated. Their ages ranged from 21 to 63 years (median 43 years). There were four women and one man. Etiology of the neoplasm was: adenoma (n=2), hepatocellular carcinoma (n=1) and metastasis (n=2). There was a single lesion in three cases (60 percent). The mean lesion diameter was 3,3 cm (1,8-5). It was analyzed: operative time, intraoperative bleeding, morbidity, length of stay and time of return to usual activity. RESULTS: The mean surgical time was 160 minutes (90-260). The mean intraoperative blood loss was 200 ml (0-500). None of the patients received transfusions. There was no mortality and no morbidity. The median hospital stay was three days (2-5). The median length of time taken to return to day-to-day activities was 12 days (7-20). The median follow-up period was 13 months (1-20). There was no tumor recurrence. CONCLUSION: Laparoscopic right posterior sectioniectomy (bi-segmentectomy VI + VII) is a good option to treat hepatic tumors located in the posterior sector of the right lobe. It is a safe procedure that avoids large incisions with no mortality or morbidity is this series. This approach also bring good cosmetic result and early return to work.

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Introdução. O tratamento padrão do abscesso hepático piogênico tem sido drenagem percutânea. Quando ocorre a falha desse método, a drenagem cirúrgica, ou mesmo a ressecção hepática, deve ser realizada. Atualmente, a via laparoscópica tem sido eleita como preferencial para as afecções hepáticas benignas devido à baixa morbidade e bom resultado estético. Relato do caso. Os autores relatam um caso de abscesso hepático piogênico tratado por hemi-hepatectomia esquerda laparoscópica. O doente apresentou evolução pós-operatória sem complicações. Não houve recidiva do abscesso no período de um ano de seguimento. Conclusão. O tratamento do abscesso hepático piogênico por hemi-hepatectomia esquerda laparoscópica representa um método seguro com baixa morbidade e bom resultado estético.

Introduction. Percutaneous drainage has been standard treatment for pyogenic liver abscess. When this approach fails surgical drainage or even hepatic resection should be performed. Nowadays, laparoscopic access has been chosen as preferential treatment for benign hepatic diseases due to both low morbidity and good cosmetic result.Case. The authors present a case of pyogenic hepatic abscess treated by means of laparoscopic left hemi-hepatectomy. The patient presented good postoperative evolution without complication. There was no abscess recurrence (one year follow-up period). Conclusion. Pyogenic hepatic abscess treatment by means of laparoscopic left hemi-hepatectomy represents a safe technique with both low morbidity and good cosmetic result.

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O adenoma hepático é neoplasia benigna rara, que apresenta particular interesse por não ser fácil diferenciá-la de outros tumores hepáticos, pelo risco de transformação maligna e grande tendência a hemorragia. A ressecção da neoplasia com a conservação do parênquima é a principal opção terapêutica. Contudo, a lesão que acomete o segmento VII, próxima à veia cava, representa um desafio técnico, e a bissegmentectomia VII-VIII pode ser boa indicação. Os autores relatam o caso de um paciente com adenoma hepático de 3,5 cm no segmento VII. Foi submetidoà bissegmentectomia VII-VIII com boa evolução e está sem a doença há dois anos.

Hepatic adenoma is a rare benign hepatic neoplasm with particular interest due to be difficult to distinguish this lesion from other hepatic tumors, for it may become malignant and it has a marked tendency to hemorrhage.The resection of the neoplasm with sparing parenchyma resection is the main therapeutic approach. However, the lesion that invades VII segment close to the inferior vena cava represents a technical challenger and VII-VIII bisegmentectomy may be a good tactical choice. The authors present a case of 3.5 cm hepatic adenoma in the VII hepatic segment thatwas treated by means of VII-VIII bisegmentectomy. The patient presented good postoperative course without tumor recurrence with two years of follow-up period.