Background
The lack of a complete hepatic overview and tactile feedback during laparoscopic hepatectomy
may result in near misses or fatal intraoperative complications despite the advantage
of a magnified laparoscopic view. The aim of the study is to describe operative techniques
and guiding principles with which to address near misses unique to laparoscopic hepatectomy
and evaluate the intraoperative complication rate overtime.
Methods
Data of 408 consecutive patients who underwent laparoscopic hepatectomy were reviewed.
Representative operative techniques and guiding principles with which to address near
misses and pitfalls unique to laparoscopic hepatectomy were evaluated among the patients
by 2 surgeons.
Results
Most near misses were due to lack of understanding of both the laparoscopic view and
anatomic aspects unique to laparoscopic hepatectomy. Operative techniques and/or guiding
principles with which to address these issues were demonstrated as follows: starting
parenchymal transection at the declivitous parts; no ligation of the right or left
portal vein before confirming the bifurcation; dissection of the short hepatic vein
using a sealing device; dissection of the root of the hepatic vein using scissors;
exposure of the middle hepatic vein, which is anatomically close to the hilar plate;
and identification of V8 using intraoperative ultrasonography. The intraoperative
massive bleeding due to vessel injury or surgical clip slippage occurred in 25 patients
(6.1%), and its rate had a significant trend to decrease with increasing years.
Conclusion
We demonstrated operative techniques and guiding principles with which to address
near misses in laparoscopic hepatectomy. The intraoperative massive bleeding rate
trended to decrease over time.
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to SurgeryAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Laparoscopic liver resection.Br J Surg. 2006; 93: 67-72
- Laparoscopic hepatectomy for liver tumors: proposals for standardization.J Hepatobiliary Pancreat Surg. 2009; 16: 720-725
- Laparoscopy-assisted major liver resections employing a hanging technique: the original procedure.Ann Surg. 2010; 251: 450-453
- Comparative benefits of laparoscopic vs open hepatic resection: a critical appraisal.Arch Surg. 2011; 146: 348-356
- Laparoscopic liver resection: an examination of our first 300 patients.J Am Coll Surg. 2011; 213: 501-507
- Laparoscopic major liver resection in Korea: a multicenter study.J Hepatobiliary Pancreat Sci. 2013; 20: 125-130
- Laparoscopic vs open hepatic resection for benign and malignant tumors: An updated meta-analysis.Arch Surg. 2010; 145: 1109-1118
- World review of laparoscopic liver resection-2,804 patients.Ann Surg. 2009; 250: 831-841
- Laparoscopic radical prostatectomy. The Creteil experience.Eur Urol. 2001; 40: 38-45
- Impact of laparoscopic surgery on bladder and sexual function after total mesorectal excision for rectal cancer.Surg Endosc. 2009; 23: 296-303
- High intra-abdominal pressure during experimental laparoscopic liver resection reduces bleeding but increases the risk of gas embolism.Br J Surg. 2011; 98: 845-852
- Usefulness of intraoperative real-time tissue elastography during laparoscopic hepatectomy.J Am Coll Surg. 2015; 221: e103-e111
- Laparoscopic segmentectomy of the liver: from segment I to VIII.Ann Surg. 2012; 256: 959-964
- Adopting Gayet's techniques of totally laparoscopic liver surgery in the United States.Liver Cancer. 2013; 2: 5-15
- V. Notes on the arrest of hepatic hemorrhage due to trauma.Ann Surg. 1908; 48: 541-549
- Surgical anatomy of the liver revisited.C. Couinaud, Paris1989
- Serum osteoprotegerin as a screening tool for coronary artery calcification score in diabetic pre-dialysis patients.Hypertens Res. 2008; 31: 1163-1170
- Investigation of the freely available easy-to-use software ‘EZR’ for medical statistics.Bone Marrow Transplant. 2013; 48: 452-458
- Comparison of the outcomes between an anatomical subsegmentectomy and a non-anatomical minor hepatectomy for single hepatocellular carcinomas based on a Japanese nationwide survey.Surgery. 2008; 143: 469-475
- Prognostic impact of anatomic resection for hepatocellular carcinoma.Ann Surg. 2005; 242: 252-259
- The Clavien-Dindo classification of surgical complications: five-year experience.Ann Surg. 2009; 250: 187-196
- Laparoscopic liver resection and the learning curve: a 14-year, single-center experience.Surg Endosc. 2014; 28: 1334-1341
- The learning curve in laparoscopic liver resection: improved feasibility and reproducibility.Ann Surg. 2009; 250: 772-782
- Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection.J Am Coll Surg. 2014; 218: e37-e41
- 3D HD versus 2D HD: surgical task efficiency in standardised phantom tasks.Surg Endosc. 2012; 26: 1454-1460
- Surgical value of contrast-enhanced ultrasonography in laparoscopic hepatectomy using energy devices.J Hepatobiliary Pancreat Sci. 2014; 21: 78-79
- Usefulness of indocyanine green-fluorescence imaging for visualization of the bile duct during laparoscopic liver resection.J Am Coll Surg. 2015; 221: e113-e117
Article info
Publication history
Published online: August 26, 2016
Accepted:
July 14,
2016
Footnotes
The authors declare that they have no conflict of interest.
Identification
Copyright
© 2016 Elsevier Inc. All rights reserved.
