A novel very simple laparoscopic hepatic inflow occlusion apparatus for laparoscopic liver surgery

作者：Peng, Yuanfei; Wang, Zheng; Wang, Xiaoying; Chen, Feiyu; Zhou, Jian; Fan, Jia; Shi, Yinghong^*

来源：Surgical Endoscopy and Other Interventional Techniques, 2019, 33(1): 145-152.

DOI：10.1007/s00464-018-6285-y

• Laparoscopy
• Liver surgery
• Hepatic inflow occlusion
• Cirrhosis
• Hepatocellular carcinoma
• Propensity case-matched analysis

BackgroundControl of bleeding is extremely important for laparoscopic liver resection. We introduce a new and operationally simple laparoscopic hepatic inflow occlusion apparatus (LHIOA) and its successful application in laparoscopic surgery for patients with cirrhosis.MethodsThe self-designed LHIOA was constructed using a tracheal catheter (7.5#) and infusion set. The tracheal catheter and infusion set were trimmed to 30 and 70cm, to serve as an occlusion tube and occlusion tape, respectively. After establishment of pneumoperitoneum, the occlusion tape was inserted to encircle the hepatoduodenal ligament. The occlusion tube was then introduced and the ends of the occlusion tape were pulled out of it to occlude the hepatic inflow. Under intermittent vascular occlusion with the LHIOA, the liver parenchyma was transected using an ultrasonic scalpel and monopolar electrocoagulation. Outcomes of the application of the LHIOA in hepatocellular carcinoma patients with cirrhosis (LHIOA group, n=46) were compared with patients undergoing laparoscopic hepatectomy without LHIOA (non-LHIOA group, n=46), using one-to-one propensity case-matched analysis.ResultsThe LHIOA effectively occluded the hepatic inflow while showing no damage to the hepatoduodenal ligament. The time required for presetting the LHIOA is 6.80.6min. The conversion rate in the non-LHIOA group was 13.0% while there was no conversion in the occlusion group (P<0.001). The median blood loss of patients in the LHIOA group (60ml, range 50-200ml) was significantly less than that of patients in the non-LHIOA group (250ml, range 100-800) (P<0.001). Transfusion was required in 8 patients in the non-LHIOA group while no transfusion was required in the LHIOA group. The median operative time in the LHIOA group (157min, range 80-217min) was significantly shorter than that in the non-LHIOA group (204min, range 105-278min) (P<0.001).Conclusions The new LHIOA is effective, safe, and simple. It can significantly reduce conversion rate, blood loss, and operative time. It facilitates laparoscopic liver resection and is recommended for use.

• 出版日期2019-1
• 单位复旦大学