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Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach |
Ying-Jun Chen, Zuo-Jun Zhen, Huan-Wei Chen, Eric CH Lai, Fei-Wen Deng, Qing-Han Li and Wan-Yee Lau |
Foshan, China
Author Affiliations: Department of Liver Surgery, The First People's Hospital of Foshan, Foshan 528000, China (Chen YJ, Zhen ZJ, Chen HW, Deng FW, Li QH and Lau WY); Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong SAR, China (Lai ECH and Lau WY)
Corresponding Author: Zuo-Jun Zhen, MD, Department of Hepatobiliary Surgery, The First People's Hospital of Foshan, Foshan 528000, China (Tel: +86-757-83833633ext1112; Email: zzjun_fsyyy@163.com) |
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Abstract BACKGROUND: With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle's maneuver, especially in patients with cirrhosis.
METHOD: From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie assistance.
RESULTS: The types of liver resection included right hepatectomy (n=1), right posterior sectionectomy (n=1), left hepatectomy and common bile duct exploration (n=1), segment 4b resection (n=1), left lateral sectionectomy (n=2), and wedge resection (n=2). Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3 minutes. The mean duration of vascular inflow occlusion was 54.5 minutes. The mean intraoperative blood loss was 361 mL. No patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 days.
CONCLUSION: Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approach was safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.
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