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Shen Z, Jiang B, Chu H, Wang G, Fang X, Chen Z, Yang Y, Wang J, Wang X. The application of a single-hand-operated hepatic pedicle clamping clamp in laparoscopic hepatectomy. Langenbecks Arch Surg 2024; 409:146. [PMID: 38691172 DOI: 10.1007/s00423-024-03334-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2024] [Accepted: 04/23/2024] [Indexed: 05/03/2024]
Abstract
OBJECTIVE In this paper, a single-hand-operated hepatic pedicle clamp was introduced, and its application value in laparoscopic liver tumor resection was preliminarily discussed. METHODS The clinical data of 67 patients who underwent laparoscopic liver tumor resection at the First Affiliated Hospital of Wannan Medical College from March 2019 to October 2023 were retrospectively analyzed. The Pringle maneuver was performed with a hepatic pedicle clamp during the operation. The preoperative, intraoperative and postoperative clinical data were observed and recorded. RESULTS Sixty-seven patients had a median block number, block time, intraoperative blood loss, and postoperative length of hospital stay of 4, 55 min, 400 ml, and 7 days, respectively. The average operation time was 304.9±118.4 min, the time required for each block was 3.2±2.4 s, and the time required for each removed block was 2.6±0.7 s. None of the patients developed portal vein thrombosis or hepatic artery aneurysm formation. CONCLUSION The hepatic pedicle clamping clamp is simple to use in laparoscopic hepatectomy, optimizes the operation process, and has a reliable blocking effect. It is recommended for clinical application.
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Affiliation(s)
- Zhengchao Shen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Bin Jiang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Hongpeng Chu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Guannan Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Xiaosan Fang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Zhiyuan Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Yuntao Yang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Jie Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China
| | - Xiaoming Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Wannan Medical College, Wuhu, Anhui, 241000, P.R. China.
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Chedid MF, Brum PW, Grezzana-Filho TDJM, Silva RKD, Pereira PF, Chedid AD, Kruel CRP. PARTIAL HEPATECTOMY USING LINEAR CUTTER STAPLER: ARE THERE ADVANTAGES? ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA : ABCD = BRAZILIAN ARCHIVES OF DIGESTIVE SURGERY 2023; 36:e1775. [PMID: 38088722 PMCID: PMC10712918 DOI: 10.1590/0102-672020230057e1775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/18/2023] [Indexed: 12/17/2023]
Abstract
BACKGROUND Morbidity of liver resections is related to intraoperative bleeding and postoperative biliary fistulas. The Endo-GIA stapler (EG) in liver resections is well established, but its cost is high, limiting its use. The linear cutting stapler (LCS) is a lower cost device. AIMS To report open liver resections, using LCS for transection of the liver parenchyma and en bloc stapling of vessels and bile ducts. METHODS Ten patients were included in the study. Four patients with severe abdominal pain had benign liver tumors (three adenomas and one focal nodular hyperplasia). Among the remaining six patients, four underwent liver resection for the treatment of colorectal liver metastases, three of which had undergone preoperative chemotherapy. The other two cases were one patient with metastasis from a testicular teratoma and the other with metastasis from a gastrointestinal neuroectodermal tumor. RESULTS The average length of stay was five days (range 4-7 days). Of the seven patients who underwent resections of segments II/III, two presented postoperative complications: one developed a seroma and the other a collection of abdominal fluid who underwent percutaneous drainage, antibiotic therapy, and blood transfusion. Furthermore, the three patients who underwent major resections had postoperative complications: two developed anemia and received blood transfusions and one had biloma and underwent percutaneous drainage and antibiotic therapy. CONCLUSIONS The use of the linear stapler in hepatectomies was efficient and at lower costs, making it suitable for use whenever EG is not available. The size of the LCS stapler shaft is more suitable for en bloc transection of the left lateral segment of the liver, which is thinner than the right one. Further studies are needed to evaluate the safety of LCS for large liver resections and resections of tumors located in the right hepatic lobe.
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Affiliation(s)
- Marcio Fernandes Chedid
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Pietro Waltrick Brum
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Tomaz de Jesus Maria Grezzana-Filho
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Rafaela Kathrine da Silva
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Pedro Funari Pereira
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Aljamir Duarte Chedid
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
| | - Cleber Rosito Pinto Kruel
- Universidade Federal do Rio Grande do Sul, Porto Alegre University Hospital, Hepatobiliary Surgery and Liver Transplantation Unit - Porto Alegre (RS), Brazil
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Serednicki WA, Hołówko W, Major P, Małczak P, Pędziwiatr M. Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review. Wideochir Inne Tech Maloinwazyjne 2023; 18:213-223. [PMID: 37680740 PMCID: PMC10481434 DOI: 10.5114/wiitm.2022.124088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 09/09/2023] Open
Abstract
Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.
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Affiliation(s)
- Wojciech A. Serednicki
- Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wacław Hołówko
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Małczak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
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Shi L, Luo B, Yang Y, Miao Y, Li X, Sun D, Zhu Q. Clinical application of regional and intermittent hepatic inflow occlusion in laparoscopic hepatectomy. Front Oncol 2022; 12:1026274. [PMID: 36276135 PMCID: PMC9583138 DOI: 10.3389/fonc.2022.1026274] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2022] [Accepted: 09/26/2022] [Indexed: 12/03/2022] Open
Abstract
Aim The aim of this study is to investigate the advantages and disadvantages of regional and intermittent hepatic inflow occlusion in laparoscopic hepatectomy. Methods The clinical data of 180 patients who underwent laparoscopic liver surgery in Taizhou People’s Hospital from 2015 to 2021 were analyzed retrospectively. The patients were divided into the regional occlusion group (n = 74) and the Pringle’s maneuver occlusion group (n = 106) according to the technique used in the intraoperative hepatic inflow occlusion. The pre- and intra-operative indicators, postoperative recovery indicators, and complications of the two groups were compared. Results There were no significant differences (p > 0.05) between the groups in terms of sex, age, preoperative alanine aminotransferase (ALT), preoperative aspartate aminotransferase (AST), preoperative albumin, alpha-fetoprotein, liver cirrhosis, hepatitis B, tumor location, gas embolism, intraoperative blood transfusion, postoperative albumin, postoperative total bilirubin (TBIL), postoperative hospital stays, and complications. The preoperative TBIL and operation time were higher in the regional occlusion group than in the Pringle’s maneuver occlusion group, while the amount of intraoperative bleeding, postoperative ALT, and AST in the regional occlusion group were significantly lower than those in the Pringle’s maneuver occlusion group (p < 0.05). Conclusion The two occlusion techniques are equally safe and effective, but regional hepatic inflow occlusion is more advantageous in operation continuity, intraoperative bleeding, and postoperative liver function recovery. The long duration and high precision of the regional blood flow occlusion technique demands a more experienced physician with a higher level of operation; therefore, it can be performed by experienced laparoscopic liver surgeons.
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Affiliation(s)
- Longqing Shi
- Department of Hepatobiliary and Pancreatic Surgery, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Baoyang Luo
- Department of Hepatobiliary Surgery, Taizhou People’s Hospital, Taizhou, China
| | - Yong Yang
- Department of Hepatobiliary and Pancreatic Surgery, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Yurong Miao
- Department of Hepatobiliary and Pancreatic Surgery, Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Xin Li
- Department of Hepatobiliary and Pancreatic Surgery, Third Affiliated Hospital of Soochow University, Changzhou, China
- *Correspondence: Xin Li, ; Donglin Sun, ; Qiang Zhu,
| | - Donglin Sun
- Department of Hepatobiliary and Pancreatic Surgery, Third Affiliated Hospital of Soochow University, Changzhou, China
- *Correspondence: Xin Li, ; Donglin Sun, ; Qiang Zhu,
| | - Qiang Zhu
- Department of General Surgery, Children’s Hospital of Nanjing Medical University, Nanjing, China
- *Correspondence: Xin Li, ; Donglin Sun, ; Qiang Zhu,
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BASILIO L, STEINBRÜCK K, FERNANDES R, D’OLIVEIRA M, CANO R, VASCONCELOS H, BARBOSA D, ENNE M. RE-HEPATECTOMY MEANS MORE MORBIDITY? A MULTICENTRIC ANALYSIS. ABCD. ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA (SÃO PAULO) 2022; 35:e1647. [PMID: 35730876 PMCID: PMC9254632 DOI: 10.1590/0102-672020210002e1647] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/06/2021] [Accepted: 12/19/2021] [Indexed: 11/21/2022]
Abstract
Colorectal cancer generally metastasizes to the liver. Surgical resection of
liver metastasis, which is associated with systemic chemotherapy, is potentially
curative, but many patients will present recurrence. In selected patients,
repeated hepatectomy is feasible and improves overall survival.
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Affiliation(s)
| | - Klaus STEINBRÜCK
- Hepatobiliary Multidisciplinary Service, Brazil; Federal Hospital of Bonsucesso, Brazil
| | - Reinaldo FERNANDES
- Hepatobiliary Multidisciplinary Service, Brazil; Federal Hospital of Bonsucesso, Brazil
| | | | - Renato CANO
- Federal Hospital of Ipanema, Brazil; Hepatobiliary Multidisciplinary Service, Brazil
| | - Hanna VASCONCELOS
- Federal Hospital of Ipanema, Brazil; Hepatobiliary Multidisciplinary Service, Brazil
| | | | - Marcelo ENNE
- Federal Hospital of Ipanema, Brazil; Hepatobiliary Multidisciplinary Service, Brazil
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