Is Intraoperative Blood Loss Underestimated in Patients Undergoing Laparoscopic Hepatectomy?

Abstract

Less intraoperative blood loss is frequently reported as an advantage of laparoscopic hepatectomy (LH) over open hepatectomy (OH). However, the small work space during laparoscopic surgery could lead to insufficient blood suction from the abdominal cavity, with possible underestimation of intraoperative blood loss. This study compared estimated blood loss (E-BL) with intraoperatively counted blood loss (IC-BL) in patients undergoing LH. This study included 110 consecutive patients undergoing partial hepatectomy for solitary liver tumors (59 had OH and 51 had LH). IC-BL and E-BL were determined, and the difference between them was calculated based on the surgical approach. Factors affecting the difference were investigated. IC-BL was quantified from the suction fluid volume and weight of surgical gauzes used for blood and fluid collection. E-BL was calculated with the total blood volume and change in hematocrit. Although there were no significant differences between IC-BL and E-BL in the OH group (292 ± 198 vs. 259 ± 167mL, p = 0.1239), E-BL was significantly greater than IC-BL in the LH group (273 ± 166 vs. 128 ± 177mL, p < 0.0001). Percentage of patients with E-BL > IC-BL in the LH group was significantly greater than in the OH group (86.3 vs. 42.4%, p < 0.0001). The surgical approach (OH/LH) was the only significant independent factor determining E-BL > IC-BL status. E-BL was significantly greater than IC-BL only in patients undergoing LH, and the surgical approach (OH/LH) was the only factor affecting E-BL > IC-BL status. These results suggest that intraoperative blood loss may be underestimated during LH.