Abstract
ObjectivesThis study was designed to evaluate the safety and effectiveness of a two-hand technique combining harmonic scalpel (HS) and laparoscopic Peng’s multifunction operative dissector (LPMOD) in patients who underwent laparoscopic hemihepatectomy (LHH).MethodsWe designed and conducted a case-control study nested in a prospectively collected laparoscopic liver surgery database. Patients who underwent LHH for liver parenchyma transection using HS + LPMOD were defined as cases (n = 98) and LPMOD only as controls (n = 47) from January 2016 to May 2018. Propensity score matching (1:1) between the case and control groups was used in the analyses.ResultsThe case group had significantly less intraoperative blood loss in milliliters (169.4 ± 133.5 vs. 221.5 ± 176.3, P = 0.03) and shorter operative time in minutes (210.5 ± 56.1 vs. 265.7 ± 67.1, P = 0.02) comparing to the control group. The conversion to laparotomy, postoperative hospital stay, resection margin, the mean peak level of postoperative liver function parameters, bile leakage rate, and others were comparable between the two groups. There was no perioperative mortality.ConclusionsWe demonstrated that the two-handed technique combing HS and LPMOD in LHH is safe and effective which is associated with shorter operative time and less intraoperative blood loss compared with LPMOD alone. The technique facilitates laparoscopic liver resection and is recommended for use.
Highlights
Massive bleeding is a big challenge for hepatic resection, especially hemihepatectomy
Significant differences were observed depending on the group; the case group was more likely to have a lower body mass index (BMI) (P = 0.02) and higher elderly population (P = 0.03) than the control group
The intraoperative blood loss was significantly diminished in the case group compared with the control group
Summary
Massive bleeding is a big challenge for hepatic resection, especially hemihepatectomy. It is a cause of death during the surgery and hemorrhage after the surgery and affects prognosis as well. Increased intraoperative bleeding during liver surgery has been reported to have a negative impact on postoperative recovery and prognosis [1]. Massive blood loss during liver surgery is related to the high risk of postoperative mortality and recurrence of hepatocellular carcinoma. Massive intraoperative blood loss may lead to a longer time of systemic hypoperfusion and affects oxygen delivery to vital organs [2]. Perioperative blood transfusion due to massive blood loss is associated with worse survival outcomes in postoperative patients [3, 4]. Techniques which can help minimize bleeding during the hepatic resection are demanded to be developed
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