Useful and convenient procedure for intermittent vascular occlusion in laparoscopic hepatectomy

Abstract

While the amount of blood loss during laparoscopic hepatectomy tends to be smaller than that during open hepatectomy, intermittent vascular occlusion to control hepatic inflow can diminish blood loss during laparoscopic hepatectomy. Described herein is a useful and convenient method for intermittent vascular occlusion, which was standardized for laparoscopic hepatectomy. A tourniquet system consisting of cloth tape and a 20-cm catheter was used for intermittent vascular occlusion. This was placed through a hole in the abdominal wall from which a 5-mm trocar had been extracted. By operating this tourniquet system outside the patient's body, we were easily able to repeat intermittent vascular occlusion. Twenty-three patients underwent laparoscopic hepatectomy using this system. The mean time of operation and vascular occlusion were 311.6 and 83.6 min, respectively. The mean blood loss was 215.0 mL. There were no intraoperative blood transfusions or critical postoperative complications. The average length of postoperative hospital stay was 6.5 days. The mean time to place this system was 354 s, and there were no complications caused by this system. During totally laparoscopic hepatectomy, surgeons can perform intermittent vascular occlusion safely by using this method.