Sung Hoon Choi1, Gi Hong Choi, Dai Hoon Han, Jin Sub Choi. 1. Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea, feel9847619@gmail.com.
Abstract
BACKGROUND: Although laparoscopic liver resection is increasingly performed worldwide, surgeons still face technical challenges because of the variety of procedures used according to tumor location. In the current study, we introduce a unique retraction method using an elastic rubber band and present its learning curve in addition to the perioperative outcomes of 100 consecutive patients. METHODS: A series of 100 consecutive patients who underwent laparoscopic liver resection using a rubber band technique between August 2008 and June 2013 were analyzed retrospectively. All the study patients underwent the rubber band technique as a method to expose the parenchymal resection plane. RESULTS: The study subjects consisted of 56 males and 44 females with a mean age of 56.7 ± 9.6 years. There were a total of four open conversions. There was no postoperative mortality. Eighty-five patients underwent minor resection, and 15 patients underwent major resection. Among the 85 patients who underwent a minor resection, 65 patients who had favorably located tumors were compared with the 20 patients who had unfavorably located tumors. A comparison of perioperative outcomes revealed a significant difference in operative time (197.3 ± 81.9 vs. 245.9 ± 116.8 min, P = 0.040) but no differences in any other parameters. There were three (4.6 %) and one (5 %) open conversions in the favorable and unfavorable tumor location group, respectively (P = 0.954). The postoperative complication rates were not statistically different between the two groups [4 (6.2 %) vs. 1 (5 %), P = 0.848]. In the learning curve analysis, operative time and blood loss for left lateral sectionectomy (n = 14) and left hepatectomy (n = 12) and minor limited resections for posterosuperior lesions (n = 20) reached a plateau after approximately ten cases. CONCLUSION: The retraction technique describes here using an elastic rubber band is a useful approach that results in a safe laparoscopic liver resection. Moreover, this can be applied proficiently after a reasonable learning curve.
BACKGROUND: Although laparoscopic liver resection is increasingly performed worldwide, surgeons still face technical challenges because of the variety of procedures used according to tumor location. In the current study, we introduce a unique retraction method using an elastic rubber band and present its learning curve in addition to the perioperative outcomes of 100 consecutive patients. METHODS: A series of 100 consecutive patients who underwent laparoscopic liver resection using a rubber band technique between August 2008 and June 2013 were analyzed retrospectively. All the study patients underwent the rubber band technique as a method to expose the parenchymal resection plane. RESULTS: The study subjects consisted of 56 males and 44 females with a mean age of 56.7 ± 9.6 years. There were a total of four open conversions. There was no postoperative mortality. Eighty-five patients underwent minor resection, and 15 patients underwent major resection. Among the 85 patients who underwent a minor resection, 65 patients who had favorably located tumors were compared with the 20 patients who had unfavorably located tumors. A comparison of perioperative outcomes revealed a significant difference in operative time (197.3 ± 81.9 vs. 245.9 ± 116.8 min, P = 0.040) but no differences in any other parameters. There were three (4.6 %) and one (5 %) open conversions in the favorable and unfavorable tumor location group, respectively (P = 0.954). The postoperative complication rates were not statistically different between the two groups [4 (6.2 %) vs. 1 (5 %), P = 0.848]. In the learning curve analysis, operative time and blood loss for left lateral sectionectomy (n = 14) and left hepatectomy (n = 12) and minor limited resections for posterosuperior lesions (n = 20) reached a plateau after approximately ten cases. CONCLUSION: The retraction technique describes here using an elastic rubber band is a useful approach that results in a safe laparoscopic liver resection. Moreover, this can be applied proficiently after a reasonable learning curve.
Authors: Joseph F Buell; Daniel Cherqui; David A Geller; Nicholas O'Rourke; David Iannitti; Ibrahim Dagher; Alan J Koffron; Mark Thomas; Brice Gayet; Ho Seong Han; Go Wakabayashi; Giulio Belli; Hironori Kaneko; Chen-Guo Ker; Olivier Scatton; Alexis Laurent; Eddie K Abdalla; Prosanto Chaudhury; Erik Dutson; Clark Gamblin; Michael D'Angelica; David Nagorney; Giuliano Testa; Daniel Labow; Derrik Manas; Ronnie T Poon; Heidi Nelson; Robert Martin; Bryan Clary; Wright C Pinson; John Martinie; Jean-Nicolas Vauthey; Robert Goldstein; Sasan Roayaie; David Barlet; Joseph Espat; Michael Abecassis; Myrddin Rees; Yuman Fong; Kelly M McMasters; Christoph Broelsch; Ron Busuttil; Jacques Belghiti; Steven Strasberg; Ravi S Chari Journal: Ann Surg Date: 2009-11 Impact factor: 12.969
Authors: Jae Keun Kim; Joon Seong Park; Dai Hoon Han; Gi Hong Choi; Kyung Sik Kim; Jin Sub Choi; Dong Sup Yoon Journal: Surg Endosc Date: 2016-02-22 Impact factor: 4.584