Yoshikuni Kawaguchi1, Vimalraj Velayutham2, David Fuks3, Frederic Mal2, Norihiro Kokudo4, Brice Gayet5. 1. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. Electronic address: yokawaguchi-tky@umin.ac.jp. 2. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France. 3. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Institut des Systèmes Intelligents et Robotique, Université Pierre et Marie Curie, Paris, France. 4. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan. 5. Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, Paris, France; Institut des Systèmes Intelligents et Robotique, Université Pierre et Marie Curie, Paris, France. Electronic address: brice.gayet@imm.fr.
Abstract
BACKGROUND: The lack of a complete hepatic overview and tactile feedback during laparoscopic hepatectomy may result in near misses or fatal intraoperative complications despite the advantage of a magnified laparoscopic view. The aim of the study is to describe operative techniques and guiding principles with which to address near misses unique to laparoscopic hepatectomy and evaluate the intraoperative complication rate overtime. METHODS: Data of 408 consecutive patients who underwent laparoscopic hepatectomy were reviewed. Representative operative techniques and guiding principles with which to address near misses and pitfalls unique to laparoscopic hepatectomy were evaluated among the patients by 2 surgeons. RESULTS: Most near misses were due to lack of understanding of both the laparoscopic view and anatomic aspects unique to laparoscopic hepatectomy. Operative techniques and/or guiding principles with which to address these issues were demonstrated as follows: starting parenchymal transection at the declivitous parts; no ligation of the right or left portal vein before confirming the bifurcation; dissection of the short hepatic vein using a sealing device; dissection of the root of the hepatic vein using scissors; exposure of the middle hepatic vein, which is anatomically close to the hilar plate; and identification of V8 using intraoperative ultrasonography. The intraoperative massive bleeding due to vessel injury or surgical clip slippage occurred in 25 patients (6.1%), and its rate had a significant trend to decrease with increasing years. CONCLUSION: We demonstrated operative techniques and guiding principles with which to address near misses in laparoscopic hepatectomy. The intraoperative massive bleeding rate trended to decrease over time.
BACKGROUND: The lack of a complete hepatic overview and tactile feedback during laparoscopic hepatectomy may result in near misses or fatal intraoperative complications despite the advantage of a magnified laparoscopic view. The aim of the study is to describe operative techniques and guiding principles with which to address near misses unique to laparoscopic hepatectomy and evaluate the intraoperative complication rate overtime. METHODS: Data of 408 consecutive patients who underwent laparoscopic hepatectomy were reviewed. Representative operative techniques and guiding principles with which to address near misses and pitfalls unique to laparoscopic hepatectomy were evaluated among the patients by 2 surgeons. RESULTS: Most near misses were due to lack of understanding of both the laparoscopic view and anatomic aspects unique to laparoscopic hepatectomy. Operative techniques and/or guiding principles with which to address these issues were demonstrated as follows: starting parenchymal transection at the declivitous parts; no ligation of the right or left portal vein before confirming the bifurcation; dissection of the short hepatic vein using a sealing device; dissection of the root of the hepatic vein using scissors; exposure of the middle hepatic vein, which is anatomically close to the hilar plate; and identification of V8 using intraoperative ultrasonography. The intraoperative massive bleeding due to vessel injury or surgical clip slippage occurred in 25 patients (6.1%), and its rate had a significant trend to decrease with increasing years. CONCLUSION: We demonstrated operative techniques and guiding principles with which to address near misses in laparoscopic hepatectomy. The intraoperative massive bleeding rate trended to decrease over time.
Authors: Alban Zarzavadjian Le Bian; Nicolas Tabchouri; Mostefa Bennamoun; Christophe Louvet; Candice Tubbax; Anthony Sarran; Marine Lefevre; Marc Beaussier; Frédéric Pamoukdjian; Philippe Wind; Brice Gayet; David Fuks Journal: Surg Endosc Date: 2019-01-22 Impact factor: 4.584