腹腔镜肝癌切除术11例临床报告

目的　探讨腹腔镜肝癌切除手术的可行性与适应症。方法　 2 0 0 2年 7月～ 11月 ,经临床筛选病灶位于肝脏边缘、右肝表面或左半肝的病例 11例 ,HBs Ag(+ ) 7例 ,HCVAb(+ ) 2例 ,有肝硬变者 10例 ,肝功能 Child分级 A级 6例、B级 5例 ,AFP(+ ) 4例。病灶直径大小 1.8～ 6.0 cm,平均 3 .8± 1.7cm。对于肿瘤位于左半肝实质中的肿瘤 ,选行规则性左肝切除 ;对于肿瘤位于肝脏边缘或右肝表面时 ,选用肝脏局部切除术。结果　全部 11例均成功地在完全腹腔镜下完成肝切除术 ,切除范围包括局部切除 7例 ,左肝解剖性切除 4例 ,左半肝切除 1例、左外叶切除 2例、肝方叶切除 1例。全部肿瘤完整切除 ,肿瘤包膜完整 ,无破裂。手术时间 90～ 3 2 0分钟 ,平均 2 10 .9± 71.9分钟 ,出血量 5 0～ 10 0 0 ml,平均 4 4 3 .6± 3 3 0 .5 m l。切除肝体积最大 12 cm× 8cm× 6cm3、最小 3 cm× 3 cm× 2 cm。术中未出现不能控制的并发症 ,腹腔引流管放置时间 2～ 4天。术后未发生胆漏和出血等并发症 ,术后恢复顺利 ,术后平均住院 6.4天。结论　本组研究表明腹腔镜肝癌切除术是安全可行的 ,腹腔镜肝切除的适应证可适当放宽至右肝表面或左半肝的肝癌的首选的术式     

腹腔镜肝切除16例临床分析

目的　探讨腹腔镜肝切除手术的解剖基础与技术问题。　方法　选择病灶位于肝脏边缘、右肝表面或左半肝且肝功能Child分级B级以上 1 6例 ,其中原发性肝癌 8例 ,肝血管瘤 3例 ,左肝管胆管癌、肝细胞腺瘤、局灶性结节性增生、肝脓肿和肝囊肿伴感染各 1例。在上腹部放置 4～ 6个Trocar,应用电刀、超声刀和腔内直线形切割钉合器等多种断肝方法 ,采用钛夹夹闭、医用生物蛋白胶粘封等处理肝断面。　结果　对 1 6例在全气腹条件下完成 1 8个病灶的腹腔镜肝切除手术 ,包括左肝规则性切除 8例 ,肝局部切除 8例。手术时间 (2 0 6± 75 )min ,出血量 (35 4± 2 82 )ml,2例出血 1 0 0 0ml,术中输血 80 0ml。腹腔引流管放置时间 2天～ 4天 ,术后未发生胆漏和出血等并发症 ,术后住院 (5 8± 1 6 )天。　结论　腹腔镜肝切除手术的关键是恰当处理要切除肝的蒂部脉管 ,对次级肝门脉管的解剖分离是行肝段或左半肝切除时控制出血的关键     

腹腔镜肝切除术的可行性

目的探讨腹腔镜肝切除手术的可行性. 方法 2002年7月～2004年2月行完全腹腔镜肝切除44例,其中原发性肝细胞癌22例、肝血管瘤10例、肝脓肿3例、肝囊肿伴感染1例、肝脏局灶结节性增生3例、肝脏腺瘤1例、胆管囊腺瘤1例、炎性肉芽肿1例、肝门部胆管癌1例、高分化胆管细胞癌1例.肝功能Child分级A级38例,B级6例(均为肝癌病人). 结果腹腔镜下完成肝局部切除17例、左肝规则性切除14例、右肝规则性切除13例.手术时间15～450 min,平均195 min.出血量50～1 500 ml,平均405 ml.输血量0～1 000 ml,平均175 ml.术后恢复顺利,术后住院2～9 d,平均5.6 d.结论腹腔镜肝切除术安全可行,不仅适于肝良性肿瘤,也为肝脏恶性肿瘤提供了切除肿瘤的新途径.     

腹腔镜肝脏手术治疗肝脏占位性病变

目的 :探讨腹腔镜肝脏手术的可行性、适应证及方法。方法 :分析 1998年 6月至 2 0 0 2年 8月腹腔镜下肝脏手术 2 3例的临床资料。结果 :2 3例手术均在腹腔镜下完成 ,其中肝左外叶切除术 2例 ,肝癌局部切除术 7例 ,肝局限性结节状增生局部切除术 3例 ,肝血管瘤摘除术 1例 ,肝癌射频治疗 2例 ,肝囊肿开窗引流术 +胆囊切除术 7例 ,肝脓肿引流术 1例。平均手术时间 16 5min ,平均出血 12 0ml,术后 4 8h内胃肠功能恢复 ,术后平均住院 7.6d ,痊愈出院 ,无严重并发症发生。结论 :腹腔镜下肝脏手术 ,包括肝切除术是一种安全、有效、微创的手术 ,但应严格掌握适应证     

后腹腔镜及手助腹腔镜肾上腺切除术治疗肾上腺肿瘤(附21例报告)

目的 :探讨腹腔镜微创手术治疗肾上腺肿瘤的适应证及手术方法。方法 :对 18例直径小于 6cm的肾上腺肿瘤患者行后腹腔镜肾上腺切除术 (后腹腔镜组 ) ;对 3例最大直径为 10～ 17cm的肾上腺肿瘤患者行手助腹腔镜肾上腺切除术 (手助腹腔镜组 ) ,并观察手术时间、术中出血量、胃肠功能恢复时间和住院时间。结果 :2 1例患者中 ,2 0例成功。其中后腹腔镜组手术时间 2 5～ 135min ,平均 (82 .8± 31.1)min ,术中出血量 6 5～ 16 0ml,平均 (113.4± 31.8)ml,均未输血。手助腹腔镜组手术时间 180～ 2 10min ,术中出血量 80～ 6 0 0ml。两组患者均于术后 2天排气 ,1～ 3天下床活动 ,术后住院 3～ 7天。结论 :与开放手术相比 ,后腹腔镜肾上腺手术具有创伤小、出血少、恢复快等优点 ;手助腹腔镜为巨大肾上腺肿瘤切除提供了微创手术的新方式。     

完全腹腔镜规则性肝切除的解剖基础与技术问题

目的探讨腹腔镜规则性肝切除的解剖基础与技术问题。方法 2 0 0 2年 7月至2 0 0 2年 11月 ,治疗原发病灶位于左半肝但未侵及左肝门的原发性肝癌 4例、肝血管瘤 2例、肝囊肿伴感染 1例。肝切除步骤包括显露第 1肝门 ,游离肝周韧带 ,解剖并离断 2、3级肝门 3管 ,解剖第 2肝门并夹闭肝左静脉 ,离断肝实质和切断肝左静脉。结果 7例完全在腹腔镜下完成手术 ,左半肝切除 2例、左外叶切除 4例、肝方叶切除 1例。均成功地在矢状部对 2至 3级肝门的 3管进行解剖和离断。手术时间为 15 0～ 32 0min ,平均 (2 5 3± 5 9)min。出血量 2 0 0～ 10 0 0ml,平均 (4 5 0± 2 6 1)ml。结论腹腔镜规则性左肝切除术是安全可行的 ,对 2级肝门 3管的解剖和离断是行肝段或左半肝切除时控制出血的关键。     

原发性肝癌的手术切除治疗

目的　总结原发性肝癌手术切除病例的治疗效果。方法　回顾性分析近 5年我院 30 1例肝癌病人手术切除治疗情况。结果　 4 0 %有乙肝病史 ,6 2 %伴有肝炎。肝功能A级 4 6 % ,B级38% ,C级 16 %。肿瘤位于左肝占 31% ,右肝 6 5 % ,左右肝 4 %。小肝癌 2 3% ,大肝癌 76 %。 6 1%合并肝硬化 ,8%合并门静脉癌栓 ,3%合并胆管癌栓。左外叶切除 8 6 % ,左半肝切除 8% ,右半肝切除12 6 % ,肝段切除 71 8%。 31%采用Pringle术 ,阻断时间为 15± 4min ,最长 30min。 10 %采用半肝血流阻断术 ,阻断时间为 2 5± 12min ,最长 6 0min。 1 3%采用全肝血流阻断术 (改良Heaney法 ) ,阻断时间为 14± 4min ,最长者为 2 0min。术中出血量为 10 5 6± 1195ml,输血量为 6 6 5± 5 91ml,手术时间为 194± 84min。术后总并发症发生率为 19 9% ,严重并发症发生率为 7 3% ,手术死亡率为2 7% ,住院时间为 2 5± 12d。术后 1,3,5年存活率分别为 74 % ,5 6 % ,4 2 %。结论　肝切除术后并发症发生率较高 ,但严重并发症发生率和手术死亡率较低。术中控制出血及肝切除量 ,减少手术时间是降低术后并发症和死亡率的关键     

三维腹腔镜下精准肝脏肿瘤切除应用分析

目的探讨三维腹腔镜精准肝脏肿瘤切除的应用价值。 方法回顾性分析10例肝脏肿瘤患者施行腹腔镜精准解剖性肝切除术的临床资料。 结果10例手术均获成功,其中肝癌8例,肝血管瘤2例;术中出血量平均(216 ± 6) ml,术后住院时间平均(10 ± 3) d;术中出血较少,视野清晰,手术时间也较短。术后无胆漏、出血等并发症发生。术后1～3 d肛门排气,术后5～11 d痊愈出院。 结论三维腹腔镜精准解剖性肝切除对于精确分离肝内管道结构具有一定优势,有助于控制术中出血,适用于肝脏肿瘤解剖性肝切除术,尤其适用于半肝切除术。     

腹腔镜肝癌切除术15例报告

目的探讨腹腔镜肝癌切除的可行性与适应证. 方法 1998年8月～2004年9月采用多功能手术解剖器(Peng's multifunctional operative dissector,PMOD)刮吸法断肝技术对15例肝癌行腹腔镜肝癌切除术. 结果 14例腹腔镜肝癌切除术成功,1例因术中出血中转开腹肝癌切除术.腹腔镜肝癌切除术手术时间60～240 min,平均125 min.术中出血量50～2 000 ml,平均501 ml.切除肝脏最大体积10 cm×9 cm×7 cm.术后无并发症发生.术后24 h均能下床活动,术后1～3 d即能进食.术后住院5～10 d,平均6.5 d. 结论对位于肝脏边缘、右肝表面或左半肝的恶性肿瘤,采用PMOD行腹腔镜肝癌切除是可行和安全的.     

腹腔镜肝切除治疗肝脏肿瘤的临床探讨

目的探讨腹腔镜肝切除治疗肝脏肿瘤的临床疗效及手术方法的可行性和优缺点。方法 2009年1月至2011年8月期间我科为32例肝脏肿瘤患者施行腹腔镜下肝脏切除治疗,对其临床资料进行回顾性总结分析。结果采用腹腔镜下解剖性肝脏切除29例,非解剖性肝脏切除3例,32例患者手术均获得成功,包括原发性肝癌23例,转移性肝癌5例,肝血管瘤3例,肝局灶性结节性增生1例。腹腔镜肝切除包括左外叶切除(Ⅱ+Ⅲ段)17例,左内叶切除(Ⅳ段)2例(左外叶已切除),左半肝切除(Ⅱ+Ⅲ+Ⅳ段)8例,Ⅴ段切除1例,Ⅵ段切除1例,Ⅲ、Ⅳ、Ⅴ段部分肝切除3例。肝切除手术时间75～285 min,平均215 min;术中出血115～760 ml,平均365 ml。未发生胆汁漏、出血、气体栓塞等并发症。术后1～3 d肛门排气、胃肠功能恢复后进食,5～11 d(平均6 d)恢复出院。随访31例,随访时间6～32个月,平均18个月,除1例术后1年因肿瘤复发转移死亡外,其余均健在,健在肿瘤患者未发现复发、转移。结论腹腔镜肝切除治疗肝脏肿瘤创伤小,痛苦少,康复快,能达到根治要求,安全、可行,临床疗效好。     

Hand-assisted laparoscopic hepatectomy for solid tumor in the posterior portion of the right lobe: initial experience

OBJECTIVE: To prove the feasibility of hand-assisted laparoscopic liver resection for tumors located in the posterior portion of the right hepatic lobe. SUMMARY BACKGROUND DATA: Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. METHODS: Between October 2001 and June 2002, a total of 7 patients with solid hepatic tumors involving the posterior portion of the right lobe of liver underwent hand-assisted laparoscopic hepatectomy with the HandPort system at our hospital. Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement. The location of tumor and its transection margin were decided by laparoscopic ultrasound. The liver resection was performed using the Ultrashear without portal triad control, with the specimens obtained then placed in a bag and removed directly via the HandPort access. RESULTS: The 5 male and 2 female patients ranged in age from 41 to 76 years (mean 62.3 +/- 14.4). Surgical procedures included partial hepatectomy for 6 patients and segmentectomy for one, all successfully completed using a variant of the minimally invasive laparoscopic procedure without conversion to open surgery. The mean duration of the operation was 140.7 +/- 42.2 minutes (90-180). The blood loss during surgery was 257.1 +/- 159 mL (250-500), without any requirement for intraoperative or postoperative transfusion. Pathology revealed hemagioma (n = 2), colon cancer metastasis (n = 2), and hepatocellular carcinoma (n = 3). There were no deaths postoperatively, with 1 patient suffering bile leakage. Mean hospital stay was 5.3 +/- 1.3 days postsurgery. CONCLUSION: The results of this study suggest that laparoscopic liver resection using the HandPort system is feasible for selected patients with lesions in the posterior portion of the right hepatic lobe requiring limited resection. Individuals with small tumors may benefit; because a large abdominal incision is not required, the wound-related complication rate might be reduced.     

Nonanatomic hepatic resection with a pledgetted suturing technique

BACKGROUND/PURPOSE: Anatomic hepatic resection is dependent on the segmental infrastructure of the liver, whereas nonanatomic resection is independent of structural planes and is often fraught with excessive bleeding. The authors describe their experience with a novel technique using pledgetted suturing for extensive liver resection in patients with benign or malignant hepatic tumors. METHODS: Four children, (mean age, 24.7 +/- 12.5 months) underwent liver resection for the following hepatic lesions: hepatoblastoma, invasive Wilms' tumor, Caroli's disease, and infantile hemangioendothelioma. In the child with hepatoblastoma, the lesion was considered unresectable by segmental anatomy. A surgical technique was designed in which nonabsorbable 2-0 Teflon felt pledgetted sutures were placed through the liver parenchyma in a nonanatomic resection plane. The mattress sutures were sequentially tied until the resection plane was defined. The resection was sharply completed with a scalpel along the line of pledgetted sutures, independent of hepatic segmental anatomy. RESULTS: Complete surgical resections of the hepatic lesions were obtained in all cases. Estimated blood loss was minimal with a mean of 5.3 +/- 0.9 mL/kg. No patient received a blood transfusion as a result of the hepatic resection. There were no postoperative hepatic complications resulting from the resection. The child with hepatoblastoma had a delayed recovery, resulting in reexploration that ruled out a subphrenic abscess. CONCLUSIONS: The pledgetted suturing technique for hepatic resection is relatively bloodless, safe, easy to perform, and may enable a complete surgical resection of otherwise unresectable lesions. We advocate this technique when approaching a large hepatic lesion that would entail a difficult or incomplete anatomic resection in infants. J Pediatr Surg 36:209-212.     

Laparoscopic liver resections: a feasibility study in 30 patients

OBJECTIVE: To assess the feasibility and safety of laparoscopic liver resections. SUMMARY BACKGROUND DATA: The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to consider laparoscopic resection in selected patients. METHODS: A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation. RESULTS: From May 1996 to December 1999, 30 of 159 (19%) liver resections were included. There were 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 atypical resections. Mean blood loss was 300 mL. Mean surgical time was 214 minutes. There were no deaths. Complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease. CONCLUSION: Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate.     

Completely laparoscopic total and partial gastrectomy for benign and malignant diseases: a single institute's prospective analysis

BACKGROUND: Laparoscopic surgery for gastrointestinal benign disease has gained worldwide acceptance; totally laparoscopic surgery for malignant diseases remains controversial. The purposes of this study were to examine prospectively our experience with laparoscopic gastric resections, to evaluate the surgical outcomes, and to discuss the role of these procedures in the treatment of benign and malignant diseases of the stomach. To the best of our knowledge, this is the largest prospective study of totally laparoscopic total and partial gastrectomies in Western countries. STUDY DESIGN: Thirty-three patients who underwent totally laparoscopic gastric resection between April 1995 and January 2004 were studied prospectively. Eight patients underwent laparoscopic total gastrectomy and 25 patients had laparoscopic partial gastrectomy. There were 21 women and 12 men with a mean age of 71 +/- 10 years. RESULTS: Twenty-one patients (63.6%) were operated on for malignant diseases and 12 patients (36.4%) had benign lesions. Conversion to laparotomy was not required in any case. Mean operative time was 138 +/- 40 minutes and mean blood loss was 58 +/- 85 mL. There were no major intraoperative complications except for one splenectomy, and there were no perioperative deaths. Two postoperative complications occurred; one patient developed an intraperitoneal abscess with a small duodenal fistula after total gastrectomy and was treated by peritoneal lavage and drain placement. The other patient developed delayed gastric emptying after subtotal gastrectomy and was managed conservatively. Mean ambulation time and mean hospital stay were 2.3 +/- 0.7 days and 14.6 +/- 5 days, respectively. All resected margins were tumor free. The mean number of retrieved lymph nodes for the malignant lesions was 22 +/- 12 (range 10 to 53). CONCLUSIONS: This prospective trial demonstrated that totally laparoscopic total and partial gastric resections had good results and were feasible and safe procedures. In addition, we concluded that the totally laparoscopic approach for early and advanced gastric cancer can obtain adequate margins and follow oncologic principles.     

手助腹腔镜肝癌切除23例

目的探讨手助腹腔镜肝癌切除的可行性和安全性。方法对病变位于肝脏外周部位(Ⅱ~Ⅵ段)的23例病人,肝细胞癌20例,肝内胆管细胞癌2例,肝囊腺癌1例。采用手助腹腔镜行肝切除术。结果23例手助腹腔镜肝切除均获得成功,规则性肝叶(段)切除17例,肝不规则切除6例,平均手术时间为105 m in,平均出血量187 m l,术后无严重并发症发生,术后平均住院日为9.5 d。结论手助腹腔镜肝切除是安全可行的,缩短手术时间,减少出血的微创手术方式。     

Laparoscopic liver resection: results for 70 patients

Background Laparoscopy is slowly becoming an established technique for liver resection. This procedure still is limited to centers with experience in both hepatic and laparoscopic surgery. Preliminary reports include mainly minor resections for benign liver conditions and show some advantage in terms of postoperative recovery. The authors report their experience with laparoscopic liver resection, the evolution of the technique, and the results. Methods From 1999 to 2006, 70 laparoscopic liver resections were performed using a procedure similar to resection by laparotomy. Results There were 38 malignant tumors (54%) and 32 benign lesions (46%). The malignant tumors were mainly hepatocellular carcinomas (19 of 24 patients had cirrhosis). The tumor mean size was 3.8 ± 1.9 cm (range, 2.2–8 cm). There were 19 major hepatectomies, 34 uni- or bisegmentomies, and 17 atypical resections. The operative time was 227 ± 109 min. Conversion to laparotomy was required for seven patients (10%), mainly for continuous bleeding during transection. Nine patients (13%) required blood transfusion. One patient had both brisk bleeding and gas embolism from a tear in the section line of the right hepatic vein requiring laparoscopic suture. Blood loss and transfusion requirements were significantly lower in recent than in early cases and in resections with prior vascular control than in those without such control. Postoperative complications were experienced by 11 patients (16%), including one bleed from the hepatic stump requiring hemostasis and two subphrenic collections requiring percutaneous drainage. One cirrhotic patient died of liver failure after resection of a partially ruptured tumor. No ascites was observed in other cirrhotic patients. The mean hospital stay was 5.9 days. Conclusion The study results confirm that laparoscopic liver resection, including major hepatectomies, can be safely performed by laparoscopy. Presented at the 2006 Society of American Gastrointestinal and Endoscopic Surgeons (SAGES) Meeting, Dallas, Texas, 26–29 April 2006     

Laparoscopic versus open left lateral hepatic lobectomy: a case-control study

BACKGROUND: After technical advances in hepatic surgery and laparoscopic surgery, some teams evaluated the possibilities of laparoscopic liver resections. The aim of our study was to assess the results of laparoscopic left lateral lobectomy (bisegmentectomy 2-3) and to perform a case-control comparison with the same operation performed by open surgery. STUDY DESIGN: From 1996 to 2002, 60 laparoscopic resections were performed in selected patients, including 18 left lateral lobectomies. The resected lesions were benign tumors, hepatocellular carcinomas with compensated cirrhosis, and metastases. Surgical procedures were performed with a harmonic scalpel, an ultrasonic dissector, linear staplers, and portal pedicule clamping when necessary. Results were compared with those of patients who underwent open left lateral lobectomies selected from our liver resection database in a case-control analysis. Both groups were similar for age, type and size of the tumor, and presence of underlying liver disease. RESULTS: Compared with laparotomy, laparoscopic left lateral lobectomies were associated with a longer surgical time (202 versus 145 minutes, p < 0.01), a longer portal triad clamping (39 versus 23 minutes, p < 0.05), and a decreased blood loss (236 versus 429 mL, p < 0.05). There were no deaths in either group, and the morbidity rates were 11% in the laparoscopic group and 15% in the open group. There were no specific complications of hepatic resection after laparoscopy (no hemorrhage, subphrenic collection, or biliary leak), but some were observed in the open group. CONCLUSIONS: This study demonstrates the safety of laparoscopic left lateral lobectomy. Despite longer operation and clamping time, without any clinical consequences, the laparoscopic approach was associated with decreased blood loss and absence of specific complications of the hepatic resection.     

Bloodless liver resection using radiofrequency energy

BACKGROUND: Liver surgery carries the risk of intraoperative bleeding. In order to avoid bleeding, transection of the liver can be performed after coagulating the parenchyma by using monoplolar or bipolar radiofrequency energy. METHODS: 236 consecutive patients underwent liver resection with the radiofrequency-assisted technique using either a monopolar or a bipolar device. Data were collected prospectively to assess the outcome including, intraoperative blood loss, blood transfusion requirement, morbidity and mortality rates. RESULTS: There were 41 major hepatectomies and 195 minor resections. Overall mean intraoperative blood loss was 157 +/- 240 ml, while mean blood loss during liver transection was 90 +/- 105 ml. 10 patients (4%) received blood transfusion. 50 patients (21%) developed postoperative complications including 5 bile leaks (2%). The mortality rate was 2.1%. No patient was reoperated for postoperative haemorrhage or bile leak. The mean postoperative stay was 11 +/- 10 days. CONCLUSION: The radiofrequency-assisted liver resection technique offers hepatobiliary surgeons an additional method for performing liver resections with minimal blood loss, low transfusion requirement, and low morbidity and mortality rates.     

An initial experience and evolution of laparoscopic hepatic resectional surgery

BACKGROUND: The use of minimally invasive procedures has revolutionized modern surgery. Only recently has laparoscopy been introduced for use in hepatic surgery. METHODS: Patient demographics, tumor characteristics, and outcomes were evaluated for all initial cases of laparoscopic hepatic resection. RESULTS: Twenty-one resections were performed in 17 patients; 5 were performed for malignancy, of which 3 had underlying cirrhosis, and the remaining 12 for benign symptomatic disease. Mean patient age was 55.4 (range, 24-82 years). The mean number of lesions was 1.4 (range, 1-5), having an average size of 7.6 cm (range, 2-30 cm). Mean operative time was 2.8 hours (range, 2-5 hours) hours. Most resections involved 1 or more Couinaud segments. Mean blood loss was 288 cc (range, 50-150 cc). Complications included re-operation for hemorrhage (n=2), biliary leakage (n=1), and death from hepatic failure (n=1). Mean length of stay was 2.9 days (range, 1-14). When compared with our series of 100 patients who underwent open hepatic resection for benign tumors, significantly greater means ( P <.05) were noted for blood loss (485 cc), operative time (4.5 hours), and length of stay (6.5 days). CONCLUSIONS: Laparoscopic hepatic surgery, though complex, can be performed safely and efficaciously. Minimally invasive surgery appears to provide several distinct advantages over traditional open hepatic surgery. However, techniques for the laparoscopic control of bleeding and bile leak remain in their infancy.     

A prospective evaluation of ultrasound-directed transparenchymal vascular control with linear cutting staplers in major hepatic resections

BACKGROUND: We prospectively evaluated a novel ultrasound-directed technique of major hepatic resection using transparenchymal application of vascular staplers intending to minimize blood loss, operative time, and hepatic warm ischemia time. METHODS: Beginning in 1998 many major hepatic resections for hepatic tumors were performed with ultrasound-directed transparenchymal application of vascular linear cutting staplers. An endoscopic flexible neck vascular linear cutting stapler was used for control of the hepatic veins. RESULTS: From December 1998 to April 2003, 346 patients undergoing hepatic resection using this technique were identified from a prospective hepatobiliary tumor surgery database. Records were reviewed for blood loss, transfusion requirement, inflow occlusion (Pringle maneuver) time, overall operative time, and perioperative and postoperative complications. The average blood loss for all patients was 396 +/- 28.4 mL. The inflow occlusion time was 13.7 +/- .64 minutes with a total operative time of 140.7 +/- 3.7 minutes. Additional liver-related procedures were performed in 52% of the patients. The overall complication rate was 29.5% with a 90-day mortality rate of 1.4%. CONCLUSIONS: Ultrasound-directed transparenchymal application of vascular staplers to control inflow and outflow during major liver resection minimizes blood loss, warm ischemia time, and operative time compared to published reports of patients undergoing resection using other techniques.