A Simplified Technique for Hepatic Resection

Lin, Tsung-Chih

doi:10.1097/00000658-197409000-00005

Cited by 123 publications

(80 citation statements)

References 1 publication

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“…A number of surgical devices and techniques for liver resection have been developed in order to reduce the intraoperative blood loss [8,9,10,11,12,13,14,15,16,17,18,19,20,21,22,23]. It has been reported that the amount of intraoperative blood loss was associated with the incidence of surgical complications [24,25], and perioperative blood transfusion have been shown to increase the recurrence rate of liver malignancies after surgical treatment [26].…”

Section: Introductionmentioning

confidence: 99%

A Worldwide Survey of the Current Daily Practice in Liver Surgery

et al. 2013

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Background: Liver resection remains the mainstay of curative treatment for liver malignancies. A variety of preoperative assessments and surgical techniques have improved the short- and long-term outcomes of liver resection in patients with liver tumors. Recently, laparoscopic hepatectomies have been increasingly performed. The aim of the present study is to survey the current practice of liver surgery in high-volume centers in the world. Methods: A questionnaire on the preoperative assessment for liver surgery, open hepatectomy, and laparoscopic hepatectomy was sent to 94 liver centers in the world. Results: Forty-two centers (45%) responded to this survey (29 Asian, 9 European, and 4 North American centers). All but one of the centers evaluated the future liver remnant (FLR) volume, and 95% of them performed preoperative portal vein embolization to increase the FLR volume. In half of the centers, the required FLR volume was over 30% in patients with normal liver and 50% in patients with cirrhotic liver. To reduce the intraoperative blood loss, half of the centers routinely used Pringle’s maneuver, and 85% restricted the intraoperative fluid infusion to reduce the central venous pressure. More than 10 laparoscopic hepatectomies were performed per year in 62% of the centers, and more than 30 were performed in 26%, respectively. Laparoscopic major hepatectomies were performed in 24%. Two-thirds answered that the laparoscopic approach would be feasible in donor hepatectomy. Conclusion: The evaluation of FLR volume in patients with normal or cirrhotic liver and the usage of preoperative portal vein embolization have become essential practice in more than 90% of the centers. Reduced blood loss has been achieved using Pringle’s maneuver, restriction of fluid infusion, and a variety of surgical devises. The laparoscopic approach is increasingly extended to major hepatectomy or donor hepatectomy.

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Section: Introductionmentioning

confidence: 99%

A Worldwide Survey of the Current Daily Practice in Liver Surgery

et al. 2013

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“…The problem of significant blood loss during the liver parenchymal transection phase of the procedure, however, limited further advances. The ‘clamp crush’ technique, allowing controlled division of liver parenchyma, was subsequently reported in the 1970s [2]. This method enabled surgeons to ligate blood vessels and bile ducts during parenchymal transection in a controlled fashion, with or without vascular inflow occlusion (Pringle manoeuvre).…”

Section: Introductionmentioning

confidence: 99%

Use of Bipolar Radiofrequency in Parenchymal Transection of the Liver, Pancreas and Kidney

Pai¹,

Spalding²,

Jiao³

et al. 2012

Dig Surg

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Background: Intraoperative blood loss has been shown to be an important factor correlating with increased morbidity and mortality in oncological surgery. Despite technological advances in parenchymal transection devices, bleeding remains the single most important complication. To address this, we designed and developed a bipolar radiofrequency (RF) device, the Habib 4X (Angiodynamics, Inc., Queensbury, N.Y., USA), which was initially used specifically for liver resections. Methods: A search using Medline, Embase and Google™ Scholar was performed for the period January 2001 to August 2011. The following Mesh terms were used: ‘bipolar radiofrequency’, ‘Habib 4X’, ‘laparoscopic’, ‘liver resection’, ‘partial nephrectomy’ and ‘distal pancreatectomy’. The references of the studies included were also reviewed. Series from our centre were excluded. Results: There wereseven series published, reporting a total of 188 liver resections [113 minor (<3 segments) and 75 major (≧3 segments)] assisted by the bipolar RF (Habib 4X) device over this period. The median blood loss reported ranged from 15 to 427 ml with a transfusion rate of 0–14% In addition, five series of partial nephrectomies were also identified, reporting a total of 149 (45 open and 104 laparoscopic) cases. Hilar clamping was not used in any of the cases, and the mean blood loss reported was 100–337 ml whilst the transfusion rate ranged from 0 to 7.1%. There was only one published series of distal pancreatectomies; these were laparoscopic and included 14 patients. Conclusion: This review of bipolar RF-assisted liver resections, partial nephrectomies and distal pancreatectomies reported in the literature to date shows that there are significant advantages in using this device in these types of operation.

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“…Advances in technology have elaborated the techniques for parenchymal transection during hepatectomy from the classic clamp crushing technique [18] to a combination of various sophisticated devices [19,20,21]. …”

Section: Discussionmentioning

confidence: 99%

Metzenbaum-Assisted Liver Resection: A Safe and Effective Liver Resection Technique

Schwartz

Miller²,

Roayaie

et al. 2014

Dig Surg

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Aim: We hereby present and evaluate a technique for hepatic parenchymal transection based on the application of Metzenbaum scissors and clips during liver ischemia. Methods: Our technique was retrospectively evaluated in 32 noncirrhotic, noncholestatic patients with intrahepatic cholangiocarcinoma and 32 patients with hepatocellular carcinoma (23 of whom cirrhotic, 71.9%). Patient data were retrieved from our Hepatobiliary Surgery Database. Type and duration of vascular clamping, blood transfusion requirements, marginal status and immediate postoperative complications were analyzed. Results: Twenty-seven extended (>4 liver segments; 42.2%) and 37 nonextended (≤4 liver segments; 57.8%) liver resections were analyzed. Warm liver ischemia duration was 14 (interquartile range: 11-17.8) min. Thirty-three patients (51.6%) were transfused with a median of 2 (1.5-3) units of packed red blood cells. Tumor-free margins were achieved in 90.6% of cases (n = 58). The overall morbidity rate was 18.8% with a 4.7% mortality rate. Our technique allowed for excellent identification and safe dissection and preservation, or ligation of major liver vessels. Conclusions: The proposed technique is simple, fast, safe and with low cost. It is associated with limited postoperative complications while from an oncologic standpoint it enables the surgeon to achieve a high percentage of tumor-free margins while protecting major vascular structures. i 2014 S. Karger AG, Basel

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A Simplified Technique for Hepatic Resection

Cited by 123 publications

References 1 publication

A Worldwide Survey of the Current Daily Practice in Liver Surgery

A Worldwide Survey of the Current Daily Practice in Liver Surgery

Use of Bipolar Radiofrequency in Parenchymal Transection of the Liver, Pancreas and Kidney

Metzenbaum-Assisted Liver Resection: A Safe and Effective Liver Resection Technique

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