Surgery strategy of 13 cases to control bleeding from the liver on laparoscopic repeat liver resection for recurrent hepatocellular carcinoma

Objective: To investigate the effect of propofol on the expression and phosphorylation of the skeletal muscle insulin receptor and its substrates following hepatic ischemia-reperfusion injury (HIRI). Methods: Sixty healthy Wistar rats were divided randomly into a propofol group (P) and an ischemia-reperfusion group (I/R). Rats in the P group received propofol infusion prior to ischemia and during a 120-minute post-reperfusion period. Plasma glucose and insulin concentrations were measured, as well as expression levels of the insulin signaling proteins insulin receptor (IR) b unit (IRb) and IR substrate 1 (IRS-1). In addition, tyrosine phosphorylation levels of these proteins were measured in skeletal muscle. Results: Plasma glucose levels in the two groups were higher at 2 hours after reperfusion (T2) versus exposure of the hepatic hilum (T1). Plasma glucose levels in the I/R group were higher than those in the P group, while insulin levels at T2 were lower. In addition, phosphotyrosine levels of IRb and IRS-1 were decreased by 32.1% and 22.4%, respectively. Conclusion: Propofol increased phosphotyrosine levels of IRb and IRS-2, resulting in an alleviation of increased plasma glucose levels following HIRI.

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Intermittent superior mesenteric artery occlusion for en bloc resection of the uncinate process during laparoscopic pancreaticoduodenectomy: A novel technique

Jiang

Bai

Liu

et al. 2022

Preprint

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Background: En bloc resection of the uncinate process of the pancreas represents the most important yet difficult step in laparoscopic pancreaticoduodenectomy (LPD), given the risk of major intraoperative bleeding which often necessitates the conversion to open surgery. We therefore developed the intermittent superior mesenteric artery occlusion (ISMAO) technique as a means of blood flow control during uncinate process resection, and investigated its role in LPD. Methods: Consecutive patients who underwent LPD at the Department of Biliary and Pancreatic Surgery, Sun Yat-sen Memorial Hospital between August 2020 and May 2022 were enrolled. Patients were divided into 2 groups, the ISMAO and non-ISMO group. Parameters such as operation time, intraoperative blood loss volume, conversion rate to open surgery, R0 resection rate, bowel function recovery time, postoperative hospital stay length, and rate of postoperative complications (including pancreatic fistula, delayed gastric emptying, and postoperative bleeding) were compared. Results: A total of 51 patients were included, of whom 22 (43.1%) underwent ISMAO. Significantly shorter mean operation time was observed in the ISMAOgroup compared to the non-ISMAO group (349.8 ± 84.9 min vs. 533.5 ± 105.9 min; P < 0.001). In addition, ISMAO associated with significantly lower intraoperative blood loss volume [112.5 (87.5-200.0) mL vs. 400.0 (250.0-600.0) mL; P < 0.001], and significantly lower conversion rate to open surgery (4.54% vs. 26.0%; P = 0.0485). R0 resection rate in the ISMAO group was significantly higher (95.5% vs. 79.3%; P = 0.0485). No significant differences were observed in postoperative hospital stay length, bowel function recovery time, and postoperative complication rate between the groups. Conclusions: ISMAO represents a novel blood flow control technique for en bloc resection of the uncinate process. Our study demonstrated its role in improving surgical safety and reducing intraoperative bleeding, and suggests its potential as a standard surgical procedure in LPD.

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Surgery strategy of 13 cases to control bleeding from the liver on laparoscopic repeat liver resection for recurrent hepatocellular carcinoma

Abstract: It can improve the safety and feasibility of LRLR for rHCC, according to the degree of adhesion of the peritoneal adhesions and the first hepatic portal, then selecting the appropriate technique to control the bleeding of the hepatectomy.

Cited by 5 publications

References 20 publications

Short-term outcomes of laparoscopic repeat liver resection after open liver resection: a systematic review

Short-term outcomes of laparoscopic repeat liver resection after open liver resection: a systematic review

Effect of propofol on the skeletal muscle insulin receptor in rats with hepatic ischemia-reperfusion injury

Intermittent superior mesenteric artery occlusion for en bloc resection of the uncinate process during laparoscopic pancreaticoduodenectomy: A novel technique

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