Advertisement

Surgical Endoscopy

, Volume 29, Issue 2, pp 387–397 | Cite as

Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases

  • Sung Hoon Choi
  • Gi Hong ChoiEmail author
  • Dai Hoon Han
  • Jin Sub Choi
Article

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.

Keywords

Laparoscopy Liver resection Hepatectomy Learning curve 

Notes

Acknowledgments

The authors would like to thank to Dong-Su Jang, (Medical Illustrator, Medical Research Support Section, Yonsei University College of Medicine, Seoul, Korea) for his help with the figures.

Disclosure

Drs. Sung Hoon Choi, Gi Hong Choi, Dae Hoon Han and Jin Sub Choi have no conflicts of interest or financial ties to disclose.

References

  1. 1.
    Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762PubMedCentralPubMedCrossRefGoogle Scholar
  2. 2.
    Dagher I, Proske JM, Carloni A, Richa H, Tranchart H, Franco D (2007) Laparoscopic liver resection: results for 70 patients. Surg Endosc 21:619–624PubMedCrossRefGoogle Scholar
  3. 3.
    Hwang DW, Han HS, Yoon YS, Cho JY, Kwon Y, Kim JH, Park JS, Yoon DS, Choi IS, Ahn KS, Kim YH, Kang KJ, Kim YH, Roh YH, Chu CW, Kim HC, Kang CM, Choi GH, Choi JS, Kim KS, Lee WJ, Yun SS, Kim HJ, Min SK, Lee HK, Song IS, Chun KS, Cho EH, Han SS, Park SJ (2013) Laparoscopic major liver resection in Korea: a multicenter study. J Hepato-Biliary-Pancreat Sci 20:125–130CrossRefGoogle Scholar
  4. 4.
    Ito K, Ito H, Are C, Allen PJ, Fong Y, DeMatteo RP, Jarnagin WR, D’Angelica MI (2009) Laparoscopic versus open liver resection: a matched-pair case control study. J Gastrointest Surg 13:2276–2283PubMedCrossRefGoogle Scholar
  5. 5.
    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2,804 patients. Ann Surg 250:831–841PubMedCrossRefGoogle Scholar
  6. 6.
    Buell JF, Cherqui D, Geller DA, O’Rourke N, Iannitti D, Dagher I, Koffron AJ, Thomas M, Gayet B, Han HS, Wakabayashi G, Belli G, Kaneko H, Ker CG, Scatton O, Laurent A, Abdalla EK, Chaudhury P, Dutson E, Gamblin C, D’Angelica M, Nagorney D, Testa G, Labow D, Manas D, Poon RT, Nelson H, Martin R, Clary B, Pinson WC, Martinie J, Vauthey JN, Goldstein R, Roayaie S, Barlet D, Espat J, Abecassis M, Rees M, Fong Y, McMasters KM, Broelsch C, Busuttil R, Belghiti J, Strasberg S, Chari RS, World Consensus Conference on Laparoscopic S (2009) The international position on laparoscopic liver surgery: The Louisville Statement, 2008. Ann Surg 250:825–830PubMedCrossRefGoogle Scholar
  7. 7.
    Vigano L, Tayar C, Laurent A, Cherqui D (2009) Laparoscopic liver resection: a systematic review. J Hepato-Biliary-Pancreatic Surg 16:410–421CrossRefGoogle Scholar
  8. 8.
    Cuschieri A (2001) Laparoscopic hand-assisted hepatic surgery. Semin Laparosc Surg 8:104–113PubMedCrossRefGoogle Scholar
  9. 9.
    O’Rourke N, Fielding G (2004) Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg 8:213–216PubMedCrossRefGoogle Scholar
  10. 10.
    Koffron AJ, Kung RD, Auffenberg GB, Abecassis MM (2007) Laparoscopic liver surgery for everyone: the hybrid method. Surgery 142:463–468; discussion 468 e461–462PubMedCrossRefGoogle Scholar
  11. 11.
    Cho JY, Han HS, Yoon YS, Shin SH (2008) Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location. Surgery 144:32–38PubMedCrossRefGoogle Scholar
  12. 12.
    Yoon YS, Han HS, Cho JY, Ahn KS (2010) Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 24:1630–1637PubMedCrossRefGoogle Scholar
  13. 13.
    Kazaryan AM, Rosok BI, Marangos IP, Rosseland AR, Edwin B (2011) Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 25:3881–3889PubMedCentralPubMedCrossRefGoogle Scholar
  14. 14.
    Yoon YS, Han HS, Cho JY, Kim JH, Kwon Y (2013) Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery 153:502–509PubMedCrossRefGoogle Scholar
  15. 15.
    Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213PubMedCentralPubMedCrossRefGoogle Scholar
  16. 16.
    Strasberg SM, Linehan DC, Hawkins WG (2009) The accordion severity grading system of surgical complications. Ann Surg 250:177–186PubMedCrossRefGoogle Scholar
  17. 17.
    Choi SH, Choi GH, Han DH, Choi JS, Lee WJ (2013) Clinical feasibility of inferior right hepatic vein-preserving trisegmentectomy 5, 7, and 8 (with video). J Gastrointest Surg 17:1153–1160PubMedCrossRefGoogle Scholar
  18. 18.
    Choi GH, Choi SH, Kim SH, Hwang HK, Kang CM, Choi JS, Lee WJ (2012) Robotic liver resection: technique and results of 30 consecutive procedures. Surg Endosc 26:2247–2258PubMedCrossRefGoogle Scholar
  19. 19.
    Dincler S, Koller MT, Steurer J, Bachmann LM, Christen D, Buchmann P (2003) Multidimensional analysis of learning curves in laparoscopic sigmoid resection: eight-year results. Dis Colon Rectum 46:1371–1378; discussion 1378–1379PubMedCrossRefGoogle Scholar
  20. 20.
    Buchmann P, Dincler S (2005) Learning curve–calculation and value in laparoscopic surgery. Therapeutische Umschau Revue therapeutique 62:69–75PubMedCrossRefGoogle Scholar
  21. 21.
    Hasegawa Y, Nitta H, Sasaki A, Takahara T, Ito N, Fujita T, Kanno S, Nishizuka S, Wakabayashi G (2013) Laparoscopic left lateral sectionectomy as a training procedure for surgeons learning laparoscopic hepatectomy. J Hepato-Biliary-Pancreat Sci 20:525–530CrossRefGoogle Scholar
  22. 22.
    Crothers IR, Gallagher AG, McClure N, James DT, McGuigan J (1999) Experienced laparoscopic surgeons are automated to the “fulcrum effect”: an ergonomic demonstration. Endoscopy 31:365–369PubMedCrossRefGoogle Scholar
  23. 23.
    Vigano L, Laurent A, Tayar C, Tomatis M, Ponti A, Cherqui D (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250:772–782PubMedCrossRefGoogle Scholar
  24. 24.
    Dagher I, Di Giuro G, Dubrez J, Lainas P, Smadja C, Franco D (2009) Laparoscopic versus open right hepatectomy: a comparative study. Am J Surg 198:173–177PubMedCrossRefGoogle Scholar
  25. 25.
    Dagher I, O’Rourke N, Geller DA, Cherqui D, Belli G, Gamblin TC, Lainas P, Laurent A, Nguyen KT, Marvin MR, Thomas M, Ravindra K, Fielding G, Franco D, Buell JF (2009) Laparoscopic major hepatectomy: an evolution in standard of care. Ann Surg 250:856–860PubMedCrossRefGoogle Scholar
  26. 26.
    Martin RC, Scoggins CR, McMasters KM (2010) Laparoscopic hepatic lobectomy: advantages of a minimally invasive approach. J Am Coll Surg 210:627–634, 634–626PubMedCrossRefGoogle Scholar
  27. 27.
    Fong Y, Jarnagin W, Conlon KC, DeMatteo R, Dougherty E, Blumgart LH (2000) Hand-assisted laparoscopic liver resection: lessons from an initial experience. Arch Surg 135:854–859PubMedCrossRefGoogle Scholar
  28. 28.
    Teramoto K, Kawamura T, Takamatsu S, Noguchi N, Nakamura N, Arii S (2003) Laparoscopic and thoracoscopic partial hepatectomy for hepatocellular carcinoma. World J Surg 27:1131–1136PubMedCrossRefGoogle Scholar
  29. 29.
    Chang S, Laurent A, Tayar C, Karoui M, Cherqui D (2007) Laparoscopy as a routine approach for left lateral sectionectomy. Br J Surg 94:58–63PubMedCrossRefGoogle Scholar
  30. 30.
    Honda G, Kurata M, Okuda Y, Kobayashi S, Tadano S, Yamaguchi T, Matsumoto H, Nakano D, Takahashi K (2013) Totally laparoscopic hepatectomy exposing the major vessels. J Hepato-Biliary-Pancreat Sci 20:435–440CrossRefGoogle Scholar
  31. 31.
    Kim J, Ahmad SA, Lowy AM, Buell JF, Pennington LJ, Soldano DA, James LE, Matthews JB, Hanto DW (2003) Increased biliary fistulas after liver resection with the harmonic scalpel. Am Surg 69:815–819PubMedGoogle Scholar
  32. 32.
    Abu Hilal M, Pearce NW (2008) Laparoscopic left lateral liver sectionectomy: a safe, efficient, reproducible technique. Dig Surg 25:305–308PubMedCrossRefGoogle Scholar
  33. 33.
    Bryant R, Laurent A, Tayar C, Cherqui D (2009) Laparoscopic liver resection-understanding its role in current practice: the Henri Mondor Hospital experience. Ann Surg 250:103–111PubMedCrossRefGoogle Scholar

Copyright information

© Springer Science+Business Media New York 2014

Authors and Affiliations

  • Sung Hoon Choi
    • 1
  • Gi Hong Choi
    • 2
    Email author
  • Dai Hoon Han
    • 2
  • Jin Sub Choi
    • 2
  1. 1.Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical CenterCHA UniversitySeongnamKorea
  2. 2.Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University Health SystemYonsei University College of MedicineSeoulKorea

Personalised recommendations