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3D vision and maintenance of stable pneumoperitoneum: a new step in the development of laparoscopic right hepatectomy

Surgical Endoscopy volume 32, pages 3706–3712 (2018)Cite this article

Abstract

Background

Although laparoscopic liver resection is widely performed, many technical difficulties remain, such as accurate isolation/division of hepatic vessels in laparoscopic right hepatectomy (LRH). Innovative surgical devices, such as three-dimensional (3D) laparoscopy and optimized carbon dioxide (CO2) insufflation system, may help to overcome technical difficulties in LRH. The purpose of this study was to analyze the efficacy of 3D vision associated with active pneumoperitoneum maintenance in LRH.

Methods

In our prospectively maintained database from 2006, 75 consecutive LRH from May 2011 to June 2017 were included in this study. All LRH were performed with 2D vision and standard CO2 insufflator (2D-LRH group, 45 cases) or 3D vision with optimized CO2 insufflator (3D-LRH group, 30 cases). Preoperative clinical characteristics, surgical data including operation time of separate steps within the procedure, and postoperative complications were compared between the two groups.

Results

Clinical and pathological factors were comparable between two groups. Total operative time was significantly shorter in 3D-LRH group than in 2D-LRH (360 vs 390 min, P = 0.029). Right hepatic pedicle dissection time was significantly shorter in 3D-LRH group (101 vs 123 min, P = 0.003). Liver parenchyma transection time was also shorter in 3D-LRH group (138 vs 151 min, P = 0.089), although not significant. There was no significant difference in liver mobilization time, intraoperative bleeding/transfusion, and postoperative complications.

Conclusions

3D vision with maintenance of pneumoperitoneum facilitates hepatic vascular isolation/division, and may contribute to the development of LRH.

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Authors and Affiliations

  1. Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpétrière Hospital, Sorbonne University, UMRS-938, Paris, France

    Takayuki Kawai, Claire Goumard, Florence Jeune & Olivier Scatton

  2. Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan

    Shohei Komatsu

  3. Department of Hepatobiliary Surgery and Liver Transplantation, Beaujon Hospital, University Paris VII Denis Diderot, Paris, France

    Olivier Soubrane

Authors
  1. Takayuki Kawai
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  2. Claire Goumard
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  3. Florence Jeune
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  4. Shohei Komatsu
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  5. Olivier Soubrane
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  6. Olivier Scatton
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Correspondence to Olivier Scatton.

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Disclosures

Takayuki Kawai, Claire Goumard, Florence Jeune, Shohei Komatsu, Olivier Soubrane, and Olivier Scatton have no conflicts of interest or financial ties to disclose.

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Kawai, T., Goumard, C., Jeune, F. et al. 3D vision and maintenance of stable pneumoperitoneum: a new step in the development of laparoscopic right hepatectomy. Surg Endosc 32, 3706–3712 (2018). https://doi.org/10.1007/s00464-018-6205-1

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  • DOI: https://doi.org/10.1007/s00464-018-6205-1

Keywords

  • Laparoscopic right hepatectomy
  • 3D vision
  • Pneumoperitoneum maintenance
  • Operative time