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Surgical Endoscopy

, Volume 33, Issue 1, pp 145–152 | Cite as

A novel very simple laparoscopic hepatic inflow occlusion apparatus for laparoscopic liver surgery

  • Yuanfei Peng
  • Zheng Wang
  • Xiaoying Wang
  • Feiyu Chen
  • Jian Zhou
  • Jia Fan
  • Yinghong ShiEmail author
Article
  • 192 Downloads

Abstract

Background

Control of bleeding is extremely important for laparoscopic liver resection. We introduce a new and operationally simple laparoscopic hepatic inflow occlusion apparatus (LHIOA) and its successful application in laparoscopic surgery for patients with cirrhosis.

Methods

The self-designed LHIOA was constructed using a tracheal catheter (7.5#) and infusion set. The tracheal catheter and infusion set were trimmed to 30 and 70 cm, to serve as an occlusion tube and occlusion tape, respectively. After establishment of pneumoperitoneum, the occlusion tape was inserted to encircle the hepatoduodenal ligament. The occlusion tube was then introduced and the ends of the occlusion tape were pulled out of it to occlude the hepatic inflow. Under intermittent vascular occlusion with the LHIOA, the liver parenchyma was transected using an ultrasonic scalpel and monopolar electrocoagulation. Outcomes of the application of the LHIOA in hepatocellular carcinoma patients with cirrhosis (LHIOA group, n = 46) were compared with patients undergoing laparoscopic hepatectomy without LHIOA (non-LHIOA group, n = 46), using one-to-one propensity case-matched analysis.

Results

The LHIOA effectively occluded the hepatic inflow while showing no damage to the hepatoduodenal ligament. The time required for presetting the LHIOA is 6.8 ± 0.6 min. The conversion rate in the non-LHIOA group was 13.0% while there was no conversion in the occlusion group (P < 0.001). The median blood loss of patients in the LHIOA group (60 ml, range 50–200 ml) was significantly less than that of patients in the non-LHIOA group (250 ml, range 100–800) (P < 0.001). Transfusion was required in 8 patients in the non-LHIOA group while no transfusion was required in the LHIOA group. The median operative time in the LHIOA group (157 min, range 80–217 min) was significantly shorter than that in the non-LHIOA group (204 min, range 105–278 min) (P < 0.001).

Conclusions

The new LHIOA is effective, safe, and simple. It can significantly reduce conversion rate, blood loss, and operative time. It facilitates laparoscopic liver resection and is recommended for use.

Keywords

Laparoscopy Liver surgery Hepatic inflow occlusion Cirrhosis Hepatocellular carcinoma Propensity case-matched analysis 

Abbreviations

HCC

Hepatocellular carcinoma

LHIOA

Laparoscopic hepatic inflow occlusion apparatus

Notes

Acknowledgements

We thank David Duchenne, Jenny Xu, Susan Zhao, and Hua Young for editorial assistance and language improvement.

Author contributions

YP, YS: Study concept and design; YP, FC: acquisition of data; YP, FC, ZW, YS: analysis and interpretation of data; YP: drafting of the manuscript; YS: critical revision of the manuscript for important intellectual content; YP, ZW: statistical analysis; YP, YS: obtained funding; JZ, JF: administrative, technical, or material support; and JF: study supervision.

Funding

This work was supported by the grants from National Natural Science Foundation of China (No. 81572296) and Zhongshan Science & Technology Innovation Fund (2015).

Compliance with ethical standards

Disclosures

Yuanfei Peng, Zheng Wang, Xiaoying Wang, Feiyu Chen, Jian Zhou, Jia Fan, and Yinghong Shi declare no conflict of interest.

Supplementary material

464_2018_6285_MOESM1_ESM.tif (2.5 mb)
Supplementary material 1 (TIF 2592 KB)

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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  1. 1.Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan HospitalFudan UniversityShanghaiChina
  2. 2.Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of EducationFudan UniversityShanghaiChina

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