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World Journal of Surgery

, Volume 42, Issue 11, pp 3685–3691 | Cite as

Is Intraoperative Blood Loss Underestimated in Patients Undergoing Laparoscopic Hepatectomy?

  • Yoshito Tomimaru
  • Kozo Noguchi
  • Shunji Morita
  • Hiroshi Imamura
  • Takashi Iwazawa
  • Keizo Dono
Original Scientific Report
  • 95 Downloads

Abstract

Background

Less intraoperative blood loss is frequently reported as an advantage of laparoscopic hepatectomy (LH) over open hepatectomy (OH). However, the small work space during laparoscopic surgery could lead to insufficient blood suction from the abdominal cavity, with possible underestimation of intraoperative blood loss. This study compared estimated blood loss (E-BL) with intraoperatively counted blood loss (IC-BL) in patients undergoing LH.

Methods

This study included 110 consecutive patients undergoing partial hepatectomy for solitary liver tumors (59 had OH and 51 had LH). IC-BL and E-BL were determined, and the difference between them was calculated based on the surgical approach. Factors affecting the difference were investigated. IC-BL was quantified from the suction fluid volume and weight of surgical gauzes used for blood and fluid collection. E-BL was calculated with the total blood volume and change in hematocrit.

Results

Although there were no significant differences between IC-BL and E-BL in the OH group (292 ± 198 vs. 259 ± 167 mL, p = 0.1239), E-BL was significantly greater than IC-BL in the LH group (273 ± 166 vs. 128 ± 177 mL, p < 0.0001). Percentage of patients with E-BL > IC-BL in the LH group was significantly greater than in the OH group (86.3 vs. 42.4%, p < 0.0001). The surgical approach (OH/LH) was the only significant independent factor determining E-BL > IC-BL status.

Conclusions

E-BL was significantly greater than IC-BL only in patients undergoing LH, and the surgical approach (OH/LH) was the only factor affecting E-BL > IC-BL status. These results suggest that intraoperative blood loss may be underestimated during LH.

Notes

Compliance with ethical standards

Conflict of interest

The authors declare that they have no conflict of interest.

References

  1. 1.
    Komorowski AL, Mitus JW, Wysocki WM et al (2017) Laparoscopic and open liver resection—a literature review with meta-analysis. Arch Med Sci 13(525–53):2Google Scholar
  2. 2.
    Morise Z, Wakabayashi G (2017) First quarter century of laparoscopic liver resection. World J Gastroenterol 23(3581–358):8Google Scholar
  3. 3.
    Vigano L, Laurent A, Tayar C et al (2009) The learning curve in laparoscopic liver resection: improved feasibility and reproducibility. Ann Surg 250(772–78):2Google Scholar
  4. 4.
    Kaneko H, Otsuka Y, Kubota Y et al (2017) Evolution and revolution of laparoscopic liver resection in Japan. Ann Gastroenterol Surg 1(33–4):3Google Scholar
  5. 5.
    Colvin H, Mizushima T, Eguchi H et al (2017) Gastroenterological surgery in Japan: the past, the present and the future. Ann Gastroenterol Surg 1:5–10CrossRefGoogle Scholar
  6. 6.
    Takahara T, Wakabayashi G, Beppu T et al (2015) Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. J Hepato-Biliary-Pancreat Sci 22(721–72):7Google Scholar
  7. 7.
    Takahara T, Wakabayashi G, Konno H et al (2016) Comparison of laparoscopic major hepatectomy with propensity score matched open cases from the National Clinical Database in Japan. J Hepato-Biliary-Pancreat Sci 23(721–73):4Google Scholar
  8. 8.
    Kobayashi S, Fukui K, Takeda Y et al (2018) Short-term outcomes of open liver resection and laparoscopic liver resection: secondary analysis of data from a multicenter prospective study (CSGO-HBP-004). Ann Gastroenterol Surg 2:87–94CrossRefGoogle Scholar
  9. 9.
    Gross JB (1983) Estimating allowable blood loss: corrected for dilution. Anesthesiology 58:277–280CrossRefGoogle Scholar
  10. 10.
    Nadler SB, Hidalgo JH, Bloch T (1962) Prediction of blood volume in normal human adults. Surgery 51(224–23):2Google Scholar
  11. 11.
    Sehat KR, Evans R, Newman JH (2000) How much blood is really lost in total knee arthroplasty? Correct blood loss management should take hidden loss into account. Knee 7:151–155CrossRefGoogle Scholar
  12. 12.
    Sehat KR, Evans RL, Newman JH (2004) Hidden blood loss following hip and knee arthroplasty. Correct management of blood loss should take hidden loss into account. J Bone Joint Surg 86:561–565CrossRefGoogle Scholar
  13. 13.
    Zhang C, Fan HW, Yi WW et al (2017) Hidden blood loss and its influential factors after laparoscopy-assisted gastrectomy for gastric cancer. J Laparoendosc Adv Surg Tech A 28:237–241CrossRefGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2018

Authors and Affiliations

  • Yoshito Tomimaru
    • 1
  • Kozo Noguchi
    • 1
  • Shunji Morita
    • 1
  • Hiroshi Imamura
    • 1
  • Takashi Iwazawa
    • 1
  • Keizo Dono
    • 1
  1. 1.Department of SurgeryToyonaka Municipal HospitalToyonakaJapan

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