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Is Intraoperative Blood Loss Underestimated in Patients Undergoing Laparoscopic Hepatectomy?

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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.

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Authors and Affiliations

  1. Department of Surgery, Toyonaka Municipal Hospital, 4-14-1 Shibahara, Toyonaka, Osaka, 560-8565, Japan

    Yoshito Tomimaru, Kozo Noguchi, Shunji Morita, Hiroshi Imamura, Takashi Iwazawa & Keizo Dono

Authors
  1. Yoshito Tomimaru
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  2. Kozo Noguchi
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  3. Shunji Morita
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  4. Hiroshi Imamura
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  5. Takashi Iwazawa
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  6. Keizo Dono
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Corresponding author

Correspondence to Yoshito Tomimaru.

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The authors declare that they have no conflict of interest.

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Tomimaru, Y., Noguchi, K., Morita, S. et al. Is Intraoperative Blood Loss Underestimated in Patients Undergoing Laparoscopic Hepatectomy?. World J Surg 42, 3685–3691 (2018). https://doi.org/10.1007/s00268-018-4655-1

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  • DOI: https://doi.org/10.1007/s00268-018-4655-1

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