Laparoscopic liver resection using a monopolar soft-coagulation device to provide maximum intraoperative bleeding control for the treatment of hepatocellular carcinoma



The popularity of laparoscopic liver resection (LLR) is spreading, worldwide, because the intraoperative blood loss is less than for open hepatectomy and it is associated with a shorter hospitalization period [1,2,3,4,5,6]. During LLR, intraoperative hemostasis is difficult to achieve, unlike during laparotomy where bleeding can be stopped instantly [7,8,9,10]. Our LLR method for the treatment of hepatocellular carcinoma (HCC) includes maximal control of intraoperative bleeding using a monopolar soft-coagulation device. Although we use a monopolar soft-coagulation device to control bleeding during LLR, while coagulating the thin blood vessels, we also developed a maneuver (the hepatocyte crush method: HeCM) to allow liver transection to progress while liver parenchymal cells are being crushed.


Between January 2008 and March 2016, we performed total LLR on 150 hepatocellular carcinoma patients (144 partial liver resections and six left lateral sectionectomies) using the maneuver shown in the video.


The patients had Child–Pugh Scores of grade A (n = 100), B (42), or C (n = 8) and the localizations of tumor were segment (S) 1(n = 7), S2 (19), S3 (23), S4 (28), S5 (17), S6 (26), S8 (17), and S8 (29). The median blood loss was 30 (range 0–490) g during a median surgical time of 207 (range 127–468) min. One patient required conversion to a laparotomy due to the presence of severe adhesions; none of the patients required conversion due to intraoperative hemorrhage. The peak aspartate aminotransferase (AST) level was 320 (range 57–1964) IU/L. Although some patients showed high AST levels, none showed signs of hepatic failure. The median postoperative hospital stay duration was 6 (range 3–21) days. Postoperative complications occurred in seven cases (4.7%), including intraabdominal abscesses (n = 2), wound infections (2), intraabdominal hemorrhage (1), bile duct stricture (1), and umbilical hernia (1). The mortality was zero.


HeCM, combined with the use of a monopolar soft-coagulation device, is a good technique for reducing bleeding during liver resection in patients with HCC.

This is a preview of subscription content, log in to check access.

Access options

Buy single article

Instant unlimited access to the full article PDF.

US$ 39.95

Price includes VAT for USA


  1. 1.

    GellerDA Tsung A (2015) Long term outcomes and safety of laparoscopic liver resection for HCC and metastatic liver cancer. J Hepatobiliary Pancreat Sci 22:728–730

  2. 2.

    Wakabayashi G, Cherqui D, Geller DA, Buell JF, Kaneko H, Han HS, Asbun H, O’Rourke N, Tanabe M, Koffron AJ, Tsung A, Soubrane O, Machado MA, Gayet B, Troisi RI, Pessaux P, Van Dam RM, Scatton O, Abu Hilal M, Belli G, Kwon CH, Edwin B, Choi GH, Aldrighetti LA, Cai X, Cleary S, Chen KH, Schön MR, Sugioka A, Tang CN, Herman P, Pekolj J, Chen XP, Dagher I, Jarnagin W, Yamamoto M, Strong R, Jagannath P, Lo CM, Clavien PA, Kokudo N, Barkun J, Strasberg SM (2015) Recommendations for laparoscopic liver resection: a report from the second international consensus conference held in Morioka. Ann Surg 261:619–622

  3. 3.

    Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63:643–645

  4. 4.

    Sposito C, Battiston C, Facciorusso A, Mazzola M, Muscarà C, Scotti M, Romito R, Mariani L, Mazzaferro V (2016) Propensity score analysis of outcomes following laparoscopic or open liver resection for hepatocellular carcinoma. Br J Surg 103:871–880

  5. 5.

    Takahara T, Wakabayashi G, Konno H, Gotoh M, Yamaue H, Yanaga K, Fujimoto J, Kaneko H, Unno M, Endo I, Seto Y, Miyata H, Miyazaki M, Yamamoto M (2016) Comparison of laparoscopic major hepatectomy with propensity score matched open cases from the National Clinical Database in Japan. J Hepatobiliary Pancreat Sci 23:721–734

  6. 6.

    Ciria R, Cherqui D, Geller D, Briceno J, Wakabayashi G (2016) Comparative short term benefits of laparoscopic liver resection: 9000 cases and climbing. Ann Surg 263:761–777

  7. 7.

    Nguyen KT, Gamblin TC, Geller DA (2009) World review of laparoscopic liver resection-2804 patients. Ann Surg 250:831–841

  8. 8.

    Belli G, Fantini C, Belli A, Limongelli P (2011) Laparoscopic liver resection for hepatocellular carcinoma in cirrhosis: long-term outcomes. Dig Surg 28:134–140

  9. 9.

    Pai M, Frampton AE, Mikhail S, Resende V, Kornasiewicz O, Spalding DR, Jiao LR, Habib NA (2012) Radiofrequency assisted liver resection: analysis of 604 consecutive cases. Eur J Surg Oncol 38:274–280

  10. 10.

    Piardi T, Sommacale D, Baumert T, Mutter D, Marescaux J, Pessaux P (2014) Laparoscopic resection for hepatocellular carcinoma: comparison between Middle Eastern and Western experience. Hepatobiliary Surg Nutr 3:60–72

Download references

Author information

Correspondence to Mitsuo Miyazawa.

Ethics declarations


Drs. Mitsuo Miyazawa, Masayasu Aikawa, Katsuya Okada, Yukihiro Watanabe, Kojun Okamoto and Isamu Koyama have no conflicts of interest or financial ties to disclose.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (MP4 250194 kb)

Supplementary material 1 (MP4 250194 kb)

Rights and permissions

Reprints and Permissions

About this article

Verify currency and authenticity via CrossMark

Cite this article

Miyazawa, M., Aikawa, M., Okada, K. et al. Laparoscopic liver resection using a monopolar soft-coagulation device to provide maximum intraoperative bleeding control for the treatment of hepatocellular carcinoma. Surg Endosc 32, 2157–2158 (2018).

Download citation


  • Laparoscopic liver resection
  • Liver transection method
  • Intraoperative bleeding
  • Monopolar soft-coagulation device