Skip to main content
SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

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.

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

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4
Fig. 5

Similar content being viewed by others

Abbreviations

HCC:

Hepatocellular carcinoma

LHIOA:

Laparoscopic hepatic inflow occlusion apparatus

References

  1. Smyrniotis V, Farantos C, Kostopanagiotou G, Arkadopoulos N (2005) Vascular control during hepatectomy: review of methods and results. World J Surg 29:1384–1396

    Article  PubMed  Google Scholar 

  2. Zhuo LW, Prasoon P, Wu H (2014) Role of vascular clamping in hepatic resection: a review. Hepato-gastroenterology 61:385–387

    PubMed  Google Scholar 

  3. Cadiere GB, Torres R, Dapri G, Capelluto E, Himpens J (2005) Multimedia article: laparoscopic left lateral hepatic lobectomy for metastatic colorectal tumor. Surg Endosc 19:152

    Article  PubMed  CAS  Google Scholar 

  4. Mise Y, Sakamoto Y, Ishizawa T, Kaneko J, Aoki T, Hasegawa K, Sugawara Y, Kokudo N (2013) A worldwide survey of the current daily practice in liver surgery. Liver Cancer 2:55–66

    Article  PubMed  PubMed Central  Google Scholar 

  5. Cherqui D, Husson E, Hammoud R, Malassagne B, Stephan F, Bensaid S, Rotman N, Fagniez PL (2000) Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg 232:753–762

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Abu Hilal M, Underwood T, Taylor MG, Hamdan K, Elberm H, Pearce NW (2010) Bleeding and hemostasis in laparoscopic liver surgery. Surg Endosc 24:572–577

    Article  PubMed  Google Scholar 

  7. Shiba H, Ishida Y, Wakiyama S, Iida T, Matsumoto M, Sakamoto T, Ito R, Gocho T, Furukawa K, Fujiwara Y, Hirohara S, Misawa T, Yanaga K (2009) Negative impact of blood transfusion on recurrence and prognosis of hepatocellular carcinoma after hepatic resection. J Gastrointest Surg 13:1636–1642

    Article  PubMed  Google Scholar 

  8. Romano F, Garancini M, Uggeri F, Degrate L, Nespoli L, Gianotti L, Nespoli A, Uggeri F (2012) Bleeding in hepatic surgery: sorting through methods to prevent it. HPB Surg. https://doi.org/10.1155/2012/169351

    Article  PubMed  PubMed Central  Google Scholar 

  9. Honda G, Kurata M, Okuda Y, Kobayashi S, Tadano S, Yamaguchi T, Matsumoto H, Nakano D, Takahashi K (2013) Totally laparoscopic hepatectomy exposing the major vessels. J Hepato-Biliary-Pancreat Sci 20:435–440

    Article  Google Scholar 

  10. Maehara S, Adachi E, Shimada M, Taketomi A, Shirabe K, Tanaka S, Maeda T, Ikeda K, Higashi H, Maehara Y (2007) Clinical usefulness of biliary scope for Pringle’s maneuver in laparoscopic hepatectomy. J Am Coll Surg 205:816–818

    Article  PubMed  Google Scholar 

  11. Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A, Matsumoto I (2009) Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc 23:906–908

    Article  PubMed  Google Scholar 

  12. Machado MA, Makdissi FF, Bacchella T, Machado MC (2005) Hemihepatic ischemia for laparoscopic liver resection. Surg Laparosc Endosc Percutaneous Tech 15:180–183

    Article  Google Scholar 

  13. Gigot JF, Glineur D, Santiago Azagra J, Goergen M, Ceuterick M, Morino M, Etienne J, Marescaux J, Mutter D, van Krunckelsven L, Descottes B, Valleix D, Lachachi F, Bertrand C, Mansvelt B, Hubens G, Saey JP, Schockmel R (2002) Laparoscopic liver resection for malignant liver tumors: preliminary results of a multicenter European study. Ann Surg 236:90–97

    Article  PubMed  PubMed Central  Google Scholar 

  14. Herman P, Perini MV, Coelho F, Saad W, D’Albuquerque LA (2010) Half-Pringle maneuver: a useful tool in laparoscopic liver resection. J Laparoendosc Adv Surg Tech Part A 20:35–37

    Article  Google Scholar 

  15. Komeda K, Hayashi M, Inoue Y, Shimizu T, Asakuma M, Hirokawa F, Miyamoto Y, Uchiyama K (2013) Clinical usefulness of endo intestinal clips during Pringle’s maneuver in laparoscopic liver resection: a technical report. Surg Laparosc Endosc Percutaneous Tech 23:e103–e105

    Google Scholar 

  16. Lee HJ, Box GN, Abraham JBA, Elchico ER, Panah RA, Taylor MB, Moskowitz R, Deane LA, McDougall EM, Clayman RV (2008) Laboratory evaluation of laparoscopic vascular clamps using a load-cell device—are all clamps the same? J Urol 180:1267–1272

    Article  PubMed  Google Scholar 

  17. Lee HJ, Box GN, Abraham JB, Elchico ER, Panah RA, Taylor MB, Moskowitz R, Deane LA, McDougall EM, Clayman RV (2008) Laboratory evaluation of laparoscopic vascular clamps using a load-cell device–are all clamps the same? J Urol 180:1267–1272

    Article  PubMed  Google Scholar 

  18. Scott DJ, Fleming JB, Watumull LM, Lindberg G, Tesfay ST, Jones DB (2002) The effect of hepatic inflow occlusion on laparoscopic radiofrequency ablation using simulated tumors. Surg Endosc 16:1286–1291

    Article  PubMed  CAS  Google Scholar 

  19. Dua MM, Worhunsky DJ, Hwa K, Poultsides GA, Norton JA, Visser BC (2015) Extracorporeal Pringle for laparoscopic liver resection. Surg Endosc 29:1348–1355

    Article  PubMed  Google Scholar 

  20. Zhang Y, Yang H, Deng X, Chen Y, Zhu S, Kai C (2016) Intermittent Pringle maneuver versus continuous hemihepatic vascular inflow occlusion using extra-glissonian approach in laparoscopic liver resection. Surg Endosc 30:961–970

    Article  PubMed  Google Scholar 

  21. Okuda Y, Honda G, Kurata M, Kobayashi S (2013) Useful and convenient procedure for intermittent vascular occlusion in laparoscopic hepatectomy. Asian J Endosc Surg 6:100–103

    Article  PubMed  Google Scholar 

  22. Yan CY, Cai XJ, Wang YF (2012) Effect of selective inflow occlusion on hemodynamic conditions during laparoscopic left hemihepatectomy effect of selective inflow occlusion on hemodynamic conditions during laparoscopic left hemihepatectomy. Hepato-gastroenterology 59:501–504

    PubMed  Google Scholar 

  23. Cho A, Yamamoto H, Kainuma O, Souda H, Ikeda A, Takiguchi N, Nagata M (2011) Safe and feasible extrahepatic Glissonean access in laparoscopic anatomical liver resection. Surg Endosc 25:1333–1336

    Article  PubMed  Google Scholar 

Download references

Acknowledgements

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

Funding

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

Author information

Author notes

  1. Yuanfei Peng, Zheng Wang and Xiaoying Wang have contributed equally to this work.

Authors and Affiliations

  1. Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, 180 FengLin Road, Shanghai, 200032, China

    Yuanfei Peng, Zheng Wang, Xiaoying Wang, Feiyu Chen, Jian Zhou, Jia Fan & Yinghong Shi

  2. Key Laboratory of Carcinogenesis and Cancer Invasion, Ministry of Education, Fudan University, Shanghai, China

    Yuanfei Peng, Zheng Wang, Xiaoying Wang, Feiyu Chen, Jian Zhou, Jia Fan & Yinghong Shi

Authors
  1. Yuanfei Peng
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Zheng Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Xiaoying Wang
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Feiyu Chen
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Jian Zhou
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Jia Fan
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Yinghong Shi
    View author publications

    You can also search for this author in PubMed Google Scholar

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.

Corresponding author

Correspondence to Yinghong Shi.

Ethics declarations

Disclosures

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

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (TIF 2592 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Peng, Y., Wang, Z., Wang, X. et al. A novel very simple laparoscopic hepatic inflow occlusion apparatus for laparoscopic liver surgery. Surg Endosc 33, 145–152 (2019). https://doi.org/10.1007/s00464-018-6285-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-018-6285-y

Keywords

Search

Navigation