Technical Refinement of Laparoscopic Hepatectomy in Porcine Model_CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Authors：

WANG Hongguang , ZHANG Xuan , DONG Jiahong

Hospital &;
Institute of Hepatobiliary Surgery, Chinese PLA General Hospital, Beijing 100853, China;

Corresponding author：

Keywords：

Laparoscopy; Hepatectomy; Technical refinement; Animal model; Portal inflow occlusion; Hepatic parenchymal transection

Video：

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Objective To refine the technique of portal inflow occlusion and parenchymal transection for laparoscopic hepatectomy in the porcine model. Methods Ten pigs were used. The portal inflow complete or selective occlusion was carried out with portal triad clamping or dissection and division of the left portal pedicle. The sequential laparoscopic local hepatectomy, left lateral lobectomy, and left medial lobectomy were performed without portal inflow occlusion. Parenchymal transection was performed with harmonic scalpel, LigaSure, microwave dissector, bipolar electrocautery, surgical clips, and endoscopic stapler. The efficacy and safety of different techniques in laparoscopic parenchymal transection of the liver were compared. Results The ischemic liver was darken with complete or selective portal triad clamping. The ischemic demarcation line between left and right lobe was obvious with the dissection and division of the left portal pedicle. There was an applicable scope of each hepatic parenchymal transection apparatus. The optimal combination of different techniques could increase efficacy and reduce hemorrhage in laparoscopic parenchymal transection of the liver. Conclusion Technical refinements of portal inflow occlusion and parenchymal transection in porcine models could provide evidences to clinical appliance of laparoscopic anatomic major hepatectomy.

Citation： WANG Hongguang,ZHANG Xuan,DONG Jiahong. Technical Refinement of Laparoscopic Hepatectomy in Porcine Model. CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY, 2010, 17(6): 538-542. doi: Copy

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11.	Bismuth H. Surgical anatomy and anatomical surgery of the liver [J]. World J Surg, 1982; 6(1): 3-9.
12.	蔡秀军, 王一帆, 梁霄, 等. 区域性血流阻断技术在腹腔镜肝切除术中的应用 [J]. 中华外科杂志, 2006; 44(19): 1307-1309.
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14.	孙学军, 卢乐, 石景森. 肝胆管结石的微创外科治疗进展 [J]. 中国普外基础与临床杂志, 2006; 13(4): 403-405.
15.	文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展 [J]. 中国普外基础与临床杂志, 2008; 15(4): 299-302.
16.	Machado MA, Makdissi FF, Bacchella T, et al. Hemihepatic ischemia for laparoscopic liver resection [J]. Surg Laparosc Endosc Percutan Tech, 2005; 15(3): 180-183.
17.	Gayet B, Cavaliere D, Vibert E, et al. Totally laparoscopic right hepatectomy [J]. Am J Surg, 2007; 194(5): 685-689.
18.	胡明根, 刘荣, 董家鸿, 等. 腹腔镜肝切除的研究进展 [J]. 腹腔镜外科杂志, 2007; 12(2): 174-177.
19.	Toyama Y, Miyake R, Son K, et al. Three-Port laparoscopic partial hepatectomy using an ultrasonically activated device (USAD) [J]. J Hepatobiliary Pancreat Surg, 2006; 13(4): 317-322.
20.	Campagnacci R, De Sanctis A, Baldarelli M, et al. Hepatic resections by means of electrothermal bipolar vessel device (EBVS) LigaSure V: early experience [J]. Surg Endosc, 2007; 21(12): 2280-2284.
21.	Jersenius U, Fors D, Rubertsson S, et al. Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques [J]. Surg Endosc, 2007; 21(2): 315-320.
22.	Imura S, Ikegami T, Morine Y, et al. Advanced application of a vessel sealing system for major hepatic resections [J]. Surg Endosc, 2008; 22(1): 273-274.
23.	Gumbs AA, Bar-Zakai B, Gayet B. Totally laparoscopic extended left hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1152.
24.	Gumbs AA, Gayet B. Multimedia article. Totally laparoscopic extended right hepatectomy [J]. Surg Endosc, 2008; 22(9): 2076-2077.
25.	Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1153.
26.	Saidi RF, Ahad A, Escobar R, et al. Comparison between staple and vessel sealing device for parynchemal transection in laparoscopic liver surgery in a swine model [J]. HPB (Oxford), 2007; 9(6): 440-443.

1. Reich H, McGlynn F, DeCaprio J, et al. Laparoscopic excision of benign liver lesions [J]. Obstet Gynecol, 1991; 78(5 Pt 2): 956-958.
2. Koffron AJ, Auffenberg G, Kung R, et al. Evaluation of 300 minimally invasive liver resections at a single institution: less is more [J]. Ann Surg, 2007; 246(3): 385-392; discussion 392-394.
3. Buell JF, Koffron AJ, Thomas MJ, et al. Laparoscopic liver resection [J]. J Am Coll Surg, 2005; 200(3): 472-480.
4. Vibert E, Perniceni T, Levard H, et al. Laparoscopic liver resection [J]. Br J Surg, 2006; 93(1): 67-72.
5. Cherqui D. Laparoscopic liver resection [J]. Br J Surg, 2003; 90(6): 644-646.
6. Dagher I, O’Rourke N, Geller DA, et al. Laparoscopic major hepatectomy: an evolution in standard of care [J]. Ann Surg, 2009; 250(5): 856-860.
7. Nguyen KT, Gamblin TC, Geller DA. World review of laparoscopic liver resection-2,804 patients [J]. Ann Surg, 2009; 250(5): 831-841.
8. Laurence JM, Lam VW, Langcake ME, et al. Laparoscopic hepatectomy, a systematic review [J]. ANZ J Surg, 2007; 77(11): 948-953.
9. Delva E, Camus Y, Nordlinger B, et al. Vascular occlusions for liver resections. Operative management and tolerance to hepatic ischemia: 142 cases [J]. Ann Surg, 1989; 209(2): 211-218.
10. 王志伟, 黄宇琦, 李朝龙. 肝脏缺血再灌注损伤 [J]. 中国普外基础与临床杂志, 1998; 5(4): 253-254.
11. Bismuth H. Surgical anatomy and anatomical surgery of the liver [J]. World J Surg, 1982; 6(1): 3-9.
12. 蔡秀军, 王一帆, 梁霄, 等. 区域性血流阻断技术在腹腔镜肝切除术中的应用 [J]. 中华外科杂志, 2006; 44(19): 1307-1309.
13. Smyrniotis V, Farantos C, Kostopanagiotou G, et al. Vascular control during hepatectomy: review of methods and results [J]. World J Surg, 2005; 29(11): 1384-1396.
14. 孙学军, 卢乐, 石景森. 肝胆管结石的微创外科治疗进展 [J]. 中国普外基础与临床杂志, 2006; 13(4): 403-405.
15. 文天夫, 严律南. 肝切除术中肝脏血流阻断技术的研究进展 [J]. 中国普外基础与临床杂志, 2008; 15(4): 299-302.
16. Machado MA, Makdissi FF, Bacchella T, et al. Hemihepatic ischemia for laparoscopic liver resection [J]. Surg Laparosc Endosc Percutan Tech, 2005; 15(3): 180-183.
17. Gayet B, Cavaliere D, Vibert E, et al. Totally laparoscopic right hepatectomy [J]. Am J Surg, 2007; 194(5): 685-689.
18. 胡明根, 刘荣, 董家鸿, 等. 腹腔镜肝切除的研究进展 [J]. 腹腔镜外科杂志, 2007; 12(2): 174-177.
19. Toyama Y, Miyake R, Son K, et al. Three-Port laparoscopic partial hepatectomy using an ultrasonically activated device (USAD) [J]. J Hepatobiliary Pancreat Surg, 2006; 13(4): 317-322.
20. Campagnacci R, De Sanctis A, Baldarelli M, et al. Hepatic resections by means of electrothermal bipolar vessel device (EBVS) LigaSure V: early experience [J]. Surg Endosc, 2007; 21(12): 2280-2284.
21. Jersenius U, Fors D, Rubertsson S, et al. Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques [J]. Surg Endosc, 2007; 21(2): 315-320.
22. Imura S, Ikegami T, Morine Y, et al. Advanced application of a vessel sealing system for major hepatic resections [J]. Surg Endosc, 2008; 22(1): 273-274.
23. Gumbs AA, Bar-Zakai B, Gayet B. Totally laparoscopic extended left hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1152.
24. Gumbs AA, Gayet B. Multimedia article. Totally laparoscopic extended right hepatectomy [J]. Surg Endosc, 2008; 22(9): 2076-2077.
25. Gumbs AA, Gayet B. Totally laparoscopic central hepatectomy [J]. J Gastrointest Surg, 2008; 12(7): 1153.
26. Saidi RF, Ahad A, Escobar R, et al. Comparison between staple and vessel sealing device for parynchemal transection in laparoscopic liver surgery in a swine model [J]. HPB (Oxford), 2007; 9(6): 440-443.

CHINESE JOURNAL OF BASES AND CLINICS IN GENERAL SURGERY

Technical Refinement of Laparoscopic Hepatectomy in Porcine Model

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