Impact of technical innovation on surgical outcome of laparoscopic major liver resection: 10 years' experience at a large-volume center.
10.4174/astr.2019.96.1.14
- Author:
Wontae CHO
1
;
Choon Hyuck David KWON
;
Jin Yong CHOI
;
Seung Hwan LEE
;
Jong Man KIM
;
Gyu Seong CHOI
;
Jae Won JOH
;
Sung Joo KIM
;
Gaab Soo KIM
;
Kwang Chul KOH
Author Information
1. Department of Surgery, Hallym University Medical Center, Dongtan Sacred Heart Hospital, Seoul, Korea.
- Publication Type:Original Article
- Keywords:
Laparoscopy;
Hepatectomy;
Minimally invasive surgical procedures;
Learning curve
- MeSH:
Bile;
Central Venous Pressure;
Electrocoagulation;
Hemorrhage;
Hepatectomy;
Humans;
Korea;
Laparoscopy;
Learning Curve;
Liver*;
Minimally Invasive Surgical Procedures;
Postoperative Complications;
Seoul;
Veins
- From:Annals of Surgical Treatment and Research
2019;96(1):14-18
- CountryRepublic of Korea
- Language:English
-
Abstract:
PURPOSE: Laparoscopic major liver resection (major LLR) remains a challenging procedure because of the technical difficulty. Several significant technical innovations have been applied in our center since 2012. They include routine application of bipolar electrocautery, initiation of temporary increase of intra-abdominal pressure during bleeding events from veins to balance the central venous pressure, and use of temporary inflow control of the Glissonean pedicle. This study evaluated the impact of these technique modifications in patients with major LLR. METHODS: Between January 2004 and February 2015, a total of 606 patients underwent LLR at Samsung Medical Center in Seoul, Korea. Major LLR was employed in 233 cases. All major LLR procedures were anatomical resections performed with a totally laparoscopic approach. We compared surgical parameters of right hepatectomy (RH), left hepatectomy (LH), and right posterior sectionectomy (RPS) before and after 2012. RESULTS: Open conversion rates of RH and LH and estimated blood loss in RPS significantly decreased after 2012. The postoperative complication rate of major LLR was 12.7% and was similar before and after 2012. Bile leakage was the most common complication (3.2%). CONCLUSION: The modifications of surgical techniques resulted in good outcomes for laparoscopic major LLR. We recommend routine application of these techniques to improve outcomes, especially in patients requiring major liver resection.
