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Rationale and surgical technique of laparoscopic left lateral sectionectomy using endoscopic staples.

Lee BH, Yun SS, Kim MK, Jung HK, Lee DS, Kim HJ - Ann Surg Treat Res (2014)

Bottom Line: Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery.There was significantly shorter in the batch group, also (P = 0.006).There were no significant complications or mortality in both groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yeungnam University Medical Center, Daegu, Korea.

ABSTRACT

Purpose: Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples.

Methods: We retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14).

Results: Mean operation time was 265.3 ± 21.3 minutes (mean ± standard deviation) in the individual group and 170 ± 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 ± 1.6 and 2.6 ± 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 ± 1.1 and 9.4 ± 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups.

Conclusion: LLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.

No MeSH data available.


Related in: MedlinePlus

Exposure of glissonian pedicles after liver parenchymal dissection.
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Figure 3: Exposure of glissonian pedicles after liver parenchymal dissection.

Mentions: The procedures are both conducted with the patient supine in the reverse Trendelenburg position. LLLS is performed by two surgeons (operator, assistant) and one scopist. The operator stands to the right of the patient with the assistant and the scopist on the patient's left. Four ports are placed as shown in Fig. 1. Carbon dioxide pneumoperitoneum is maintained at 12 mmHg to minimize the risk of gas embolism. We use a 90' flexible scope and a 12-mm trochar is inserted in the supraumbilical area. An additional 12-mm trochar is inserted at around the intersection of the right subcostal and midclavicular lines and 5-mm trochar is inserted at around the intersection of the right subcostal and midaxillary lines. The assistant inserts the 5-mm trochar in the left subcostal area. The Pringle maneuver is not used during transaction of liver parenchyme. Intraoperative ultrasonography is performed to exclude any other lesion, to define tumor size, and to position and remark the resection anatomy. The falciform ligament and triangular ligament are divided with a Harmonic scalpel (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) up to the level of the inferior vena cava (IVC) and the left hepatic vein (LHV) through the right port. The left round ligament is divided up to the Arantius duct to free the left lateral segment and to allow easy stapling of the LHV. A Harmonic scalpel is used to dissect the anterosuperior portion of liver to reach umbilical plate (Fig. 2). After reaching the glissonian pedicle of left lobe (Fig. 3), glissonian pedicles to segments II and III are controlled using either of two methods.


Rationale and surgical technique of laparoscopic left lateral sectionectomy using endoscopic staples.

Lee BH, Yun SS, Kim MK, Jung HK, Lee DS, Kim HJ - Ann Surg Treat Res (2014)

Exposure of glissonian pedicles after liver parenchymal dissection.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4127897&req=5

Figure 3: Exposure of glissonian pedicles after liver parenchymal dissection.
Mentions: The procedures are both conducted with the patient supine in the reverse Trendelenburg position. LLLS is performed by two surgeons (operator, assistant) and one scopist. The operator stands to the right of the patient with the assistant and the scopist on the patient's left. Four ports are placed as shown in Fig. 1. Carbon dioxide pneumoperitoneum is maintained at 12 mmHg to minimize the risk of gas embolism. We use a 90' flexible scope and a 12-mm trochar is inserted in the supraumbilical area. An additional 12-mm trochar is inserted at around the intersection of the right subcostal and midclavicular lines and 5-mm trochar is inserted at around the intersection of the right subcostal and midaxillary lines. The assistant inserts the 5-mm trochar in the left subcostal area. The Pringle maneuver is not used during transaction of liver parenchyme. Intraoperative ultrasonography is performed to exclude any other lesion, to define tumor size, and to position and remark the resection anatomy. The falciform ligament and triangular ligament are divided with a Harmonic scalpel (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) up to the level of the inferior vena cava (IVC) and the left hepatic vein (LHV) through the right port. The left round ligament is divided up to the Arantius duct to free the left lateral segment and to allow easy stapling of the LHV. A Harmonic scalpel is used to dissect the anterosuperior portion of liver to reach umbilical plate (Fig. 2). After reaching the glissonian pedicle of left lobe (Fig. 3), glissonian pedicles to segments II and III are controlled using either of two methods.

Bottom Line: Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery.There was significantly shorter in the batch group, also (P = 0.006).There were no significant complications or mortality in both groups.

View Article: PubMed Central - PubMed

Affiliation: Department of Surgery, Yeungnam University Medical Center, Daegu, Korea.

ABSTRACT

Purpose: Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples.

Methods: We retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14).

Results: Mean operation time was 265.3 ± 21.3 minutes (mean ± standard deviation) in the individual group and 170 ± 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 ± 1.6 and 2.6 ± 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 ± 1.1 and 9.4 ± 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups.

Conclusion: LLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.

No MeSH data available.


Related in: MedlinePlus