Parenchymal Dissection Technique in Laparoscopic Hepatectomy

Satoshi Kaihara, MD, PhD, FACS, Kenji Uryuhara, MD, PhD, Junji Komori, MD, PhD, Sena Iwamura, MD, Ryo Hosotani, MD, PhD. Kobe Medical Center General Hospital

[INTRODUCTION] One of the crucial points in laparoscopic hepatectomy is how to manage the intraoperative bleeding during the parenchymal dissection. In the dry field we can precisely realize the fine anatomical structures in the liver parenchyma and treat the intrahepatic vessels properly. For this purpose we established new hepatic-parenchymal dissection technique with pre-coagulation using VIO® system followed by parenchymal crushing using CUSA® so called “pre-coagulated dissection technique (PCD technique)”. Here we introduce this technique and the results.

[PATIENTS and METHODS] Fifty two consecutive patients, performed laparoscopic hepatectomy using PCD technique in our hospital from June 2012 to September 2015, were included in this study. Original disease was HCC in 15 cases, metastatic liver tumor in 32 cases, and benign tumor in 5 cases. Pure laparoscopic operation was performed in 34 cases, hand assisted in 12 cases, and hybrid in 6 cases. Operation mode was lateral segmentectomy in 16 cases and partial resection in 36 cases. For the parenchymal dissection, 1st assistant coagulated the cutting area first using VIO system (soft coagulation mode, power 60W, effect 5) and the operator crushed this pre-coagulated tissue using CUSA. With this method we encountered little bleeding during the parenchymal dissection and could realize the fine anatomical structures in the liver parenchyma. Glissonian and hepatic veins were dissected using various methods according to the size. Pringle maneuver was applied only to the complicated resection.

[RSULTS] Operation time was 109 to 424 minutes (mean; 252 minutes) and intraoperative blood loss was 0 to 642 ml (mean; 91ml). One liver cirrhosis case needed intraoperative blood transfusion. Post-operative peak AST was 235 +/- 324 IU/L and T-Bil was 1.3 +/- 1.0 mg/dL(mean +/- SD). One case suffered from PHLF by ISGLS Grade B. The patient with Clavian-Dindo classification Grade 3a was 2 cases (cerebral infarction, intra-abdominal abscess), who recovered without any severe prognostic symptoms. All patients discharged hospital with good condition 3 to 14 days (mean; 6.6 days) after the operation.

[CONCLUSIONS] The pre-coagulated dissection technique was effective to reduce the intraoperative bleeding and the incidence of post-operative severe complications.

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