An extracorponeal hepatic inflow control for pure laparoscopic liver resection can extend an indication of liver resection

Toru Mizuguchi, Makoto Meguro, Kenji Okita, Tohsihiko Nishidate, Tomomi Ueki, Emi Akizuki, Masafumi Imamura, Goro Kutomi, Yasutoshi Kimura, Ichiro Takemasa. Sapporo Medical University

Factors Pr group (N=9) NPr group (N=38) P
Clinical demographics

Sex (M:F)

4:5 23:15 0.609
Age (Years) 60.8 + 12.9 65.7 + 10.6 0.231
Albumin (g/dl) 3.86 + 0.37 4.06 + 0.33 0.167
ICG R15 (%) 14.5 + 9.7 9.8 + 5.1 0.046
Tumor sizes (cm) 1.8 + 0.7 3.3 + 2.1 0.041
Tumor numbers 1.4 + 1.3 1.3 + 0.6 0.535
Operation time (min) 231.3 + 104.4 323.7 + 99.4 0.017
Bleeding (ml) 71.7 + 145.8 131.9 + 175.9 0.347
Complication (Y:N) 0:9 1:37 0.999

Backgroud: We have developed an extracorponeal device to control hepatic inflow for pure laparoscopic liver resection (pure Lap).  The technique is simple by clamping outside the abdominal wall using a long silicone tube and polyester tape.  Aim of this report is to show that our technique successfully controls bleeding and enables pure Lap to be completed without increasing any risk even for a large tumor.     

Methods : We developed an extracorponeal device which composed a 30 cm silicone tube 10 mm in diameter and a 100 cm long polyester tape 5 mm wide.   A prospective study of pure Lap was initiated in January 2010.  We have used a new Pringle method outside the abdominal wall in 2009 and applied an US patent in 2011.  We compared the consecutive patients who received pure Lap with (Pr group: n=38) and without (NPr group: n=9) this Pringle maneuver.

Results: There was no difference between the groups regarding clinical demographics except ICG R15 levels (9.8 + 5.1% in the Pr group vs. 14.5 + 9.7% in the NPr group: P=0.041).  There was no difference of surgical complication between the groups (18.4% in the Pr group vs 22.2% in the NPr group: P=0.999).  Although tumor size in the Pr group was significantly larger than in the NPr group (3.3 + 2.1 vs. 1.8 + 0.7 cm, respectively: P=0.041), intraoperative bleeding was not significantly different (131.9 +175.9 ml in the Pr group vs. 71.7 + 145.8 ml in the NPr group).  On the other hand, operation time in the Pr group was significantly longer than in the NPr group (323.7 + 99.4 min. vs. 231.3 + 104.4 min., respectively: P=0.017). 

Conclusion : We confirmed a clinical safety of the device for controlling hepatic inflow  outside the abdominal wall for pure Lap.  Although we have no open-conversion case so far, hepatic inflow control can be achievable during extend wound for open surgery and use it after the conversion for open surgery.  Pure Lap for large tumors is feasible when employing this method. 

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