Laparoscopic liver resection using the rubber band technique: its usefulness and perioperative outcome of 100 consecutive cases

Sung Hoon Choi, MD, Gi Hong Choi, MD, Dai Hoon Han, MD, Jin Sub Choi, MD, PhD. Division of Hepatobiliary and Pancreas, Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.

Introduction: Although laparoscopic liver resection is increasingly performed worldwide, surgeons still face technical challenge according to multiple different procedures by tumor locations. Therefore, various techniques and instruments have been introduced. The purpose of this study was to present our rubber band technique with the basic constant principal and to show perioperative and early postoperative outcomes.

Methods: A series of 100 consecutive patients who underwent laparoscopic liver resection using the pure rubber band technique between August 2008 and June 2013 was analyzed retrospectively in terms of demographics, operation type, and in-hospital outcomes. All the study patients were applied rubber band retraction method at both resection edges to keep the resection plane horizontal with laparoscope view.

Results: Overall, 36% of the patients had underlying liver cirrhosis. There were 4 conversions. Types of operation included 86% of minor hepatectomy (wedge resection (60%), segmentectomy (12%), and left lateral sectionectomy (14%)) and 14% of major hepatectomy (left hepatectomy (12%), and right hepatectomy (2%)). When 56 favorable location tumors (II, III, IVb, V, and VI) were compared with the remaining 30 unfavorable location tumors (I, Iva, VII, and VIII) among the minor hepatectomy, the former group required a shorter operation time (185 [60-395] minutes vs 248 [92-655], P=0.002) and showed a lesser amount of blood loss 150 [10-550] vs 263 [10-1000] ml, P=0.017). However, open conversion rate (2% vs 1%, P=1.0), postoperative complication rate (7% vs 3%, P=1.0), and hospital stay (6.7 days vs 6.8 days, P=0.946) were not different between the two groups. When the operative time was analyzed using the moving average method, operative time for left lateral sectionectomy and left hepatectomy were stabilized at 9 and 6 cases, respectively. There was no postoperative mortality.

Conclusion: Rubber band technique in laparoscopic liver resection provides useful and safe laparoscopic hepatectomy including unfavorably located tumors or major hepatectomy, and allows reasonable learning curve applying a constant surgical principle.

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