Masayasu Aikawa, MD, Kenichiro Takase, MD, Yosuke Ueno, MD, Katsuya Okada, MD, Yukihiro Watanabe, MD, Kojun Okamoto, MD, Hiroshi Sato, MD, Shinichi Sakuramoto, MD, Shigeki Yamaguchi, MD, Isaum Koyama, MD. Saitama Medical University, International Medical Center
Background: Laparoscopic liver resection (LLR) is becoming widespread. However, the use of devices in LLR has not yet been Standardized for various facilities and operators. This study investigated whether Standardized use of devices in LLR improves perioperative outcome.
Methods: Between 2008 and 2017, of 260 patients who underwent LLR for whole hepatoma in our facility, 176 underwent LLR for a solitary hepatoma and were divided into “before standardization” (BS; n = 147) and “after standardization” (AS) groups (n = 29). Patient background, characteristics, and perioperative outcomes were compared between these groups.
Procedure: We chose the devices according to phases of liver transection. A soft-coagulation monopolar device was used for marking surface. An ultrasonically activated device was used for transection of the liver surface within a 2-cm depth. Crash and sealing with BiClamp were indicated for deep-phase transection. The Cavitron Ultrasonic Surgical Aspirator was used if the lesion was close to the major Glisson’s sheath or the major hepatic vein.
Results: No significant differences in the patients’ background were found between the two groups. The operative durations were 128 min (60–312 min) and 203 min (50–470 min) in the AS and BS groups, respectively, with a significant difference (p < 0.001). The blood loss volumes were 5 cc (0-150 cc) and 30 cc (0-850 cc), respectively (p = 0.0548). The lengths of hospital stay after LLR were 5 days (range, 3–7 days) and 6 days (2-21 days), respectively, with a significant difference (p=0.0012). A postoperative complication higher than grade III of the Clavien-Dindo classification occurred in none of the patients in the AS group and in 8 patients in the BS group (p=0.365).
Conclusion: LLR requires the use of various energy devices. However, standardization of the use of energy devices may improve perioperative outcomes such as operative duration, blood loss, complications, and hospital stay associated with LLR.
Presented at the SAGES 2017 Annual Meeting in Houston, TX.
Abstract ID: 86951
Program Number: P831
Presentation Session: iPoster Session (Non CME)
Presentation Type: Poster
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