Mitsuo Miyazawa, MD, FACS, Masayasu Aikawa, MD, Katsuya Okada, Yukihoro Watanabe, Kojun Okamoto, Shigeki Yamaguchi, Isamu Koyama. Saitama Medical University International Medical Center
Among intraoperative complications of total laparoscopic hepatectomy (TLH), venous hemorrhage is the most frequent and difficult-to-treat complication. We developed hepatocyte crush method: (HeCM) using a monopolar soft-coagulation devices for not only hemostasis, but also detachment of blood vessels. The aim of this prospective, nonrandomized study was to investigate the potential contribution of a monopolar soft-coagulation device to the limitation of intraoperative blood loss in patients undergoing TLH.
(Methods) From January 2008 to July 2014 at our department, TEH was performed in 150 cases, including 140 cases of partial hepatectomy and 5 cases of lateral sectionectomy of the left hepatic lobe. We keep the following points in mind for the procedure of partial hepatectomy using a monopolar soft-coagulation device for hepatocellular carcinoma. 1) For detachment of the vein, a monopolar soft-coagulation device is pressed on the resection surface of the liver to crush hepatocytes (hepatocyte crush method: HeCM). 2) Regarding the area around the hepatic vein, holes from which the branches of the hepatic vein fall out are identified with a monopolar soft-coagulation device (while dripping water) and closed.
[Results] The blood loss was 62.0 (0-500) ml. The operative time was 207 (127-468) minutes. The duration of hospital stay after surgery was 7.6 (3-21) days. Postoperative complications occurred in 5 cases (intraabdominal abscess, wound infection, intraabdominal hemorrhage, bile duct stricture [stricture of B2 and B3 after resection of a tumor in S4], and umbilical hernia in one case each). The peak aspartate aminotransferase (AST) level was 320 (57-1,964) IU/L. Although there were cases showing high AST levels, no sign of hepatic failure was observed during the perioperative period in any case.
[Conclusion and discussion] The use of a monopolar soft-coagulation device (HeCM) improves surgical results with minimal blood loss and low rate morbidity.