Utility of vessel sealing system in laparoscopic hepatectomy

Fumiki Kushihata, Takaaki Takebayashi, Tetsuya Mizumoto, Shoichi Kageyama, Hitoshi Inoue, Akihiro Takai, Jota Watanabe, Taiji Toyama, Yasutsugu Takada. Department of HBP Surgery and Breast Surgery, Graduate School of Medicine Ehime University.

 Introduction: The number of laparoscopic hepatectomy (LH) has been increasing, but its technical aspect is still difficult and remains to be solved.
Purpose: We examined initial results of LH special reference to the usefulness of Vessel sealing system.

Object, Method: 31 hepatocellular carcinoma (HCC), 21 metastasis liver cancer and others 5 cases are enrolled. 5 Re-hepatectomy cases are 2 HCC recurrence and metastasis of one gastric cancer and 2 colon cancer. As for liver dysfunction cases with high ICG (>30%), one HCC explosion in 2 cases. 45 pure laparoscopic hepatectomy and 12 hybrid hepatectomy were carried out. A procedure of pure laparoscopic hepatectomy is as following; VSS (Ligasure vessel sealing system) is mainly adapted for dissection of hepatic parenchyma, and partially CUSA for deep layer with Pringle maneuver and precoagulation. Hybrid hepatectomy: We took cholecystectomy / liver mobilization in laparoscopy and performed hepatectomy by CUSA in laparotomy. ?

Result: 1 left hepatectomy, 7 lateral segmentectomy, 4 subsegmentectomy, and 45 partial hepatectomy cases. For median tumor diameter 2.0 cm, operation time 285 minutes, bleeding 100 ml, postoperative hospitalization 13 days. There is no postoperative complication including bile leakage and SSI.? There were definite differences between the two procedures among those parameters.

Conclusion:
1. VSS is an effective device for transecting liver parenchyma during pure laparoscopic hepatectomy.
2. Pure laparoscopic hepatectomy could be standardization from our initial results.

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