Department of Hepatobiliary Surgery and Liver Transplantation, Pitié-Salpétrière Hospital, Sorbonne University, UMRS-938, Paris, France.
Department of Surgery, Graduate School of Medicine, Kobe University, Hyogo, Japan.
Surg Endosc. 2018 Aug;32(8):3706-3712. doi: 10.1007/s00464-018-6205-1. Epub 2018 May 22.
Although laparoscopic liver resection is widely performed, many technical difficulties remain, such as accurate isolation/division of hepatic vessels in laparoscopic right hepatectomy (LRH). Innovative surgical devices, such as three-dimensional (3D) laparoscopy and optimized carbon dioxide (CO) insufflation system, may help to overcome technical difficulties in LRH. The purpose of this study was to analyze the efficacy of 3D vision associated with active pneumoperitoneum maintenance in LRH.
In our prospectively maintained database from 2006, 75 consecutive LRH from May 2011 to June 2017 were included in this study. All LRH were performed with 2D vision and standard CO insufflator (2D-LRH group, 45 cases) or 3D vision with optimized CO insufflator (3D-LRH group, 30 cases). Preoperative clinical characteristics, surgical data including operation time of separate steps within the procedure, and postoperative complications were compared between the two groups.
Clinical and pathological factors were comparable between two groups. Total operative time was significantly shorter in 3D-LRH group than in 2D-LRH (360 vs 390 min, P = 0.029). Right hepatic pedicle dissection time was significantly shorter in 3D-LRH group (101 vs 123 min, P = 0.003). Liver parenchyma transection time was also shorter in 3D-LRH group (138 vs 151 min, P = 0.089), although not significant. There was no significant difference in liver mobilization time, intraoperative bleeding/transfusion, and postoperative complications.
3D vision with maintenance of pneumoperitoneum facilitates hepatic vascular isolation/division, and may contribute to the development of LRH.
尽管腹腔镜肝切除术得到了广泛的应用，但仍存在许多技术难题，如腹腔镜右半肝切除术（LRH）中肝血管的准确分离/切断。创新的手术设备，如三维（3D）腹腔镜和优化的二氧化碳（CO）充气系统，可能有助于克服 LRH 中的技术难题。本研究旨在分析 3D 视觉联合主动气腹维持在 LRH 中的疗效。
在我们 2006 年开始前瞻性维护的数据库中，纳入了 2011 年 5 月至 2017 年 6 月期间连续进行的 75 例 LRH。所有 LRH 均采用二维视觉和标准 CO 充气机（2D-LRH 组，45 例）或三维视觉和优化 CO 充气机（3D-LRH 组，30 例）进行。比较两组患者的术前临床特征、手术数据（包括手术过程中各步骤的手术时间）和术后并发症。
两组患者的临床和病理因素无差异。3D-LRH 组的总手术时间明显短于 2D-LRH 组（360 分钟比 390 分钟，P=0.029）。3D-LRH 组右肝蒂解剖时间明显短于 2D-LRH 组（101 分钟比 123 分钟，P=0.003）。3D-LRH 组肝实质切开时间也较短（138 分钟比 151 分钟，P=0.089），尽管差异无统计学意义。两组肝游离时间、术中出血量/输血、术后并发症无差异。
3D 视觉联合气腹维持有助于肝血管的分离/切断，可能有助于 LRH 的发展。
