Department of Surgery, University Medical Centre Schleswig-Holstein, Campus Lübeck, Ratzeburger Allee 160, 23538, Lübeck, Germany.
Medical Laser Center Lübeck, Peter Monnik Weg 4, 23562, Lübeck, Germany.
Surg Endosc. 2018 Dec;32(12):4966-4972. doi: 10.1007/s00464-018-6258-1. Epub 2018 Jun 4.
Hepatocellular carcinoma is a highly prevalent and lethal primary neoplasia of the liver and metastases of other malignancies affect most frequently the liver. Minimally invasive surgical approach for liver resections is advancing. Dissection of liver parenchyma by laparoscopic technique remains challenging and new technologies are in need. Therefore, we asked whether it is feasible to dissect liver tissue comparably in terms of speed and hemostasis with a non-contact 1.9-µm cw-laser device and whether there are differences in the postoperative healing process compared to a gold standard device (ultrasound aspirator) in an experimental model.
Laparoscopic laser and ultrasound aspirator standardized partial liver resections were performed in seven pigs. Resection time, hemostasis time, and blood loss were evaluated. After at least 10 days, representative specimen of the resection areas was collected via re-laparoscopy and biopsy and side effects like hematoma, abscess, or bilioma were noted. Histologically, coagulation necrosis margin, granulation tissue zone, tissue fibrosis, and giant cell count were analyzed.
Laparoscopic laser liver resection was three times faster compared to the laparoscopic ultrasound aspirator. Blood loss was equal in both groups. No side effects like hematoma or bilioma occurred. Histologically, specimen showed the same expansion of coagulation necrosis zone and granulation tissue. Fibrotic scar could be determined in three cases in both groups, respectively. However, giant cell count was significant higher in the laser resection group.
The 1.9-µm cw-laser device enables a safe and fast liver resection in an experimental pig model compared to a gold standard (ultrasound aspirator) laparoscopic liver resection method. Wound healing is not interfered by laser liver resection.
肝细胞癌是一种高发且致命的肝脏原发性肿瘤，其他恶性肿瘤的转移最常累及肝脏。微创外科手术方法在不断发展。腹腔镜技术下的肝实质解剖仍然具有挑战性，需要新的技术。因此，我们想知道使用非接触式 1.9μm 连续波激光设备是否可以在速度和止血方面与金标准设备（超声吸引器）一样，在实验模型中对肝脏组织进行解剖，以及在术后愈合过程中是否存在差异。
在 7 头猪中进行了腹腔镜激光和超声吸引器标准化部分肝切除术。评估了切除时间、止血时间和失血量。至少 10 天后，通过再次腹腔镜和活检采集代表性的切除区域标本，并注意血肿、脓肿或胆漏等副作用。组织学上，分析了凝固性坏死边界、肉芽组织区、组织纤维化和巨细胞计数。
与腹腔镜超声吸引器相比，腹腔镜激光肝切除术的速度快了三倍。两组的失血量相等。两组均未出现血肿或胆漏等副作用。组织学上，标本显示相同的凝固性坏死区和肉芽组织扩张。在两组中，均有 3 例可确定纤维化瘢痕。然而，激光切除组的巨细胞计数明显更高。
与金标准（超声吸引器）腹腔镜肝切除术方法相比，1.9μm 连续波激光设备可在实验猪模型中实现安全且快速的肝切除术。激光肝切除不会干扰伤口愈合。
