Xiao Liang, Wang Zhiming, Zhou Ledu
Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China.
Ann Transl Med. 2020 Aug;8(15):940. doi: 10.21037/atm-20-4674.
Anatomical laparoscopic hepatolobectomy (ALH) is a difficult and challenging operation, and avoiding massive hemorrhage during parenchyma transection remains one of its major concern. Glissonean pedicle approach (GPA) has achieved great success in open liver surgery due to its simplicity and reproducibility, but it is difficult to apply in ALH for the limited vision and motion. We thus aimed to introduce a modified method to facilitate the GPA in ALH.
In this retrospective study, in 15 patients who underwent ALH (at least 2 couinaud segments), the liver parenchyma was dissected at first (LPDF) adequately under intermittent total inflow control to reveal the Glissonean pedicle (GP) sufficiently for safe and precise transection. The technical details of LPDF for different types of hepatolobectomy and a modified laparoscopic Pringle maneuver are described, and the surgical outcomes are reviewed.
LPDF was applied in all patients, and intraoperative blood transfusion was not needed. LPDF facilitated GPA in ALH without any severe morbidity or mortality.
LPDF is a safe and effective technique, it reduces the difficulties in inflow occlusion in GPA and can promote the application of ALH. Further clinical control trails are needed to validate the superiority of LPDF compared with GPA in ALH.
解剖性腹腔镜肝叶切除术（ALH）是一项困难且具有挑战性的手术，在肝实质离断过程中避免大量出血仍然是其主要关注点之一。肝蒂入路（GPA）因其操作简单且可重复性强，在开放性肝脏手术中取得了巨大成功，但由于视野和操作空间有限，难以应用于ALH。因此，我们旨在引入一种改良方法以促进GPA在ALH中的应用。
在这项回顾性研究中，对15例行ALH（至少切除2个Couinaud肝段）的患者，首先在间歇性全肝血流阻断下充分解剖肝实质（LPDF），以充分显露肝蒂（GP），从而实现安全、精确的离断。描述了不同类型肝叶切除术的LPDF技术细节以及改良的腹腔镜Pringle手法，并回顾了手术结果。
所有患者均应用了LPDF，且无需术中输血。LPDF促进了GPA在ALH中的应用，未出现任何严重并发症或死亡。
LPDF是一种安全有效的技术，它降低了GPA中血流阻断的难度，可促进ALH的应用。需要进一步的临床对照试验来验证LPDF在ALH中相对于GPA的优越性。
