Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishi-shinbashi, Minato-ku, Tokyo, 105-8461, Japan.
Surg Endosc. 2021 Sep;35(9):5375-5380. doi: 10.1007/s00464-021-08516-9. Epub 2021 Apr 28.
It has been known that repeat laparoscopic hepatectomy (RLH) after open hepatectomy is technically challenging because of adhesions around the hilum. It is quite often that conventional tourniquet technique for the Pringle maneuver is difficult in RLH, and we introduced Laparoscopic Satinsky Vascular Clamp (LSVC) for inflow control in RLH. The Spiegel lobe is the anatomical landmark in LSVC technique. If a space behind the hepatoduodenal ligament and the Spiegel lobe was obtained, LSVC was applied laterally from the left side of the hepatoduodenal ligament, whereas LSVC was vertically applied for those with obstruction of a space behind the hepatoduodenal ligament. We performed 14 cases of RLH for those with histories of open hepatectomies by lateral (n = 6) and vertical (n = 8) LSVC technique with successful inflow control, confirmed by intraoperative Doppler ultrasound. Five patients underwent 2 or more previous histories of hepatectomies. The RLH included segmentectomy (n = 1), subsegmentectomy (n = 2) and partial hepatectomy (n = 11). The median time for the Pringle maneuver, operative time, and blood loss was 47 min, 237.5 min, and 160 mL. All the patients completed pure laparoscopic hepatectomy. In conclusion, LSVC technique is a safe and reliable technique for the Pringle maneuver in RLH.
已知由于门脉周围粘连，开腹肝切除术后再次腹腔镜肝切除术（RLH）在技术上具有挑战性。在 RLH 中，传统的阻断钳技术对于阻断血流往往较为困难，因此我们引入了腹腔镜 Satinsky 血管夹（LSVC）用于 RLH 的入肝血流控制。 Spiegel 叶是 LSVC 技术中的解剖学标志。如果在肝十二指肠韧带和 Spiegel 叶后面获得空间，则从肝十二指肠韧带的左侧横向应用 LSVC，而对于肝十二指肠韧带后面空间受阻的患者，则垂直应用 LSVC。我们通过侧向（n=6）和垂直（n=8）LSVC 技术对 14 例有开腹肝切除术史的患者进行了 14 例 RLH，术中多普勒超声证实入肝血流得到成功控制。5 例患者有 2 次或更多次肝切除术史。RLH 包括肝段切除术（n=1）、亚段切除术（n=2）和部分肝切除术（n=11）。阻断钳时间、手术时间和出血量的中位数分别为 47 分钟、237.5 分钟和 160 毫升。所有患者均完成了纯腹腔镜肝切除术。总之，LSVC 技术是 RLH 中阻断血流的一种安全可靠的技术。
