Center for Liver and Pancreatobiliary Cancer, National Cancer Center, 323 Ilsan-ro, Ilsandonggu, Goyang-si, Gyeonggi-do, 10408, Republic of Korea.
World J Surg. 2022 Oct;46(10):2454-2458. doi: 10.1007/s00268-022-06654-2. Epub 2022 Jul 8.
Effective inflow and outflow control of the liver is essential for a safe hepatectomy. Detachment of the hilar plate is a fundamental technique in the Glissonean approach. The hilar plate is situated near the middle hepatic vein, which runs in the midplane of the liver, and serves as a landmark during hemihepatectomy. In this study, we describe the technical details and surgical outcomes of laparoscopic left hemihepatectomy using the hilar plate-first approach.
The key procedures of the hilar plate-first approach included the following: (1) detachment of the hilar plate for the left Glissonean approach, (2) the middle hepatic vein approach from the hilar plate, (3) parenchymal transection along the ischemic line and middle hepatic vein, and (4) transection of the left Glissonean pedicle at the ventral aspect of the Arantius ligament.
Between September 2020 and September 2021, 12 patients underwent laparoscopic left hemihepatectomy using the hilar plate-first approach. The median operation time was 227 min (range 140-350 min), and the median estimated blood loss was 82.5 ml (range 50-150 ml). The median length of postoperative hospital stay was 7 days (range 5-10 days). No major complications, including biliary complications, were observed.
The hilar plate-first approach contributes to the standardization of surgical techniques for laparoscopic left hemihepatectomy. This technique is a safe and effective approach for the inflow and outflow systems of the left hemiliver.
有效的肝流入道和流出道控制对于安全的肝切除术至关重要。肝门板的游离是 Glissonian 入路的基本技术。肝门板位于靠近中肝静脉的位置，中肝静脉在肝脏的中平面运行，在半肝切除术中作为一个标志。在本研究中，我们描述了使用肝门板优先入路的腹腔镜左半肝切除术的技术细节和手术结果。
肝门板优先入路的关键步骤包括：（1）左 Glissonian 入路的肝门板游离，（2）从肝门板开始的中肝静脉入路，（3）沿缺血线和中肝静脉行肝实质离断，（4）在 Arantius 韧带腹侧离断左 Glissonian 蒂。
2020 年 9 月至 2021 年 9 月，12 例患者采用肝门板优先入路行腹腔镜左半肝切除术。中位手术时间为 227 分钟（范围 140-350 分钟），中位估计出血量为 82.5ml（范围 50-150ml）。中位术后住院时间为 7 天（范围 5-10 天）。无主要并发症，包括胆漏。
肝门板优先入路有助于腹腔镜左半肝切除术的手术技术标准化。该技术是左半肝流入道和流出道的安全有效的方法。
