Onda Shinji, Haruki Koichiro, Furukawa Kenei, Yasuda Jungo, Okui Norimitsu, Shirai Yoshihiro, Horiuchi Takashi, Ikegami Toru
Department of Surgery, The Jikei University School of Medicine, 3-25-8, Nishishimbashi, Minato-ku, Tokyo, 105-8461, Japan.
Division of Gastrointestinal Surgery, Saku Central Hospital Advanced Care Center, Saku, Nagano, Japan.
Langenbecks Arch Surg. 2023 Apr 4;408(1):138. doi: 10.1007/s00423-023-02880-x.
This study was performed to propose a strategy for repeat laparoscopic liver resection (RLLR) and investigate the preoperative predictive factors for RLLR difficulty.
Data from 43 patients who underwent RLLR using various techniques at 2 participating hospitals from April 2020 to March 2022 were retrospectively reviewed. Surgical outcomes, short-term outcomes, and feasibility and safety of the proposed techniques were evaluated. The relationship between potential predictive factors for difficult RLLR and perioperative outcomes was evaluated. Difficulties associated with RLLR were analyzed separately in two surgical phases: the Pringle maneuver phase and the liver parenchymal transection phase.
The open conversion rate was 7%. The median surgical time and intraoperative blood loss were 235 min and 200 mL, respectively. The Pringle maneuver was successfully performed in 81% of patients using the laparoscopic Satinsky vascular clamp (LSVC). Clavien-Dindo class ≥III postoperative complications were observed in 12% of patients without mortality. An analysis of the risk factors for predicting difficult RLLR showed that a history of open liver resection was an independent risk factor for difficulty in the Pringle maneuver phase.
We present a feasible and safe approach to address RLLR difficulty, especially difficulty with the Pringle maneuver using an LSVC, which is extremely useful in RLLR. The Pringle maneuver is more challenging in patients with a history of open liver resection.
本研究旨在提出一种重复腹腔镜肝切除术（RLLR）的策略，并探讨RLLR难度的术前预测因素。
回顾性分析了2020年4月至2022年3月期间在2家参与研究的医院接受各种技术RLLR的43例患者的数据。评估了手术结果、短期结果以及所提出技术的可行性和安全性。评估了RLLR困难的潜在预测因素与围手术期结果之间的关系。在两个手术阶段分别分析与RLLR相关的困难：Pringle手法阶段和肝实质离断阶段。
开放转换率为7%。中位手术时间和术中出血量分别为235分钟和200毫升。81%的患者使用腹腔镜Satinsky血管夹（LSVC）成功进行了Pringle手法。12%的患者出现Clavien-Dindo≥III级术后并发症，无死亡病例。对预测RLLR困难的危险因素分析表明，开腹肝切除史是Pringle手法阶段困难的独立危险因素。
我们提出了一种可行且安全的方法来解决RLLR困难，特别是使用LSVC进行Pringle手法时的困难，这在RLLR中非常有用。对于有开腹肝切除史的患者，Pringle手法更具挑战性。
