Department of Gastrointestinal Surgery, Second Affiliated Hospital of Soochow University, Suzhou, Jiangsu, China.
Department of Gastroenterological Surgery, Gastroenterological Center, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3‑8‑31 Ariake, Koto‑Ku, Tokyo, 135‑8550, Japan.
BMC Surg. 2024 Oct 23;24(1):327. doi: 10.1186/s12893-024-02635-5.
Retraction of the hepatic left lateral segment (HLLS) is a crucial maneuver for surgical field exposure during laparoscopic gastrectomy with systematic lymphadenectomy. Though various methods of retraction are available, there is no perfect solution. Here, we report the results of our initial 42 cases with HLLS inversion method and discuss the feasibility, safety, effectiveness and technical aspects of this method.
The intraoperative and postoperative short-term outcomes of 42 patients who underwent HLLS inversion during laparoscopic total gastrectomy and proximal gastrectomy in our department September, 2023 to January, 2024 were reviewed. HLLS inversion was performed by mobilizing the HLLS and inverting it to the right supra-hepatic space through an incision at the falciform ligament.
42 patients underwent HLLS inversion successfully with an average time of 13.9 min. 7 patients needed re-inversion due to slipping back of the HLLS during operation. Optimal exposure of the surgical field was achieved in all patients. No intra-operative complications occurred, except for 1 patient presented with mild intraoperative hepatic hemorrhage requiring electrocoagulation for hemostasis. Alanine aminotransferase and glutamine aminotransferase elevated in some patients on postoperative day 1(POD1), but declined to preoperative levels on the 7th postoperative day. There were no Clavien-Dindo II grade or higher digestive complications after surgery. In 5 patients with preservation the hepatic branch of the vagus nerve, the contractile function of the gall bladder was intact or slightly impaired 2 weeks after operation.
For laparoscopic proximal gastrectomy (LPG) and laparoscopic total gastrectomy (LTG), HLLS inversion is a feasible method for optimizing visualization of the surgical field with preservation of the function of the hepatic branch of the vagus nerve. It is safe and acceptable as to the manipulation time. Re-inversion is easy and effective even in case of failure of inversion. HLLS inversion seems to be a promising technique for retraction of the liver during laparoscopic gastrectomy.
在腹腔镜胃癌根治术中，为了充分暴露手术野，需要对肝左外叶（HLLS）进行牵拉。目前有多种牵拉方法，但尚无完美的解决方案。本文报道了我们采用肝左外叶翻转法对 42 例患者进行手术的初步结果，并探讨了该方法的可行性、安全性、有效性和技术要点。
回顾性分析 2023 年 9 月至 2024 年 1 月期间，我院 42 例行腹腔镜全胃切除术和近端胃切除术的患者的术中及术后短期结果。术中采用镰状韧带切口，游离肝左外叶并将其翻转至肝上间隙，完成肝左外叶翻转。
42 例患者均成功完成肝左外叶翻转，平均用时 13.9 分钟。术中 7 例患者因肝左外叶翻转后滑脱而需再次翻转。所有患者均获得了满意的手术野暴露。术中无并发症发生，仅 1 例患者出现轻度术中肝出血，行电凝止血。部分患者术后第 1 天（POD1）丙氨酸氨基转移酶和谷氨酰转肽酶升高，但在术后第 7 天降至术前水平。术后无 Clavien-Dindo II 级及以上消化道并发症。在 5 例行保留迷走神经肝支的患者中，术后 2 周胆囊收缩功能完整或轻度受损。
对于腹腔镜近端胃切除术（LPG）和腹腔镜全胃切除术（LTG），肝左外叶翻转法是一种可行的方法，可在保留迷走神经肝支功能的情况下优化手术野的可视化，操作时间安全且可接受。即使翻转失败，再次翻转也很容易且有效。肝左外叶翻转术似乎是腹腔镜胃癌手术中肝脏牵拉的一种有前途的技术。
