An Experimental Study on the Relationship Among Airway Pressure, Pneumoperitoneum Pressure, and Central Venous Pressure in Pure Laparoscopic Hepatectomy

Kobayashi, Shin; Honda, Goro; Kurata, Masahiro; Tadano, Sosuke; Sakamoto, Katsunori; Okuda, Yasuhiro; Abé, Keisuke

doi:10.1097/sla.0000000000001482

Cited by 78 publications

(60 citation statements)

References 33 publications

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“…A recent study investigated the relationship of airway pressure, PP, and CVP in experimental LLR 44. The authors hypothesized that when airway pressure is high, increasing PP is not effective in controlling the hepatic venous hemorrhage because of increased intrathoracic pressure, bleeding from hepatic veins cannot be controlled under high airway pressure but can be successfully controlled under low airway pressure.…”

Section: Surgical Proceduresmentioning

confidence: 99%

Evolution and revolution of laparoscopic liver resection in Japan

Kaneko

Otsuka

Kubota

et al. 2017

Annals of Gastroent Surgery

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Due to important technological developments and improved endoscopic techniques, laparoscopic liver resection (LLR) is now considered the approach of choice and is increasingly performed worldwide. Recent systematic reviews and meta‐analyses of observational data reported that LLR was associated with less bleeding, fewer complications, and no oncological disadvantage; however, no prospective randomized trials have been conducted. LLR will continue to evolve as a surgical approach that improves patient's quality of life. LLR will not totally supplant open liver surgery, and major LLR remains to be technically challenging procedure. The success of LLR depends on individual learning curves and adherence to surgical indications. A recent study proposed a scoring system for stepwise application of LLR, which was based on experience at high‐volume Japanese centers. A cluster of deaths after major LLR was sensationally reported by the Japanese media in 2014. In response, the Japanese Society of Hepato‐Biliary‐Pancreatic Surgery conducted emergency data collection on operative mortality. The results demonstrated that mortality was not higher than that for open procedures except for hemi‐hepatectomy with biliary reconstruction. An online prospective registry system for LLR was established in 2015 to be transparent for patients who might potentially undergo treatment with this newly developed, technically demanding surgical procedure.

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Section: Surgical Proceduresmentioning

confidence: 99%

Evolution and revolution of laparoscopic liver resection in Japan

Kaneko

Otsuka

Kubota

et al. 2017

Annals of Gastroent Surgery

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“…Major advantages of laparoscopy over the open approach in liver surgery include minimized trauma to the abdominal wall, decreased postoperative pain and decreased operative blood loss (BL); this benefit could possibly be due to the pneumoperitoneum pressure suppressing capillary and venous bleeding. The majority of comparative studies have demonstrated decreased BL during laparoscopic surgery compared with open surgery, particularly for hepatectomy, where venous bleeding during hepatic dissection accounts for most BL.…”

Section: Introductionmentioning

confidence: 99%

Possible underestimation of blood loss during laparoscopic hepatectomy

et al. 2019

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Background Previous studies have documented potential advantages of laparoscopic hepatectomy in decreasing blood loss compared with open surgery. This study aimed to compare intraoperative blood loss estimated using four different methods in open versus laparoscopic hepatectomy. Methods Patients undergoing liver resection between 2014 and 2017 were evaluated prospectively, differentiating between the laparoscopic and open approach. Groups were compared using univariable and multivariable analyses. Intraoperative blood loss was estimated using three formulas based on the postoperative decreases in haematocrit, haemoglobin or red blood cell volume, and using the conventional method of the sum of suction fluid amounts and gauze weight. In addition, blood loss per hepatic transection area was calculated to compare groups. Results Some 125 patients who underwent hepatectomy were selected, including 56 open hepatectomies and 69 laparoscopic liver resections. Intraoperative blood loss per hepatic transection area estimated by the conventional method was significantly less in the laparoscopic than the open group (3·6 (range 0·2–50·0) versus 6·6 (1·2–82·5) ml/cm 2 respectively; P < 0·001). In contrast, there were no significant differences between groups in blood loss estimated based on the decrease in haematocrit (12·9 (0–65·2) versus 8·1 (0–123·7) ml/cm 2 ; P = 0·818), haemoglobin or red blood cell volume. Blood loss estimation using three formulas showed significant linear correlations with the blood loss estimated by the conventional method in the open group ( r s = 0·758 to 0·762), but not in the laparoscopic group ( r s = –0·019 to 0·031). Conclusion The conventional method of calculating blood loss in laparoscopic hepatectomy can underestimate losses.

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“…The greatest advantage of LLR compared to open hepatectomy is that less bleeding from the hepatic vein occurs as a result of pneumoperitoneum 5, 23, 24. However, the disadvantages involve movement restrictions and the disorientation that can be caused by the limited surgical view 29.…”

Section: Discussionmentioning

confidence: 99%

“…After April 2012, the intermittent Pringle maneuver was routinely used except for LLLS. Additionally, low central venous pressure, the reverse Trendelenburg position, low airway pressure, and low tidal volume contributed to less bleeding from the hepatic vein 5, 23, 24…”

Section: Methodsmentioning

confidence: 99%

Laparoscopic left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy

Hasegawa

Nitta

Takahara

et al. 2018

Annals of Gastroent Surgery

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AimAs a procedure, major laparoscopic liver resection (LLR) remains in the exploration phase. Previous studies have assessed major LLR en bloc, including hepatectomies of varying complexities; however, the number of segments alone does not convey the complexity of a resection. This study aimed to assess operative outcomes of LLR procedures with more than one sectionectomy, and to identify the best procedure as a first step when learning to carry out major LLR in order to make LLR a safer, more widely used procedure.MethodsWe carried out a retrospective review of the operative outcomes of 120 consecutive patients who underwent pure LLR with more than one sectionectomy. Operative outcomes were compared according to the complexity classification recently published, and the learning curve for each LLR procedure was assessed and compared.ResultsOperative outcomes, including operative time, blood loss, and the comprehensive complication index, were significantly stratified according to complexity. There were significant differences in operative outcomes among the medium complexity procedures. The operative time for left hemihepatectomy was the shortest, and the amount of blood loss was the lowest among the medium complexity LLR. Operative times for left hemihepatectomy shortened significantly with time and experience (r = −0.639), and the slope of the learning curve was steeper than for right hemihepatectomy and right posterior sectionectomy.ConclusionLeft hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy and, given its safety and rapid learning curve for surgeons, it could become the gold standard procedure.

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An Experimental Study on the Relationship Among Airway Pressure, Pneumoperitoneum Pressure, and Central Venous Pressure in Pure Laparoscopic Hepatectomy

Cited by 78 publications

References 33 publications

Evolution and revolution of laparoscopic liver resection in Japan

Evolution and revolution of laparoscopic liver resection in Japan

Possible underestimation of blood loss during laparoscopic hepatectomy

Laparoscopic left hemihepatectomy is suitable as a first step in pure laparoscopic major hepatectomy

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