Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review.

Abstract

Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.

Benefits of a modified local precision liver resection using intraoperative laparoscopic ultrasound in the treatment and prognosis of patients with liver cancer.

“…However, the limited field of laparoscopy and the complex vascular and bile duct systems in the liver have brought many difficulties to laparoscopic liver resection, such as how to reduce liver vascular damage, avoid tumor residues, and reduce the postoperative recurrence rate and mortality, which have always been significant in liver surgery 12 . In order to preserve more normal liver tissue, the pursuit of the concept of an accurate liver resection has gradually become an objective to accomplish 13 . In surgery, the LUS probe can reach deeper lesions, allowing more comprehensive liver information to be presented to the operator.…”

“…In recent years, ultrasound examination has been gradually applied to laparoscopic surgery. The period of clinical use has not been very long, and since the related studies are few, the therapeutic effect of laparoscopic surgery on liver cancer still needs further analysis 13 . Therefore, this study aimed to evaluate the clinical benefits of modified precision hepatectomy using intraoperative LUS in patients with liver cancer so that this new treatment technique can be tested to find a better way to treat liver cancer.…”

The impact of obesity on short-term outcomes after the laparoscopic liver resection: a single-institution experience

“…Our results show that there were no higher rates of estimated bleeding intraoperatively in the obese group. Hepatic pedicle clamping is the traditional technique of controlling bleeding in liver resection, and it was not used more commonly when performing LLR on our group of obese patients [ 17 ]. In laparoscopy, pneumoperitoneum reduces bleeding from exposed vessels at the transected surface of the liver, making this another benefit of laparoscopy in obese patients with a higher number of comorbidities that lessen their cardiovascular reserve [ 41 ].…”

“…Established indicators of technical difficulties, such as blood loss, blood transfusion requirements, operative time, the need for the hepatic pedicle clamping, its duration, and R0 resection, were used as surrogate endpoints [ 17 ].…”

Is operation time over the benchmark value a risk factor for worse short-term outcomes after laparoscopic liver resection?

“…Despite optimal case selection, the learning curve for laparoscopic liver resection covers up to 40-60 cases per surgeon [8]. Successive acquirement of defined laparoscopic skills [9] results predominantly in reducing the operation time and intraoperative blood loss [10][11][12].…”