Possible underestimation of blood loss during laparoscopic hepatectomy

Abstract

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.

Impact on operative outcomes of laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases

“…In our study, estimated blood loss in the pure laparoscopic group was significantly less than in the open/hybrid group, even after stratification according to hepatectomy procedure. However, this positive effect may have been overestimated because of unaspirated bloody fluid remaining in the abdomen after laparoscopic hepatectomy 27 …”

Feasibility of Microwave-Based Scissors and Tweezers in Partial Hepatectomy: An Initial Assessment on Canine Model

“…Both AS and AT gave positive outcomes in terms of transection speed. Although the speed with AS seemed equivalent to other energy devices, AT outperformed energy devices applied in previous studies (2.1 vs. 1.07, 1.11, and 1.16 cm 2 /min) (7,8,28). The overwhelming cutting speed and minor bleeding associated with the use of AT compared to other energy devices (even with AS) might be explained by its sealing process.…”

“…The bleeding rates when using AS or AT were lower than those reported by recent studies that employed conventional energy devices in open hepatectomy. Although it is difficult to compare experimental data with clinical outcomes, the use of AT resulted in a bleeding rate that was less than onesixth of the published clinical data (0.5 vs. 6.6, 5.04, 3.19, or 3.4 mL/cm 2 ) (7,8,15,28). Both AS and AT gave positive outcomes in terms of transection speed.…”

Association between cervical length and massive intraoperative bleeding in patients with suspected placenta accreta spectrum combined with placenta previa: A retrospective cohort study

“…Intraoperative massive bleeding was defined as intraoperative bleeding ≥1,000 ml, and intraoperative bleeding <1,000 ml was considered as nonmassive bleeding. Intraoperative blood loss was calculated using preoperative and postoperative hemoglobin values (14).…”