Safety And Feasibility Study Of "Tunnel Method" Laparoscopic Anatomical Right Hemihepatectomy

Objective: To investigate the feasibility and safety of "tunnel method" of laparoscopic anatomical right hemihepatectomy.Methods: The clinical data of patients who underwent laparoscopic right hemihepatectomy in the Department of hepatobiliary surgery of Jianyang people’s Hospital Affiliated to Southwest Medical University from January2019 to October 2021 were retrospectively analyzed.According to the different operation methods,they were divided into two groups: 19 cases in the "tunnel method" laparoscopic anatomical right hemihepatectomy group and 18 cases in the anterior laparoscopic anatomical right hemihepatectomy group.The clinical data were recorded and analyzed,including the operation time,liver disconnection time,the intraoperative blood loss,the intraoperative blood transfusion volume,the hospitalization days and the postoperative complications.Results: By comparing the data related to the surgery of the two groups,preoperative data: the preoperative Child-Pugh classification of both groups was A,and there was no statistically significant difference in gender,age and remaining volume of liver parenchyma(P>0.05);intraoperative data: all 37 patients completed the surgery successfully,and all of them have no intraoperative open abdomen,in the "tunnel method" group,there was no intraoperative blood transfusion,but there was one intraoperative blood transfusion in the "anterior approach" group,and the difference in intraoperative blood transfusion was not statistically significant(P>0.05).The "tunnel method" group was superior to the anterior approach group in terms of operative time,liver dissection time,and intraoperative bleeding,[(222.1±16.9)min vs(286.1±29.7)min;(21.6±3.6)min vs(45.8±2.9)min;(305.3±36.9)ml vs(479.4±57.9)ml],and the differences were statistically significant(P<0.01,P<0.01,P<0.01).There were no statistically significant difference in the number of days of hospitalization and postoperative complications between the patients(P > 0.05,P > 0.05).Conclusion: The "tunnel" laparoscopic right hemihepatectomy is safe and feasible,and it has significant advantages over the "anterior approach" in terms of operative time,liver dissection time and intraoperative bleeding,and it is expected to become a standard procedure for laparoscopic right hemihepatectomy.However,the number of studies is still small and the long-term results of patients have not yet been followed up in this paper,so further research is needed on this procedure.