Clinical Research Of Modeling Laparoscopic Liver Resection

Objective:1.Animal Research.A:To assess the feasibility of laparoscopic hepatic lobe procurement for living donor liver transplantation according to establish a porcine model.The aim of this study is to establish.B:To assess the feasibility, efficacy and safety of laparoscopic anatomical liver resection in a porcine model using radiofrequency ablation technique to determination of the resection area, inflow vascular occlusion and division of the liver parenchyma.2. Modeling Hemihepatectomy Research. A:Modeling method for laparoscopic left hemihepatectomy (LLH)was established and outcomes analyzed. B:Modeling method for laparoscopic righthemihepatectomy (LRH)was established and outcomes analyzed.3. To evaluate the surgical techniques necessary to complete totallaparoscopic hepatectomy (LH) of liver special segments (S1, S6+S7 and S8).Methods:1.A:The technique included pneumoperitoneum with CO2, ports placement, porta hepatis dissection, laparoscopic ultrasound mapping, mobilization of the liver, and transection of the parenchyma into right and left lobes. The vascular structures were stapled and sectioned just prior to removal of the specimen. B:Laparoscopic anatomical segmentectomy using ultrasound-guided radiofrequency ablates the pedicle of the liver segment (study group) was compared with conventional laparoscopic segmentectomy (control group) that each groups have 10 pigs. We compared the operation methods between the laparoscopic left lateral lobe resection using radiofrequency ablate to assist transaction of the parenchyma (study group) with conventional laparoscopic left lateral lobe resection (control group) on 20 pigs that each groups have 10 pigs.2. A:The surgical procedures of LLH were carried out with the patient placed in a supineposition and 4 trocars placed on the abdomen. After complete mobilization of the left liver, the left portal pedicles were freed and obstructed. After liver parenchymal transection, the portal pedicles and left hepatic vein(LHV) was completedivided with a stapler.Finally by wound surface management, specimen removal, wound drainage, and abdominalincision closure. B:The surgical procedures of LRH were carried out with the patient placed in the 45° left lateralposition and 4 or 5 trocars placed on the abdomen. After complete mobilization of the right liver, the right portal pedicles were freed and obstructed. After liver parenchymal transection, the right portal pedicles and right hepatic vein(RHV) was dissociated and completedivided with a stapler. Finally by wound surface management, specimen removal, wound drainage, and abdominalincision closure.3. Data ofpatients who underwent laparoscopichepatectomy were reviewed. The laparoscopic approach was facilitated by patients position, using intraoperativeultrasonography for vessels and to expose every sides of S1.Results:1. A:Hepatic lobectomies were successfully performed laparoscopically in 9 adult pigs. One pig was dead due to bleeding in IVC and following gas embolism during the parenchymal transection. The operative time was 208±25 minutes. The duration of warm ischemia was 8±2.3 minutes. The blood loss was 313±75 ml. The vascular and biliary structures were preserved to allow for subsequent transplantation. B:Laparoscopic anatomical segmentectomy using ultrasound-guided radiofrequency ablates the pedicle of the liver segment was successfully performed in 9 of 10 pigs. Mean operation time was 74±16 minutes, mean blood loss was 84±20 ml. Comparing with the control group, there has significant differences at the operation time(P=0.0118) and blood loss(P=0.0272). To the group of laparoscopic left lateral lobe resection using radiofrequency ablation, mean operation time was 136±26 minutes and mean blood loss was 110 ±36 ml. Blood loss of the study group significantly less than the control group(P=0.0126) and mean operation time has no significant differences between two groups.2. A:Between November 2011 and October 2013,23 Modelingleft hepatectomieswere performed by laparoscopy:8 for malignant and 15 forbenign tumors. Mean duration of the operation was 95.0±34.6 min. Meanoperative blood loss was 154.0±36.4 ml. None of our patientsrequired intraoperative blood transfusion. Onepatient developed a postoperative complications.Mean hospital stay was 6.3±2.4 days. B:November 2011 and October 2013,21 Modelingrighthemihepatectomieswere performed by laparoscopy:15 for malignant and 6 for benign tumors. Mean duration of the operation was 115.0 ± 44.5 min. Meanoperative blood loss was 214.0±56.4 ml. None of our patientsrequired intraoperative blood transfusion. Conversion tolaparotomy was required in 1 patient. There was no mortality. Twopatient developed postoperative complications.Mean hospital stay was 6.3±2.4 days.3.Between November 2011 and October 2013,15 hepatectomiesof liver special segments (S1, S6+S7 and S8)were performed by laparoscopy:4 for malignant and 11 for benign tumors. Mean duration of the operation was 65.0±32.5 min. Meanoperative blood loss was 154.0±43.4 ml. None of our patientsrequired intraoperative blood transfusion. Conversion tolaparotomy was never required. There was no mortality. Onepatient developed postoperative complications.Mean hospital stay was 4.7±1.8 days.Conclusion:1. A:Laparoscopic living donor procurement for liver transplantation in a porcine model is safe and feasible, from a technical perspective. B:Our study demonstrates that laparoscopic anatomical segmentectomy using RFA ablates the pedicle of the liver segment is technically feasible and is proved to be highly effective and safe. Compare to the conventional laparoscopic left lateral lobe resection, the laparoscopic left lateral lobe resection using radiofrequency ablate to assist transaction of the liver parenchyma has less blood loss.2. A:This modelingmethod can simplify the surgical procedure of LLH, reduce blood loss,Being less technically demanding, this method can be safely performed in hospitals at various levels. B:The modeling LRH is technicallydemanding but can be safely accomplished by surgeons who have experience in advanced laparoscopicprocedures and open hepatic surgery.3. LH of special segments (S1, S6+S7 and S8)is more complex and potentiallymore dangerous than other hepatectomies but that is feasible now.Such procedures should be performed by surgeonswith advanced experience both in open and minimally invasivesurgery.