Key Technical Points And Clinical Analysis Of Stylized Laparoscopic Right Hemihepatectomy

Objective:With the continuous improvement of laparoscopic instruments and the continuous accumulated experience of surgeons,laparoscopic hepatectomy has made great progress.At present,laparoscopic hepatectomy can be performed not only in simple parts such as left lateral lobe of liver,but also in complicated parts such as right posterior lobe,caudate lobe,left half liver and even right half liver.Among them,laparoscopic right hemihepatectomy(LRH)has many technical difficulties,so it is considered as a difficult and high-risk operation.At present,although large-scale hepatobiliary surgery centers at home and abroad have carried out LRH operation one after another,however,due to limited time and fewer surgical cases,there is still a lack of stylized and standardized research on LRH operation.Therefore,standardized research on LRH operation can further simplify the operation procedure and narrow the regional level gap.It is an urgent problem to develop and popularize the LRH operation.This article aims to summarize the technical points of LRH operation in our department,and proposes "seven-step and two-cut" stylized laparoscopic right hemihepatectomy,and researches its safety,feasibility and clinical value by comparing its clinical data with open right hemihepatectomy.Methods:According to the inclusion and exclusion criteria set out in this study,the clinical data of 68 patients from January 2014 to December 2018 for the right hemihepatectomy in the hepatobiliary surgery department of Qilu Hospital of Shandong University were analyzed retrospectively.There were 32 cases of stylized laparoscopic right hemihepatectomy(SLRH)and 36 cases of open right hemihepatectomy(ORH).Of these,32 patients in the SLRH group were treated with the "seven-step and two-cut" stylized laparoscopic right hemihepatectomy in our department.By comparing and analyzing the operative time,intraoperative blood loss,perioperative liver function,postoperative hospital stay,postoperative complications and tumor recurrence rate,we try to summarize the technical points of "seven-step and two-cut " stylized laparoscopic right hemihepatectomy,and research its safety,feasibility and clinical value.Results:All 32 patients in SLRH group were operated under laparoscopy;none of them were converted to laparotomy.All 68 patients in SLRH group and ORH group were successfully discharged from the hospital,and there were no death cases in perioperative period.There was no significant difference in preoperative general data,intraoperative blood loss,intraoperative blood transfusion rate,postoperative complications and tumor recurrence rate between the two groups(P>0.05).The operation time of SLRH group was longer than that of ORH group(239.69±58.79 vs 163.89±26.76 min,P<0.01),but it has better performance in the postoperative liver function,length of surgical incision(6.25±0.98 vs 24.56±2.37 cm,P<0.01),postoperative hospital stay(12.31±2.26 vs 15.28±2.21 d,P<0.01)and postoperative drainage time(9.63±2.51 vs 13.06±2.15 d,P<0.01)than ORH group(P<0.05),Conclusion:Although the "seven-step and two-cut" stylized laparoscopic right hemihepatectomy has longer operation time than open right hemihepatectomy,it has the advantages of smaller incision,shorter hospital stay and faster postoperative recovery.Therefore,it is a safe and feasible operation technique and it is worth further clinical promotion.In the future,it is expected to further promote the standardization process of laparoscopic right hemihepatectomy and become another standard surgical procedure for laparoscopic hepatectomy.