Ann Surg Treat Res.  2014 Aug;87(2):66-71. 10.4174/astr.2014.87.2.66.

Rationale and surgical technique of laparoscopic left lateral sectionectomy using endoscopic staples

• Lee BH
• Yun SS
• Kim MK
• Jung HK
• Lee DS
• Kim HJ

• KMID: 1882833
• DOI: http://doi.org/10.4174/astr.2014.87.2.66

Abstract

PURPOSE
Laparoscopic left lateral sectionectomy (LLLS) has been widely accepted due to benefits of minimally invasive surgery. Some surgeons prefer to isolate glissonian pedicles to segments II and III and to control individual pedicles with surgical clips, whereas opt like to control glissonian pedicles simultaneously using endoscopic stapling devices. The aim of this study was to find the rationale of LLLS using endoscopic staples.
METHODS
We retrospectively analyzed and compared the clinical outcomes (operation time, drainage length, transfusion, hospital stay, and complication rate) of 35 patients that underwent LLLS between April 2004 and February 2012. Patients were dichotomized by surgical technique based on whether glissonian pedicles were isolated and controlled (the individual group, n = 21) or controlled using endoscopic staples at once (the batch group, n = 14).
RESULTS
Mean operation time was 265.3 +/- 21.3 minutes (mean +/- standard deviation) in the individual group and 170 +/- 22.9 minutes in the batch group. Operation time in the batch group was significantly shorter than the individual group (P = 0.007). Mean drainage length was 4.8 +/- 1.6 and 2.6 +/- 1.5 days in the individual and the batch group. There was significantly shorter in the batch group, also (P = 0.006). No transfusion was required in the batch group, but 4 patients in the individual group needed transfusion. Mean hospital stay was 10.7 +/- 1.1 and 9.4 +/- 0.8 days in the individual and the batch groups (P = 0.460). There were no significant complications or mortality in both groups.
CONCLUSION
LLLS using endoscopic staples (batch group) was found to be an easier and safer technique without morbidity or mortality.

Keyword

Laparoscopy; Hepatectomy; Surgical staples

MeSH Terms

Drainage
Hepatectomy
Humans
Laparoscopy
Length of Stay
Mortality
Retrospective Studies
Surgical Instruments
Surgical Procedures, Minimally Invasive
Sutures

Figure

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  Fig. 1 The four ports used for laparoscopic left lateral sectionectomy.

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  Fig. 2 Dissection of liver parenchyme using a Harmonic scalpel (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA). Starting just left of the falciform ligament.

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  Fig. 3 Exposure of glissonian pedicles after liver parenchymal dissection.

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  Fig. 4 (A) Transection of glissonian pedicles to segments II and III using an Endo-GIA (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) and a 60-mm white cartridge. (B) Transection of glissonian pedicles to segments II and III using an Endo-GIA and a 60-mm white cartridge. Arrows: staple lines after using an Endo-GIA.

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  Fig. 5 Transection of the left hepatic vein using an Endo-GIA (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) and a 60-mm white cartridge.

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  Fig. 6 Postoperative finding of laparoscopic left lateral sectionectomy using an Endo-GIA (Ethicon Endo-Surgery Inc., Cincinnati, OH, USA) and a 60-mm white cartridge. Arrow: The staple line is always located at the lowermost portion of transected liver parenchyma.

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  Fig. 7 Postoperative laboratory finding in the individual group and batch group. There was no significant difference between the individual and the batch group (A, P = 0.584; B, P = 0.617; C, P = 0.107). POD, postoperative day.

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