J Vet Sci.  2014 Sep;15(3):417-422. 10.4142/jvs.2014.15.3.417.

Laparoscopic left hepatectomy in swine: a safe and feasible technique

Affiliations
  • 1Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin 150030, China. hbwang1940@126.com
  • 2Department of Histology and Embryology, Harbin Medical University, Harbin 150081, China.

Abstract

A purely laparoscopic four-port approach was created for left hepatectomy in pigs. A polyethylene loop was placed on the left two hepatic lobes for traction and lift. Next, penetrating ligation of the lobes using of a double row of silk sutures was performed to control bleeding. A direct hepatic transection was completed using a monopolar hook electrode without meticulous dissection of the left hepatic vein. The raw surface of the liver was coagulated and sealed with fibrin glue. Lobes were retrieved through an enlarged portal. Laparoscopic hepatic lobectomy was completed in all pigs without the use of specialized instruments and with a mean operative time of 179 +/- 9 min. No significant perioperative complications were observed. The average weight of each resected lobe was 180 +/- 51 g. Complete blood count as well as serum organics and enzyme levels normalized after about 2 weeks. During necropsy, adhesion of the hepatic raw surface to the gastric wall and omentum were observed. No other abnormalities were identified. This minimally invasive left hepatectomy technique in swine could serve as a useful model for investigating liver diseases and regeneration, and offer preclinical information to improve hepatobiliary surgical procedures.

Keyword

hepatectomy; laparoscopy; left; pigs; technique

MeSH Terms

Animals
Female
Hepatectomy/methods/*veterinary
Laparoscopy/methods/veterinary
Liver/surgery
Male
Postoperative Care/methods/veterinary
Swine/*surgery
Swine, Miniature/surgery

Figure

  • Fig. 1 Portal locations. Portal 1 (laparoscope) was located 2~3 cm below the umbilicus along the ventral midline (portal 1 was shifted 2~3 cm to the left in male pigs). Portals 2 and 3 were 3~5 cm cranial to portal 1 and 8~10 cm to the left and right of the ventral midline, respectively. Portal 4 was 3~5 cm cranial to portal 3 and 8~10 cm to the left of the ventral midline. These portals were used to introduce various laparoscopic instruments.

  • Fig. 2 Simulated intraoperative view. A polyethylene loop (arrow) was placed on the left median lobe for traction and lifting.

  • Fig. 3 Simulated intraoperative view. Penetrating ligature of the hepatic parenchyma at the root of the lobe using three needles threaded with a silk suture (arrows).

  • Fig. 4 Intraoperative view. The left branches of the portal vein (arrow) were dissected and then clamped with medium titanium clips before cutting.

  • Fig. 5 Simulated intraoperative view. A knot was tied between the ends of the snipped sutures with the aid of needle-holding forceps (F).

  • Fig. 6 Simulated intraoperative view. A knot was tied with the aid of needle-holding forceps (F) inserted from the third trocar.

  • Fig. 7 Intraoperative view. The raw area observed immediately after liver resection.


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