Operative techniques to avoid near misses during laparoscopic hepatectomy
Operative techniques to avoid near misses during laparoscopic hepatectomy
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DOI：
10.1016/j.surg.2016.07.023
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发表时间：
2017-02-01
期刊：
影响因子：
3.8
通讯作者：
Gayet, Brice
中科院分区：
文献类型：
--
作者：
Kawaguchi, Yoshikuni;Velayutham, Vimalraj;Gayet, Brice
背景。尽管具有放大腹腔镜视图的优势，但腹腔镜肝切除术期间缺乏完整的肝脏概览和触觉反馈可能会导致险些发生或致命的术中并发症。本研究的目的是描述手术技术和指导原则，以解决腹腔镜肝切除术特有的险情，并评估术中并发症发生率。方法。回顾了 408 名接受腹腔镜肝切除术的连续患者的数据。两名外科医生对患者进行了评估，以解决腹腔镜肝切除术特有的险情和陷阱的代表性手术技术和指导原则。结果。大多数未遂事故是由于缺乏对腹腔镜肝切除术独特的腹腔镜视图和解剖学方面的了解。解决这些问题的操作技术和/或指导原则如下：从下斜部分开始实质横断；在确认分叉前未结扎右门静脉或左门静脉；使用密封装置解剖短肝静脉；使用剪刀解剖肝静脉根部；暴露肝中静脉，其在解剖学上靠近肝门板；并使用术中超声检查识别 V8。术中因血管损伤或手术夹滑脱导致大出血的患者有25例（6.1%），其发生率随年限有明显下降趋势。结论。我们展示了解决腹腔镜肝切除术中未遂事故的手术技术和指导原则。随着时间的推移，术中大出血发生率呈下降趋势。
Background. The lack of a complete hepatic overview and tactile feedback during laparoscopic hepatectomy may result in near misses or fatal intraoperative complications despite the advantage of a magnified laparoscopic view. The aim of the study is to describe operative techniques and guiding principles with which to address near misses unique to laparoscopic hepatectomy and evaluate the intraoperative complication rate overtime.Methods. Data of 408 consecutive patients who underwent laparoscopic hepatectomy were reviewed. Representative operative techniques and guiding principles with which to address near misses and pitfalls unique to laparoscopic hepatectomy were evaluated among the patients by 2 surgeons.Results. Most near misses were due to lack of understanding of both the laparoscopic view and anatomic aspects unique to laparoscopic hepatectomy. Operative techniques and/or guiding principles with which to address these issues were demonstrated as follows: starting parenchymal transection at the declivitous parts; no ligation of the right or left portal vein before confirming the bifurcation; dissection of the short hepatic vein using a sealing device; dissection of the root of the hepatic vein using scissors; exposure of the middle hepatic vein, which is anatomically close to the hilar plate; and identification of V8 using intraoperative ultrasonography. The intraoperative massive bleeding due to vessel injury or surgical clip slippage occurred in 25 patients (6.1 %), and its rate had a significant trend to decrease with increasing years.Conclusion. We demonstrated operative techniques and guiding principles with which to address near misses in laparoscopic hepatectomy. The intraoperative massive bleeding rate trended to decrease over time.