Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd International Consensus Conference on Laparoscopic Liver Resection
Laparoscopic hepatectomy is theoretically better than open hepatectomy: preparing for the 2nd International Consensus Conference on Laparoscopic Liver Resection
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DOI：
10.1002/jhbp.139
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发表时间：
2014-10-01
影响因子：
3
通讯作者：
Buell, Joseph F.
中科院分区：
文献类型：
--
作者：
Wakabayashi, Go;Cherqui, Daniel;Buell, Joseph F.
自首届腹腔镜肝切除术国际共识会议召开以来，已经过去了六年。从那时起，这种相对较新的手术技术不断发展，并迅速在世界范围内采用。我们以右肝切除术为例，比较了开放和腹腔镜肝切除术的理论差异。我们还在Cochrane图书馆搜索了关键词“腹腔镜肝切除术”。通过检索检索到的论文被审查、分类，并应用于将在第二届共识会议上讨论的临床问题。腹腔镜肝切除术比开放式肝切除术更难掌握，因为当我们从体腔外进行手术时，我们的行动受到限制。然而，位于肋弓下方的肝周围手术野的良好可视性和放大提供了肝实质的整齐横切。另一个理论上的优势是气腹压力减少肝静脉出血。文献检索得到67篇论文，我们排除了23篇，只剩下44篇。两项随机对照试验（rct）正在进行中，但其结果尚未发表。大多数研究（n = 15）涉及短期结果，一些研究涉及长期结果（n = 7）、成本（n = 6）、能源设备（n = 4）等。腹腔镜肝切除术由于其放大效果，术野可见性好，减少了因气腹压力引起的肝静脉出血，理论上优于开放式肝切除术。然而，从短期和长期的结果来看，之前的研究还没有证据支持这一观点。第二届腹腔镜肝切除术国际共识会议将在现有最佳证据的基础上达成共识，视频演示侧重于手术技术，并根据专家的经验发布程序标准化指南。
Six years have passed since the first International Consensus Conference on Laparoscopic Liver Resection was held. This comparatively new surgical technique has evolved since then and is rapidly being adopted worldwide. We compared the theoretical differences between open and laparoscopic liver resection, using right hepatectomy as an example. We also searched the Cochrane Library using the keyword "laparoscopic liver resection." The papers retrieved through the search were reviewed, categorized, and applied to the clinical questions that will be discussed at the 2nd Consensus Conference. The laparoscopic hepatectomy procedure is more difficult to master than the open hepatectomy procedure because of the movement restrictions imposed upon us when we operate from outside the body cavity. However, good visibility of the operative field around the liver, which is located beneath the costal arch, and the magnifying provide for neat transection of the hepatic parenchyma. Another theoretical advantage is that pneumoperitoneum pressure reduces hemorrhage from the hepatic vein. The literature search turned up 67 papers, 23 of which we excluded, leaving only 44. Two randomized controlled trials (RCTs) are underway, but their results are yet to be published. Most of the studies (n = 15) concerned short-term results, with some addressing long-term results (n = 7), cost (n = 6), energy devices (n = 4), and so on. Laparoscopic hepatectomy is theoretically superior to open hepatectomy in terms of good visibility of the operative field due to the magnifying effect and reduced hemorrhage from the hepatic vein due to pneumoperitoneum pressure. However, there is as yet no evidence from previous studies to back this up in terms of short-term and long-term results. The 2nd International Consensus Conference on Laparoscopic Liver Resection will arrive at a consensus on the basis of the best available evidence, with video presentations focusing on surgical techniques and the publication of guidelines for the standardization of procedures based on the experience of experts.