Discussion On A Standardized Laparoscopic Left Hemihepatectomy Model:"tunnel Method" Laparoscopic Anatomical Left Hemihepatectomy

Objective:Through retrospective study and sorting out clinical data,the relevant data of two different surgical methods of anterior laparoscopic anatomical left hemihepatectomy and "tunnel" laparoscopic anatomical left hemihepatectomy were compared and analyzed to explore the safety and feasibility of "tunnel" laparoscopic anatomical left hemihepatectomy.Methods:The clinical data of patients who underwent laparoscopic left hemihepatectomy in the Department of hepatobiliary surgery of Jianyang people’s Hospital Affiliated to Southwest Medical University from August 2018 to April 2021 were retrospectively analyzed.According to different operation methods,they were divided into two groups:19 cases in the "tunnel method"laparoscopic anatomical left hemihepatectomy group and 20 cases in the anterior laparoscopic anatomical left hemihepatectomy group.The operation time,bleeding volume,liver disconnection time,liver disconnection bleeding volume,postoperative hospital stay and postoperative complications of the two groups were statistically analyzed.Results:The operation time,bleeding volume,liver cutting time and bleeding volume of the tunnel group were lower than those of the anterior approach group[(185.53±59.84)min vs(232.50±62.92)min;(244.74±88.03)ml vs(327.50±154.30)ml;(15.11±5.53)min vs(41.25±21.21)min;(65.26±23.66)ml vs(156.50±69.46)ml],The difference was statistically significant(P<0.05,P<0.05,P<0.01,and P<0.01).There were 6 cases of postoperative complications in the anterior approach group,including 3 cases of pulmonary infection,2 cases of bile leakage and 1 case of small amount of pleural effusion.There were 4 cases of postoperative complications in the tunnel group,including 2 cases of pulmonary infection and 2 cases of bile leakage.There was no significant difference in postoperative complications between the two groups(P>0.05).There was no significant difference between the anterior approach group and the tunnel group(7.90 ± 2.27dvs7.26 ± 1.41d)(P>0.05).Conclusion:"Tunnel method" laparoscopic anatomical left hemihepatectomy is safe and feasible,with short operation time and less bleeding.It can become a choice for laparoscopic left hemihepatectomy.However,in the future,it still needs to be further confirmed by large sample research in order to be popularized in clinic.