Experimental And Clinical Study On Laparoscopic Liver Resection

Objective: Laparoscopic liver resection is still on the stage of research due to its high difficulty and complexity on operation. There are a lot kinds of methods on the resection, but each method has its advantages and limitations. The operative technique is still immature and the clinical experience is still nonsystematic and insufficient. In order to investigate safe and feasible methods of laparoscopic liver resection and offer help for clinical application, we studied the experimental laparoscopic liver resection in pigs and clinical laparoscopic liver resection in 15 cases.Methods: 1. Experimental laparoscopic liver resection: We selected pigs as experimental models aiming to approach human being's physiological and anatomical condition. After CO2 pneumoperitoneum was established, the ligaments around liver were dissociated. Livers were cut off by the methods such as clamp dissection, microwave tissue coagulator, ultrasound dissector, Ligsure dissection, hand-assisted, short abdominal incision laparoscopy-assisted, and Endo-GIA switcher. The operation time and bleeding volume were compared between different methods of laparoscopic liver resection. The advantages and limitations of different methods were summarized. 2. Clinical laparoscopic liver resection: 15 cases with tumors in segment V of anterior right lobe or segments II, III of left lateral lobe or segment IV of left internal lobe were selected in this study. The liver diseases included hepatocellular cancer, hepatic cavernous hemangioma and hepatic focal nodular hyperplasia. The ligaments around liver were dissociated after CO2 pneumoperitoneum established. Laparoscopic liver resection were carried out by some of the methods combined such as clamp dissection, microwave tissue coagulator, hand-assisted, short abdominal incision laparoscopy-assisted, ultrasound dissector, rotation and suction dissector. The uncovered tracts and the liver wound surface were managed by some of the methods combined such as high frequency electrocoagulation, titanium clamp, suture, hemostatic gauze oppression, argon-beam coagulation, protein glue adherence, and Endo-GIA switcher. The total operative outcome, operating time, blood loss, postoperative complications and postoperative hospital stay were summarized in order to assess feasibility and safety of the clinical laparoscopic liver resection.Results: 1. Laparoscopic liver resection with clamp dissection method needs only the ordinary (without any special) laparoscopic equipment. It has a low cost but causes a little more bleeding. 2. Laparoscopic liver resection operated by microwave tissue coagulation method had very little bleeding when dissecting hepatic parenchyma. The operative field is clear and the cost is low. It is a safe, convenient and effective method. 3. Ultrasound dissector is a relatively ideal appliance for laparoscopic liver resection at present because ofless bleeding during operation. But the speed is slow thus prolongs the operation time. Its separating intensity is not strong enough, and it can only be applied to patients without hepatic cirrhosis. 4. Ligsure has clamp dissection and electrocoagulation functions. It can carbonize hepatic tissue including the tracts whose diameters are less than 7mm. It has some advantage in dissecting. However, it has the shortcomings of the clamp dissector during coagulating. 5. Hand-assisted laparoscopic liver resection can make use of the flexibility and feeling of the operator's left hand. It is convenient for exposure, dissection and bleeding control during operation. The left hand can also assist the operation of the right hand freely. In this way, the operating time is reduced and the safety of laparoscopic liver resection is greatly increased. The improved hand-assisted method of Li Chaolong has not only the advantage of classical hand-assisted laparoscopic liver resection, but also a low cost. 6. Short abdominal incision laparoscopy-assisted liver resection can use the equipment and techniques of traditional open liver resection. It is convenient an...