Clinical Application Of A Modified Liver Hanging Maneuver Technique In Laparoscopic Left Hepatectomy

Objective: To explore the safety,feasibility and Clinical application value of a modified liver hanging maneuver technique in laparoscopic left hepatectomy.Methods: The clinical data of 28 patients who underwent laparoscopic left hemihepatectomy in the Department of Hepatobiliary Surgery,Affiliated Hospital of Youjiang Medical College for Nationalities from January 2019 to February 2023 were retrospectively analyzed.They were divided into study group and control group according to different surgical schemes.The study group was treated with modified liver hanging maneuver technique combined with total hepatic inflow occlusion of the first hepatic portal in 13 cases,and the control group was treated with total hepatic inflow occlusion of the first hepatic portal(Pringle method)in 15 cases.The differences in preoperative general data(age,gender,body mass index BMI,combined with Chronic viral hepatitis B,combined with cirrhosis,preoperative liver function indicators,coagulation function indicators),intraoperative conditions(operation time,intraoperative blood loss)and postoperative conditions(liver function indicators,complication rate,anal exhaust time,abdominal drainage tube indwelling time and postoperative hospital stay)were compared between the two groups.Results: There were 13 cases in the modified liver 1iver hanging maneuver group and 15 cases in the non-1iver hanging maneuver group.All patients were successfully operated without conversion to laparotomy and no death after operation.There was no significant difference in preoperative general data between the two groups(all P > 0.05).The intraoperative blood loss of the modified liver hanging maneuver group was(100.00 ±50.00)ml,and that of the non-1iver hanging maneuver group was(193.33 ± 99.76)ml.The intraoperative blood loss of the 1iver hanging maneuver group was significantly less than that of the non-1iver hanging maneuver group.The difference between the two groups was statistically significant(P < 0.05).There were statistically significant differences in serum ALT levels on the 3 rd and 5 th day after operation,serum AST levels on the 3 rd day after operation,serum ALB levels on the 5 th and 7 th day after operation,serum TBIL levels on the 5 th day after operation,serum PT levels on the 1 st,3 rd and 5 th day after operation,and average postoperative hospital stay between the two groups(all P < 0.05).There were no significant differences in the operation time,postoperative abdominal drainage tube indwelling time,incidence of postoperative complications,and postoperative anal exhaust time between the 1iver hanging maneuver group and the non-1iver hanging maneuver group(all P > 0.05).Conclusion: This modified 1iver hanging maneuver technique is safe and effective in laparoscopic left hepatectomy.Compared with traditional laparoscopic hepatectomy,the use of liver hanging maneuver in laparoscopic left hepatectomy has the advantages of significantly reducing intraoperative blood loss,accelerating postoperative recovery of liver function and shortening postoperative hospital stay.However,laparoscopic use of this modified liver hanging maneuver did not significantly shorten the operation time.The main reason is that pulling the hanging maneuver belt under laparoscopy may sometimes hinder the normal use of liver resection equipment and prolong the operation time.The application of this modified liver hanging maneuver in laparoscopic left hepatectomy still need to further study.