Application of hemihepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy

Objective:To explore the application value of hemihepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.
Methods:The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemihepatic blood flow occlusion using descending hilar plate technique at the First People′s hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed. The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles. Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate. Anatomic hepatectomy was performed when hemihepatic blood flow was occluded. The followup by telephone interview and outpatient examination was done till October 2014.
Results:Among the 15 patients, the conversion to open surgery was done in 1 patient, Pringle maneuver in 1 patient, and hemihepatic blood flow occlusion by descending the hilar plate in 14 patients. Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemihepatic blood flow occlusion using descending hilar plate technique, including 4 of left hemihepatectomy, 4 of left lateral lobectomy, 2 of right hemihepatectomy, 1 of right posterior lobectomy, 1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy. Bile duct exploration was applied to 4 patients with left hepatic duct stones and Ttube was placed in 2 patients. Nine and 4 patients received left and right hemihepatic blood flow occlusion, respectively. The operation time, mean volume of intraoperative blood loss and time of hemihepatic blood flow occlusion in 13 patients were (196±63)minutes, 320 mL (range, 50-1 200 mL) and (51±20)minutes, respectively. The time of descending the hilar plate in 14 patients was (10±4)minutes. Among the 13 patients, bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/day, liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2. Two patients were cured by conservative treatment, and no liver failure and perioperative death were occurred. The duration of hospital stay was (6.9±2.4)days. Among the 15 patients, 2 patients were loss to followup and other patients were followed up for 5-26 months with good survival, 1 patient died.
Conclusion:Hemihepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.