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Objective To investigate the safety and feasibility of modified hand-assisted laparoscopic surgery (MHALS) in the abdominal surgery.Methods The clinical data of 8 patients who underwent long-sleeved MHALS at the First People's Hospital of Foshan between September 2014 and January 2015 were retrospectively analyzed.Among the 8 patients,right liver cancer with intrahepatic metastasis was found in 2 patients,left liver cancer in 1 patient,hepatic peripheral nerve sheath tumor in 1 patient,left retroperitoneal leiomyosarcoma in 1 patient,extra-and intra-hepatic cholangiolithiasis in 1 patient,choledochocyst in 1 patient and ampulla cancer in 1 patient.Laparoscopic protection sleeve went through the middle of incision-retractor,and then wrapped around it about 10 cm.Incision-retractor was fixed at the abdominal incision firstly,laparoscopic procedures were performed when the wrist of assisted hand was bound and fixed by the distal of sleeve.The patients were followed up by outpatient examination and telephone interview till March 2015.Results All the 8 patients underwent successful MHALS,including 1 of right hemihepatectomy in situ,1 of ligation of right portal vein + left liver split (the patient gave up two-stage operation due to intractable ascites and elevated bilirubin),1 of hepatic left lateral lobectomy (the patient underwent hemostatic sutures in open surgery due to hemorrhage of liver's cutting surface),1 of hepatic peripheral nerve sheath tumor resection,1 of left retroperitoneal leiomyosarcoma resection,1 of choledocholithotomy + left hepatectomy + cholecystectomy + T tube drainage,1 of choledochocyst + biliary enteric drainage and 1 of pancreaticoduodenectomy.Four patients had assisted incision of 4 cm,and another 4 patients of 7 cm.Eight patients were followed up for a median time of 3 months (range,2-7 months).The patient who received ligation of right portal vein + left liver split died at postoperative month 3,and the others didn't have recurrence of tumor or lithiasis.Conclusion The MHALS is safe and feasible in the abdominal surgery.
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Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic 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 hemi-hepatic blood flow was occluded.The follow-up 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 hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients.Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic 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 T-tube was placed in 2 patients.Nine and 4 patients received left and right hemi-hepatic blood flow occlusion,respectively.The operation time,mean volume of intraoperative blood loss and time of hemi-hepatic 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 follow-up and other patients were followed up for 5-26 months with good survival,1 patient died.Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.