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Objective To evaluate the feasibility and safety of laparoscopic right hemihepatectomy under selective hemihepatic inflow occlusion.Methods In performing this procedure,first dissect the right hepatic portal,and under selective hemihepatic inflow occlusion,laparoscopie Peng's multifunctional operative dissector (LPMOD) was used to transect the hepatic parenchyma by stepwise curettage and aspiration.Results Procedures were successful in all six patients of benign liver diseases,though a small subcostal auxiliary incision was needed in one case to control the middle hepatic vein branch hemorrhage.Operation time was 300-540 min[mean,( 399 ± 75 ) min].The time of hepatic portal dissect was 30-75 min[mean,(51 ± 16) min].The time of liver parenchyma transection was 60-160 min[mean,( 116 ± 32) min].Intraoperative blood loss was 600-3000 ml[mean,( 1486 ± 809 ) ml].The level of ALT increased to (302-557) U/L[mean,(386 ± 85 ) U/L]after the operation,and back to normal level in 5-11 d[mean,( 7.1 ± 2.0) d].The postoperative hospital stay was 10-18 d[mean,( 12.4 ± 2.6 ) d].No severe complication occurred after the operation.Conclusions Laparoscopic right hemihepatectomy under selective hemihepatic inflow occlusion is safe and feasible.
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Objective To evaluate if continuous hemihepatic inflow occlusion(HH)during hepatectomy can be as safe and effective as intermittent total hepatic inflow occlusion(TH)in reducing blood loss during hepatectomy.Methods From November 2001 to March 2006.eighty patients undergoing liver resections were included in a prospective randomized study comparning the intra-and postoperative course underTH(n=40)or HH(n=40).TH was performed with periods of 20 minutes of occlusion and 5 minutes of releasing,while HH with continuous occlusion.The surface area of liver transection was measured and blood loss was calculated.The amount of blood loss,levels of alanine aminotransferuse (ALT)and aspartate aminotransferase(AST),and postoperative course were recorded. Results The total ischemic time of the HH groups was longer than in the TH group[(42±13)min,(31±13)min,P=0.37],and the operative time in the HH group was longer than in the TH group[(236 ±49)min,(204±38)min,P=0.02 ].No signincant difierenee was found between HH and TH group in blood loss during liver parenchyma transection[(500 ±269)ml,(416 ±235)ml,P=0.14]and in the changes of ALT and AST on the first postoperative day[ALT:(677±572)IU/L,(577 ±327)IU/L,P=0.12;AST:(591 ±468)IU/L,(512±301)IU/L,P=0.66].There were no difierences on postoperative morbidity between the two groups(22.5%versus 20.0%,P=0.35).Conclusion The technique of continuous hemihepatic inflow occlusion is as safe and effective as intermittent total hepatic inflow occlusion.