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CLC number: R605

On-line Access: 2016-09-07

Received: 2016-04-27

Revision Accepted: 2016-06-23

Crosschecked: 2016-08-20

Cited: 0

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Citations:  Bibtex RefMan EndNote GB/T7714

 ORCID:

Liu-xin Cai

http://orcid.org/0000-0002-6734-5949

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Journal of Zhejiang University SCIENCE B 2016 Vol.17 No.9 P.712-721

http://doi.org/10.1631/jzus.B1600180


Can retrohepatic tunnel be quickly and easily established for laparoscopic liver hanging maneuver by Goldfinger dissector in laparoscopic right hepatectomy?


Author(s):  Liu-xin Cai, Fang-qiang Wei, Yi-chen Yu, Xiu-jun Cai

Affiliation(s):  Department of General Surgery, Institute of Minimally Invasive Surgery, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou 310016, China

Corresponding email(s):   cxjzu@hotmail.com

Key Words:  Retrohepatic tunnel, Liver hanging maneuver, Goldfinger dissector, Laparoscopic right hepatectomy


Liu-xin Cai, Fang-qiang Wei, Yi-chen Yu, Xiu-jun Cai. Can retrohepatic tunnel be quickly and easily established for laparoscopic liver hanging maneuver by Goldfinger dissector in laparoscopic right hepatectomy?[J]. Journal of Zhejiang University Science B, 2016, 17(9): 712-721.

@article{title="Can retrohepatic tunnel be quickly and easily established for laparoscopic liver hanging maneuver by Goldfinger dissector in laparoscopic right hepatectomy?",
author="Liu-xin Cai, Fang-qiang Wei, Yi-chen Yu, Xiu-jun Cai",
journal="Journal of Zhejiang University Science B",
volume="17",
number="9",
pages="712-721",
year="2016",
publisher="Zhejiang University Press & Springer",
doi="10.1631/jzus.B1600180"
}

%0 Journal Article
%T Can retrohepatic tunnel be quickly and easily established for laparoscopic liver hanging maneuver by Goldfinger dissector in laparoscopic right hepatectomy?
%A Liu-xin Cai
%A Fang-qiang Wei
%A Yi-chen Yu
%A Xiu-jun Cai
%J Journal of Zhejiang University SCIENCE B
%V 17
%N 9
%P 712-721
%@ 1673-1581
%D 2016
%I Zhejiang University Press & Springer
%DOI 10.1631/jzus.B1600180

TY - JOUR
T1 - Can retrohepatic tunnel be quickly and easily established for laparoscopic liver hanging maneuver by Goldfinger dissector in laparoscopic right hepatectomy?
A1 - Liu-xin Cai
A1 - Fang-qiang Wei
A1 - Yi-chen Yu
A1 - Xiu-jun Cai
J0 - Journal of Zhejiang University Science B
VL - 17
IS - 9
SP - 712
EP - 721
%@ 1673-1581
Y1 - 2016
PB - Zhejiang University Press & Springer
ER -
DOI - 10.1631/jzus.B1600180


Abstract: 
Objective: The liver hanging maneuver (LHM) is rarely applied in laparoscopic right hepatectomy (LRH) because of the difficulty encountered in retrohepatic tunnel (RT) dissection and tape positioning. Thus far no report has detailed how to quickly and easily establish RT for laparoscopic LHM in LRH, nor has employment of the goldfinger dissector to create a total RT been reported. This study’s aim was to evaluate the safety and feasibility of establishing RT for laparoscopic LHM using the goldfinger dissector in LRH. Methods: Between March 2015 and July 2015, five consecutive patients underwent LRH via the caudal approach with laparoscopic LHM. A five-step strategy using the goldfinger dissector to establish RT for laparoscopic LHM was adopted. Perioperative data were analyzed. Results: The median age of patients was 58 (range, 51–65) years. Surgery was performed for one intrahepatic lithiasis and four hepatocellular carcinomas with a median size of 90 (40–150) mm. The median operative time was 320 (282–358) min with a median blood loss of 200 (200–600) ml. Laparoscopic LHM was achieved in a median of 31 (21–62) min, and the median postoperative hospital stay was 14 (9–16) d. No transfusion or conversion was required, and no severe liver-related morbidity or death was observed. Conclusions: The goldfinger dissector is a useful instrument for the establishment of RT. A five-step strategy using the goldfinger dissector can quickly and easily facilitate an RT for a laparoscopic LHM in LRH.

能否运用金手指在腹腔镜右半肝切除术中快速简易建立肝后隧道实行绕肝带提拉?

目的:评估金手指在腹腔镜右半肝切除术中快速简易建立肝后隧道实行绕肝带提拉的可行性和安全性。
创新点:在腹腔镜右半肝中很少采用绕肝带提拉,这是因为在腹腔镜下解剖肝后隧道和置放绕肝带难度极大。本文首次详细报道在腹腔镜右半肝切除术中快速简易建立肝后隧道来实行绕肝带提拉,同时首次报道运用金手指在腹腔镜下建立完整的肝后隧道。
方法:选取2015年3月至7月间5例连续接受前入路腹腔镜右半肝切除术并行绕肝带提拉的患者为研究对象,运用金手指在腹腔镜下进行5步法建立肝后隧道,收集和研究这些患者的手术资料。
结论:这5例患者的中位年龄为58岁(范围51~65岁)。其中,1例患有肝内胆管结石,4例患有肝细胞性肝癌。肿瘤中位直径为90 mm(范围40~150 mm),手术中位时间为320 min(范围282~358 min),中位失血量为200 ml(范围200~600 ml),腹腔镜下绕肝带提拉中位完成时间为31 min(范围21~62 min),术后中位住院时间为14 d(范围9~16 d)。术中未行输血,未发生中转开腹;术后并未发生严重肝脏并发症,无患者死亡。因此运用金手指进行肝后隧道建立是有效可行的。采取5步法可快速简易建立肝后隧道,有助于在腹腔镜右半肝切除术中安全有效进行绕肝带提拉。

关键词:肝后隧道;绕肝带提拉;金手指;腹腔镜右半肝切除术

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[23]List of electronic supplementary materials

[24]Fig. S1 Establishing the initial caudal portion of the retrohepatic tunnel (initial cad-RT)

[25]Fig. S2 Establishing the median portion of the retrohepatic tunnel (med-RT)

[26]Fig. S3 Establishing the total retrohepatic tunnel (RT)

[27]Fig. S4 Placement of the hanging tape through the whole retrohepatic tunnel (RT)

[28]Fig. S5 Parenchymal transection of the median hepatic fissure (MHF)

[29]Fig. S6 Achievement of hemostasis after removal of the specimen

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