120
views
0
recommends
+1 Recommend
0 collections
    24
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Perioperative outcome of laparoscopic left lateral liver resection is improved by using a bioabsorbable staple line reinforcement material in a porcine model

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          Hypothesis

          Laparoscopic liver surgery is significantly limited by the technical difficulty encountered during transection of substantial liver parenchyma, with intraoperative bleeding and bile leaks. This study tested whether the use of a bioabsorble staple line reinforcement material would improve outcome during stapled laparoscopic left lateral liver resection in a porcine model.

          Study design

          A total of 20 female pigs underwent stapled laparoscopic left lateral liver resection. In group A ( n = 10), the stapling devices were buttressed with a bioabsorbable staple line reinforcement material. In group B ( n = 10), standard laparoscopic staplers were used. Operative data and perioperative complications were recorded. Necropsy studies and histopathological analysis were performed at 6 weeks. Data were compared between groups with the Student’s t-test or the chi-square test.

          Results

          Operating time was similar in the two groups (64 ± 11 min in group A versus 68 ± 9 min in group B, p = ns). Intraoperative blood loss was significantly higher in group B (185 ± 9 mL versus 25 ± 5 mL, p < 0.05). There was no mortality. There was no morbidity in the 6-week follow-up period; however, two animals in group B had subphrenic bilomas (20%) at necropsy. At necropsy, methylene blue injection via the main bile duct revealed leakage from the biliary tree in four animals in group B and none in group A ( p < 0.05). Histopathological examination of the resection site revealed minor abnormalities in group A while animals in group B demonstrated marked fibrotic changes and damaged vascular and biliary endothelium.

          Conclusion

          Use of a bioabsorbable staple line reinforcement material reduces intraoperative bleeding and perioperative bile leaks during stapled laparoscopic left lateral liver resection in a porcine model.

          Related collections

          Most cited references35

          • Record: found
          • Abstract: found
          • Article: not found

          Laparoscopic liver resections: a feasibility study in 30 patients.

          To assess the feasibility and safety of laparoscopic liver resections. The use of the laparoscopic approach for liver resections has remained limited for technical reasons. Progress in laparoscopic procedures and the development of dedicated technology have made it possible to consider laparoscopic resection in selected patients. A prospective study of laparoscopic liver resections was undertaken in patients with preoperative diagnoses including benign lesion, hepatocellular carcinoma with compensated cirrhosis, and metastasis of noncolorectal origin. Hepatic involvement had to be limited and located in the left or peripheral right segments (segments 2-6), and the tumor had to be 5 cm or smaller. Surgical technique included CO2 pneumoperitoneum and liver transection with a harmonic scalpel, with or without portal triad clamping or hepatic vein control. Portal pedicles and large hepatic veins were stapled. Resected specimens were placed in a bag and removed through a separate incision, without fragmentation. From May 1996 to December 1999, 30 of 159 (19%) liver resections were included. There were 18 benign lesions and 12 malignant tumors, including 8 hepatocellular carcinomas in cirrhotic patients. Mean tumor size was 4.25 cm. There were two conversions to laparotomy (6.6%). The resections included 1 left hepatectomy, 8 bisegmentectomies (2 and 3), 9 segmentectomies, and 11 atypical resections. Mean blood loss was 300 mL. Mean surgical time was 214 minutes. There were no deaths. Complications occurred in six patients (20%). Only one cirrhotic patient developed postoperative ascites. No port-site metastases were observed in patients with malignant disease. Laparoscopic resections are feasible and safe in selected patients with left-sided and right-peripheral lesions requiring limited resection. Young patients with benign disease clearly benefit from avoiding a major abdominal incision, and cirrhotic patients may have a reduced complication rate.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: not found

            Laparoscopic anatomical (hepatic) left lateral segmentectomy-technical aspects.

            Laparoscopic liver surgery is a tremendous challenge. The authors report a left liver lobectomy and removal by a total laparoscopic approach. Anatomical left lateral laparoscopic segmentectomy was performed on a woman who had a symptomatic hepatic adenoma. The patient was discharged after an uncomplicated postoperative recovery; the hospital stay and convalescence period were very short. The cosmetic result was good.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Laparoscopic versus open hepatic resections for benign and malignant neoplasms--a meta-analysis.

              Laparoscopic surgery for hepatic neoplasms aims to provide curative resection while minimizing complications. The present study compared laparoscopic versus open surgery for patients with hepatic neoplasms with regard to short-term outcomes. Comparative studies published between 1998 and 2005 were included. Evaluated endpoints were operative, functional, and adverse events. A random-effects model was used and sensitivity analysis performed to account for bias in patient selection. Eight nonrandomized studies were included, reporting on 409 resections of hepatic neoplasms, of which 165 (40.3%) were laparoscopic and 244 (59.7%) were open. Operative blood loss (weighted mean difference = -123 mL; confidence interval = -179, -67 mL) and duration of hospital stay (weighted mean difference = -2.6 days; confidence interval = -3.8, -1.4 days) were significantly reduced after laparoscopic surgery. These findings remained consistent when considering studies matched for the presence of malignancy and segment resection. There was no difference in postoperative adverse events and extent of oncologic clearance. Laparoscopic resection results in reduced operative blood loss and earlier recovery with oncologic clearance comparable with open surgery. When performed by experienced surgeons in selected patients it may be a safe and feasible option. Because of the potential of significant bias arising from the included studies, further randomized controlled trials should be undertaken to confirm this bias and to assess long-term survival rates.
                Bookmark

                Author and article information

                Contributors
                ECJ.Consten@meandermc.nl
                +31 33 4227848 , +31 33 4227850 , j.l.robertus@path.umcg.nl
                Journal
                Surg Endosc
                Surgical Endoscopy
                Springer-Verlag (New York )
                0930-2794
                1432-2218
                1 February 2008
                May 2008
                : 22
                : 5
                : 1188-1193
                Affiliations
                [1 ]Department of Surgery, Meander Medical Center, Teaching Hospital affiliated to the University Medical Center Utrecht, Utrechtseweg 160, Amersfoort, JB 3816 The Netherlands
                [2 ]Department of Surgery, Weill College of Medicine, Cornell University, 525 East 68th Street, Box 294, New York, NY 10021 USA
                [3 ]Department of Pathology and Laboratory Medicine, University Medical Center, Groningen, The Netherlands
                [4 ]Mount Sinai Medical Center, 4300 Alton Road, Miami Beach, FL 33140 USA
                Article
                9718
                10.1007/s00464-007-9718-6
                2358937
                18246395
                e4978f0f-7735-4ea3-9315-af85766e3380
                © The Author(s) 2008
                History
                : 14 August 2006
                : 17 October 2007
                : 2 November 2007
                Categories
                Article
                Custom metadata
                © Springer Science+Business Media, LLC 2008

                Surgery
                staple line reinforcement,bile duct leak,complications,laparoscopic surgery,hemorrhage.,liver resections

                Comments

                Comment on this article