Scientific paper
Hepatic resection using stapling devices

https://doi.org/10.1016/j.amjsurg.2003.11.005Get rights and content

Abstract

Background

The progress and development of stapling devices has been remarkable. They have become indispensable for gastrointestinal diseases and are increasingly utilized in laparoscopic operations. Liver surgery applications for this technique are continuing to emerge, and in this study, we introduced the use of stapling devices to hepatic surgery.

Methods

We examined the operative procedure and efficacy of hepatic resections using stapling devices as follows: transection of Glisson's pedicle and the hepatic vein using endolineal stapling devices in right and left lobectomies; bisegmentectomy II and III en masse using a stapling device; and application of endolineal stapling devices to vessel transections and dissections of the hepatic parenchyma in laparoscopic hepatectomies.

Results

It was considered useful to tactfully apply stapling devices to vessel transections and dissections of the hepatic parenchyma in order to simplify the operative procedures of right or left lobectomies and lateral segmentectomies. Furthermore, the use of endoscopic stapling devices was an acceptable alternative to vessel transactions and dissections of the hepatic parenchyma in laparoscopic hepatectomies.

Conclusions

We believe that stapling devices will become utilized in liver surgery hereafter.

Section snippets

Glisson's pedicle and hepatic vein transections using stapling devices in right and left hepatic lobectomies

For the transection of Glisson's pedicle (Fig. 1), the first branch of Glisson's pedicle was exposed after dissecting the bifurcation of Glisson's sheath from the liver parenchyma following cholecystectomy. The right main portion of Glisson's pedicle for approximately 2 cm was exposed to allow safe stapling across Glisson's pedicle. In right lobectomies, Glisson's pedicle had to be dissected almost up to the anterior and posterior branches since the right main branch of Glisson's pedicle was

Results

Transection of the main Glisson's pedicle and the hepatic veins with stapling devices during right and left hepatic lobectomies was applied in 15 cases; there were 8 cases of hepatocellular carcinoma and 7 cases of metastatic liver carcinoma. The mean operative time and the blood loss in the right lobectomy cases were, respectively 282 minutes (range 235 to 430) and 950 mL (range 390 to 3,620 mL); in left lobectomy cases, the corresponding values were 194 minutes (range 132 to 402) and 490 mL

Comments

Glisson's pedicle is defined as the fibrous pedicle consisting of the portal triad within the hepatic parenchyma. The standard technique for performing a major hepatectomy is to separately divide the hepatic artery, portal vein, and hepatic duct. In patients with chronic hepatitis or cirrhosis, however, this technique often causes excessive blood loss and ascites accumulation because of preexisting coagulopathy and aggravation of portal hypertension. Thus, for right or left lobectomies it is

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