Scientific paperHepatic resection using stapling devices
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
References (11)
- et al.
Hepatic resection using stapling devices to control the hepatic veins
Am J Surg
(1989) - et al.
Laparoscopic partial hepatectomy and left lateral segmentectomytechnique and results of a clinical series
Surgery
(1996) - et al.
Use of vascular staplers in major hepatic resection
Br J Surg
(1991) - et al.
Vascular endostapler as aid to hepatic vein control during hepatic resection
Am J Surg
(1996) - et al.
Laparoscopic hepatectomy for extrahepatic growing tumor. Surgical strategy based on extrahepatic growing index
Surg Endosc
(2002)
Cited by (53)
The Prognostic Value of Varying Definitions of Positive Resection Margin in Patients with Colorectal Cancer Liver Metastases
2018, Journal of Gastrointestinal SurgeryAnesthesia for Hepatobiliary Surgery
2015, Anesthesiology ClinicsCitation Excerpt :A newer device, the harmonic scalpel,62,63 is a saline-linked radiofrequency sealer that delivers energy through saline dripping from the tip, causing coagulation via necrosis on the transection surface. The large hepatic vessels are left intact by these techniques and exposed vascular structures are separately ligated, stapled,64 or controlled with diathermy. There is no definitive evidence for one technique, because clinical studies tend to include small patient numbers.
Laparoscopic Liver Resection
2009, Surgical PitfallsPARTIAL HEPATECTOMY USING LINEAR CUTTER STAPLER: ARE THERE ADVANTAGES?
2023, Arquivos Brasileiros de Cirurgia DigestivaA fast and easy-to-learn technique for liver resection in a porcine model
2021, Journal of International Medical ResearchEfficiency of a radiofrequency sealer (Aquamantys) for parenchymal transection during laparoscopic hepatectomy
2020, Asian Journal of Endoscopic Surgery