Laparoscopic Liver Resection, Tourniquet, Vascular Occlusion
Conditions
Keywords
Laproscopic hepatectomy, Bulldog, Vascular occlusion
Brief summary
LLR was applied for tumors located at the lower edge and lateral segments of the liver that could be resected more easily than posterosuperior segments. With the development of technology and the growing experience of hepatobiliary surgeons, LLR has been expanded to major liver resections, anatomical resections, and donor hepatectomies by skilled surgeons. However, postoperative mortality, mobility and recovery of liver function are associated with major blood loss which is always the main cause of conversion to laparotomy and remains a challenge for surgeons. Pringle first described the method to arrest the hepatic hemorrhage by compression of the porta hepatis and this procedure was widely spread as well as in laparoscopic feild currently. Here, we described a new modified of Pringle maneuver using Bulldog to block vascular during LLR, and compared its effects with traditional pringle maneuver.
Detailed description
With the innovations of laparoscopic technique and specialized equipment , laparoscopic liver resection became the dominating resection surgery approach. December of 2014, laparoscopic hepatectomy was carried out in our department, extracorporeal Pringle maneuver has been applied in most laparoscopic liver resections which need to block the hepatic inflow, cotton tape was the frequently used tourniquet. We used to blocked the hepatic inflow by extracorporeal Pringle maneuver method with cotton tape for its validity , softness and no visible damages for vessel, but it was always difficult for clamping in a two-dimensional view to encircle the hepatoduodenal ligament , and it delayed operation time for freshmen. Bulldog has been widely used in urinary surgery for vascular occlusion, but bulldog in hepatic surgery has rarely been mentioned, this is the first report to formally demonstrate the clinical application in hepatic surgery. However, it is not clear that whether the bulldog for vascular occlusion is useful and easy to implement in laparoscopic hepatectomy. In this study, we will compare the cotton and the bulldog for vascular occlusion during laparoscopic hepatectomy
Interventions
PROCEDUREBULLDOG ,A Useful Vascular Occlusion Tourniquet In Laparoscopic Liver Resection
Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle manuever.
PROCEDUREcotton tourniquet
cotton tourniquet
Sponsors
hui hou
Study design
Allocation
RANDOMIZED
Intervention model
PARALLEL
Primary purpose
PREVENTION
Masking
TRIPLE (Subject, Caregiver, Investigator)
Eligibility
Sex/Gender
ALL
Age
18 Years to 80 Years
Healthy volunteers
No
Inclusion criteria
* Patient who underwent hepatectomy for benign or malignant neoplasm of the liver, and is suitable for laparoscopic liver resection * Child-Pugh A without portal hypertension * No portosystemic shunt * No previous abdominal operation history * American society of anesthesiology class(ASA): I or II * Age 18 to 80
Exclusion criteria
* Additional intervention to the liver (Radio Frequent Ablation, Percutaneous Ethanol. Injection Therapy or others) * Emergence hepatectomy * Previous hepatectomy * Combined operation for extrahepatic disease * Vulnerable population (mental retardation, pregnancy)
Design outcomes
Primary
| Measure | Time frame | Description |
|---|---|---|
| Blood loss | intraoperative | the volume of blood loss |
Secondary
| Measure | Time frame | Description |
|---|---|---|
| Postoperative complication(Rates in different grades) | up to 30 days after liver resection | According to The Clavien-Dindo Classification,https://www.assessurgery.com/clavien-dindo-classification/ |
| Mortality rates | up to 30 days after liver resection | the rate of postoperative death |
| Hospital duration after operation (days) | up to 30 days after liver resection | the length of hospital stay |
| Operation time(min) | intraoperative | the during of operation |
| Blood transfusion (times and units) | intraoperative | intraoperative blood transfusion |
| Liver functional recovery | up to 7 days after liver resection | AST(glutamic oxalacetic transaminase, u/l) |
| Duration of abdominal drain (days) | up to 14 days after liver resection | Duration of abdominal drain |
| Duration to first flatus (days) | up to 14 days after liver resection | Duration to first flatus |
| Comfort questionnaire measures (GCQ) measures by Kolcaba | up to 30 days after liver resection | GCQ measures by Kolcaba, download from http://www.thecomfortline.com/resources/cq.html |
| Intensive care unit stay(days) | up to 7 days after liver resection | Intensive care unit stay in days |
| the clamping and declamping time(s) | intraoperative | the clamping and declamping time of using bulldog or cotton |
Countries
China
Contacts
Primary ContactLiang He, Master
Outcome results
None listed