title: Laparoscopic liver resection using a rubber band retraction technique: usefulness and perioperative outcome in 100 consecutive cases.
abstract: BACKGROUND
  Although laparoscopic liver resection is increasingly performed worldwide, surgeons still face technical challenges because of the variety of procedures used according to tumor location. In the current study, we introduce a unique retraction method using an elastic rubber band and present its learning curve in addition to the perioperative outcomes of 100 consecutive patients.
  
  
  METHODS
  A series of 100 consecutive patients who underwent laparoscopic liver resection using a rubber band technique between August 2008 and June 2013 were analyzed retrospectively. All the study patients underwent the rubber band technique as a method to expose the parenchymal resection plane.
  
  
  RESULTS
  The study subjects consisted of 56 males and 44 females with a mean age of 56.7 ± 9.6 years. There were a total of four open conversions. There was no postoperative mortality. Eighty-five patients underwent minor resection, and 15 patients underwent major resection. Among the 85 patients who underwent a minor resection, 65 patients who had favorably located tumors were compared with the 20 patients who had unfavorably located tumors. A comparison of perioperative outcomes revealed a significant difference in operative time (197.3 ± 81.9 vs. 245.9 ± 116.8 min, P = 0.040) but no differences in any other parameters. There were three (4.6 %) and one (5 %) open conversions in the favorable and unfavorable tumor location group, respectively (P = 0.954). The postoperative complication rates were not statistically different between the two groups [4 (6.2 %) vs. 1 (5 %), P = 0.848]. In the learning curve analysis, operative time and blood loss for left lateral sectionectomy (n = 14) and left hepatectomy (n = 12) and minor limited resections for posterosuperior lesions (n = 20) reached a plateau after approximately ten cases.
  
  
  CONCLUSIONS
  The retraction technique describes here using an elastic rubber band is a useful approach that results in a safe laparoscopic liver resection. Moreover, this can be applied proficiently after a reasonable learning curve.
authors.affiliation: Division of Hepatobiliary and Pancreas, Department of Surgery, CHA Bundang Medical Center, CHA University, Seongnam, Korea, feel9847619@gmail.com.
authors.forename: Sung Hoon
authors.initials: SH
authors.lastname: Choi
authors.forename: Gi Hong
authors.initials: GH
authors.lastname: Choi
authors.forename: Dai Hoon
authors.initials: DH
authors.lastname: Han
authors.forename: Jin Sub
authors.initials: JS
authors.lastname: Choi
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D059032:Learning Curve; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D011184:Postoperative Period; D012189:Retrospective Studies; D013536:Suture Techniques; D016896:Treatment Outcome