title: Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach.
abstract: BACKGROUND
  With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle's maneuver, especially in patients with cirrhosis.
  
  
  METHODS
  From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie assistance.
  
  
  RESULTS
  The types of liver resection included right hepatectomy (n=1), right posterior sectionectomy (n=1), left hepatectomy and common bile duct exploration (n=1), segment 4b resection (n=1), left lateral sectionectomy (n=2), and wedge resection (n=2). Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3 minutes. The mean duration of vascular inflow occlusion was 54.5 minutes. The mean intraoperative blood loss was 361 mL. No patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 days.
  
  
  CONCLUSIONS
  Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approach was safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.
authors.affiliation: Department of Liver Surgery, The First People's Hospital of Foshan, Foshan 528000, China. zzjun_fsyyy@163.com.
authors.forename: Ying-Jun
authors.initials: YJ
authors.lastname: Chen
authors.forename: Zuo-Jun
authors.initials: ZJ
authors.lastname: Zhen
authors.forename: Huan-Wei
authors.initials: HW
authors.lastname: Chen
authors.forename: Eric C H
authors.initials: EC
authors.lastname: Lai
authors.forename: Fei-Wen
authors.initials: FW
authors.lastname: Deng
authors.forename: Qing-Han
authors.initials: QH
authors.lastname: Li
authors.forename: Wan Yee
authors.initials: WY
authors.lastname: Lau
mesh_terms: D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D003250:Constriction; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D006965:Hyperplasia / Q000601:surgery; D010535:Laparoscopy / Q000009:adverse effects / Q000379:methods*; D007902:Length of Stay; D008099:Liver / Q000098:blood supply* / Q000473:pathology / Q000601:surgery*; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged