title: Pure laparoscopic hepatectomy combined with a pure laparoscopic pringle maneuver in patients with severe cirrhosis.
abstract: Laparoscopic hepatectomy is a standard surgical procedure. However, it is difficult to perform in patients with severe cirrhosis because of fibrosis and a high risk of hemorrhage. We report our recent experience in five cases of pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver in patients with severe cirrhosis. From 2012 to 2014, we performed pure laparoscopic partial hepatectomy in five patients with severe liver cirrhosis (indocyanine green retention rate at 15 min [ICG R15] >30% and fibrosis stage f4). A pure laparoscopic Pringle maneuver was employed in all patients. We investigated operative time, blood loss, duration of hospitalization and the days when discharge was possible, and compared these findings with those of patients with a normal liver (ICG R15 <10%, f0) who underwent pure laparoscopic partial hepatectomy during the same period (n = 7). As a result, operative time, blood loss, duration of hospitalization and the days when discharge was possible were similar in patients with cirrhosis undergoing pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver to those in patients with a normal liver undergoing pure laparoscopic partial hepatectomy. In conclusion, pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver appears to be safe in patients with severe cirrhosis.
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Shigehito
authors.initials: S
authors.lastname: Miyagi
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Chikashi
authors.initials: C
authors.lastname: Nakanishi
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Naoki
authors.initials: N
authors.lastname: Kawagishi
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kamei
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Susumu
authors.initials: S
authors.lastname: Satomi
authors.affiliation: Division of Transplantation, Reconstruction and Endoscopic Surgery, Tohoku University Graduate School of Medicine, Sendai, Japan.
authors.forename: Noriaki
authors.initials: N
authors.lastname: Ohuchi
keywords: Ascites; Liver cirrhosis; Pringle maneuver; Pure laparoscopic hepatectomy