title: Hemorrhage control for laparoscopic hepatectomy: technical details and predictive factors for intraoperative blood loss.
abstract: Controlling bleeding during laparoscopic hepatectomy (LH) is technically demanding, but reportedly associated with less estimated blood loss (EBL) than open surgery. The present study aimed to describe and evaluate hemorrhage control techniques during LH and identify predictors of high intraoperative EBL.
  
  
  
  The data of 438 consecutive patients undergoing LH between 1995 and 2012 were reviewed. Bleeding control was facilitated by the proper use of hemostatic devices and surgical maneuvers unique to LH and by preserving intra-abdominal pressure. EBL was evaluated among three groups of 146 patients in each group: 1995-2006 (group A), 2006-2009 (group B), and 2009-2012 (group C). We also sought factors that predicted EBL ≥800 mL.
  
  
  
  Mean EBL decreased overtime from groups A to C: group A, 378 ± 619 mL; group B, 293 ± 391 mL; groups C, 257 ± 366 mL; P = 0.127. Transfusion rate was 6.7 % in group A, 5.5 % in group B, and 4.8 % in group C (P = 0.743). Hypertension (odds ratio (OR) 2.82, 95 % confidence interval CI 1.37-5.78; P = 0.006), preoperative chemotherapy (OR 2.55, 95 % CI 1.26-5.31; P = 0.009), resection of posterosuperior segments (OR 3.73, 95 % CI 1.33-12.17; P = 0.012), and major hepatectomy (OR 4.21, 95 % CI 1.64-13.02; P < 0.001) independently predicted high EBL.
  
  
  
  Improvements in bleeding control techniques over time have reduced EBL during LH. The use of these techniques and an understanding of the predictive factors for high EBL will help surgeons improve outcomes after LH.
authors: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. yokawaguchi-tky@umin.ac.jp.|Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan. yokawaguchi-tky@umin.ac.jp.|Department of Surgery, Asahi General Hospital, Chiba, Japan. yokawaguchi-tky@umin.ac.jp.
authors: Yoshikuni
authors: Y
authors: Kawaguchi
authors: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors: Takeo
authors: T
authors: Nomi
authors: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors: David
authors: D
authors: Fuks
authors: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France.
authors: Frederic
authors: F
authors: Mal
authors: Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.
authors: Norihiro
authors: N
authors: Kokudo
authors: Department of Digestive Diseases, Institut Mutualiste Montsouris, Université Paris Descartes, 42 Boulevard Jourdan, 75014, Paris, France. brice.gayet@imm.fr.
authors: Brice
authors: B
authors: Gayet
mesh_terms: D016063:Blood Loss, Surgical; D001803:Blood Transfusion / Q000706:statistics & numerical data; D017024:Chemotherapy, Adjuvant / Q000009:adverse effects; D005260:Female; D006470:Hemorrhage / Q000517:prevention & control*; D006489:Hemostatic Techniques; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D006973:Hypertension / Q000150:complications; D007431:Intraoperative Complications / Q000517:prevention & control*; D010535:Laparoscopy; D008113:Liver Neoplasms / Q000601:surgery; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy
keywords: Bleeding control; Intraoperative blood loss; Laparoscopic hepatectomy; Laparoscopic liver resection; Surgical technique