Anterior approach for right hepatectomy using the 5-steps stapling technique: A preliminary study.
BACKGROUND
Right hepatectomy via the anterior approach without prior liver mobilization is an accepted technique and the liver hanging maneuver facilitates this procedure. Hepatic parenchymal transection remains a critical part of this operation during which excessive blood loss can occur. Control of blood loss is important in hepatectomy as excessive bleeding and blood transfusion are associated with increased postoperative morbidity/mortality rates and compromised long-term oncological outcomes in these patients.


METHODS
A 5-steps stapling technique was developed to decrease blood loss during right hepatectomy using the anterior approach with the liver hanging maneuver. All consecutive patients who underwent elective right hepatectomy in our center using this technique from January 2014 to June 2015 were retrospectively studied. This study aimed to describe this technique and report the preliminary outcomes.


RESULTS
Eleven patients with hepatitis B-related hepatocellular carcinoma (HCC) with cirrhosis underwent the 5-steps stapling technique for right hepatectomy using the anterior approach with the liver hanging maneuver. The mean blood loss, liver parenchymal transection time and operation time were 227.3 ± 91.4 ml (SD), 40.0 ± 7.8 min, and 261.8 ± 48.5 min, respectively. No patients developed postoperative bleeding or bile leak. There was no 90-day mortality.


CONCLUSIONS
The preliminary results of this 5-steps stapling technique for right hepatectomy using the liver hanging maneuver are encouraging as the technique resulted in little intraoperative blood loss and short operation time, and it caused no major complications and mortality.
Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, 528000, Guang Dong, People's Republic of China. Electronic address: chwei@fsyyy.com.
Huan Wei
HW
Chen
Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, 528000, Guang Dong, People's Republic of China; Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Chai Wan, Hong Kong Special Administrative Region.
Eric C H
EC
Lai
Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, 528000, Guang Dong, People's Republic of China.
Feng Jie
FJ
Wang
Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, 528000, Guang Dong, People's Republic of China.
Jie Yuan
JY
Li
Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, 528000, Guang Dong, People's Republic of China.
Feng Wen
FW
Deng
Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, 528000, Guang Dong, People's Republic of China.
Jian Yuan
JY
Hu
Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, 528000, Guang Dong, People's Republic of China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong Special Administrative Region. Electronic address: josephlau@cuhk.edu.hk.
Wan Yee
WY
Lau
D000368:Aged; D016063:Blood Loss, Surgical; D006528:Carcinoma, Hepatocellular / Q000601:surgery* / Q000821:virology; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery* / Q000821:virology; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D012189:Retrospective Studies; D017792:Surgical Stapling / Q000379:methods*; D016896:Treatment Outcome
Anterior approach; Hepatectomy; Liver surgery; Ultrasonic dissector; Vascular stapler