title: [The application of the three-step approach based on the regional distribution of hepatic vessel in laparoscopic hemihepatectomy].
abstract: OBJECTIVE
  To investigate the clinical significance of the three-step approach in laparoscopic hemihepatectomy.
  
  
  METHODS
  A total of 32 patients received laparoscopic hemihepatectomy with the three-step approach in Yijishan Hospital affiliated to Wannan Medical College between Aug 2013 and Oct 2015. All patients underwent thin slice CT scan and hemihepatectomy was imitated with the imagic explorer, preoperatively. The vessel distribution was observed at the section and the three-step approach was used in the hemihepatectomy. Pre- and post-operative data were collected and analyzed retrospectively.
  
  
  RESULTS
  The length of middle hepatic vein (MHV) was (59.1±12.9) mm and the number of branchs to the left and right lobe were 3.07±0.78 and 3.11±0.64 respectively. The distance between the first branch of MHV and the diaphragmatic surface was (28.07±3.74) mm and the distance between MHV and the visceral surface was (14.4±4.3) mm. The laparoscopic surgeries (left hemihepatectomy in 28 and right hemihepatectomy in 4) were performed successfully in all cases with the three-step approach, without any conversion to the open surgeries. The operation time was (165±42) min in left hemihepatectomy and (305±50) min in right hemihepatectomy. The intraoperative blood loss was (242±65) ml in left hemihepatectomy and (695±122)ml in right hemihepatectomy. All the patients recovered well without severe complications except for bile leakage in 3 patients who were cured with drainage. The postoperative hospital stay was (7.96±1.8) d.
  
  
  CONCLUSIONS
  the distribution of vessel is regional at the section of hemihepatectomy and the three-step approach based on this feature is safe and effective in laparoscopic hemihepatectomy, which can shorten the operation time and reduce the difficulty of operation.
authors.affiliation: The Department of Hepatic-biliary Surgery of Yi Ji-shan Hospital , Wannan Medical College, Wuhu 241001, China.
authors.forename: X M
authors.initials: XM
authors.lastname: Wang
authors.forename: W D
authors.initials: WD
authors.lastname: Sun
authors.forename: M H
authors.initials: MH
authors.lastname: Hu
authors.forename: G N
authors.initials: GN
authors.lastname: Wang
authors.forename: Y Q
authors.initials: YQ
authors.lastname: Jiang
authors.forename: X S
authors.initials: XS
authors.lastname: Fang
authors.forename: M
authors.initials: M
authors.lastname: Han
mesh_terms: D016063:Blood Loss, Surgical; D006498:Hepatectomy / Q000295:instrumentation / Q000379:methods*; D006503:Hepatic Veins / Q000000981:diagnostic imaging*; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay; D008099:Liver / Q000000981:diagnostic imaging / Q000601:surgery*; D012189:Retrospective Studies; D016896:Treatment Outcome