Application of Hemostatic Devices in Laparoscopic Hepatectomy

Summary

High-grade hemostatic devices are essential for laparoscopic hepatectomy. However, these devices are not generalized in basic medical organizations. Therefore, a suite of simple and easy hemostatic devices is shown in this article, which can make the laparoscopic hepatectomy easier to perform.

Abstract

Laparoscopic hepatectomy is considered a conventional method for treating benign and malignant liver diseases because it is a minimally invasive method. Despite its non-invasive aspect, bleeding and bile leakage occur in liver parenchyma tissue resection during the operation or in the post-operation period, indicating the requirement for high-grade hemostatic devices, such as ultrasonic surgical aspiration, bipolar electrocoagulation, etc. The lack of availability of these high-grade hemostatic devices prevents laparoscopic hepatectomy from becoming a generalized procedure in basic medical organizations. In view of the situation mentioned above, a suite of simple and easy hemostatic devices is developed in this protocol, which includes a harmonic scalpel, monopole electrocoagulation, and a single lumen catheter, to innovatively perform liver parenchyma tissue resection. First of all, the porta hepatis or hepatic pedicle is occluded intermittently by a single lumen catheter, followed by clamping for 15 min and releasing for 5 min. Subsequently, using the harmonic scalpel, clamping and crushing of the liver are done to cut off the hepatic parenchyma tissue and to reveal the intrahepatic arteries, veins, and bile ducts. Lastly, the bleeding spots are coagulated by using monopole electrocoagulation at each spot. Intrahepatic pipeline structures are then visible by using these methods, which could stop bleeding easily, reduce the incidence rate of bile leakage, and improve the safety and feasibility of laparoscopic hepatectomy. Therefore, the simple and easy hemostatic devices shown here are suitable for conducting procedures in primary medical institutions.

Introduction

Hepatocellular carcinoma is one of the most common malignant tumors of the digestive system. According to the different primary sites, it can be divided into primary hepatocellular carcinoma and secondary liver cancer. Cells can metastasize from primary tumors from organs outside the liver into the liver in various ways, leading to carcinoma in the liver. It has been reported that more than 50% of metastatic cells in the liver come from colorectal cancer, while others are from breast, pancreas, lung, and stomach tumors, etc¹. In recent years, many treatments for secondary liver cancer are available, including systematic chemotherapy, interventi....

Protocol

The operation is routine and received ethics approval. The approvals are as follows: Approval for rapid review by the Clinical Research and Application Ethics Committee of the Second Affiliated Hospital of Guangzhou Medical University: The scientific research ethics review project "Application of simple and easy Hemostatic Devices in Laparoscopic Hepatectomy" (acceptance No.: 2022-hg-ks-02) was approved by the clinical research and application ethics committee of the Second Affiliated Hospital of Guangzhou Medica.......

Discussion

Hepatectomy is one of the most important treatment methods for patients with primary liver cancer and secondary liver cancer. In 1991, Reich et al. applied laparoscopy to remove benign tumors of the liver and completed the world's first laparoscopic hepatectomy⁴. After years of rapid development and promotion, laparoscopic hepatectomy has become one of the mainstream methods to treat liver malignant tumors and has been widely carried out in recent years. With the advantages of less intraoperat.......

Materials

Name	Company	Catalog Number	Comments
HARMONIC ACE Ultrasonic Surgical Devices	Ethicon Endo-Surgery,LLC	HAR36
Hem-o-lock	Teleflex Medical	544233
Monopole Electrocoagulation	KANGJI MEDICAL	/
single lumen ureter	WELL LEAD MEDICAL CO.,LTD.	12F