Application of Hemostatic Devices in Laparoscopic Hepatectomy

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.

The main advantage of this technique is that the hemostatic device is simple and easy to obtain and can be carried out in basic hospitals. This set of hemostatic equipment can be further applied to laparoscopic hepatectomy and other systems. It is highly recommended to have a certain basis of laparoscopic surgery, especially skilled use of a harmonic scalpel to apply this set of hemostatic devices in laparoscopic hepatectomy.

Begin by applying direct puncture to establish pneumoperitoneum in laparoscopy. Place a 10 millimeter trocar in each observation hole in the subumbilical area, right mid-clavicular line under the costal margin and ventral midline. Then place a five millimeter trocar in the right anterior auxiliary line and the ventral midline.

Assemble the hemostatic devices starting from the harmonic scalpel, monopole electrocoagulation, and single lumen catheter to be innovatively used in liver parenchyma tissue resection. To perform a Pringle maneuver, occlude the first porta hepatis intermittently by using a single lumen catheter. Clamp the lumen catheter with a hemostatic clip for 15 minutes followed by releasing it for five minutes using the harmonic scalpel to cut off the clip and take the clip out to restore blood supply to the first porta hepatis.

Separate the hepatic pedicles supplying the tumor. Resect and divide them one by one with a harmonic scalpel. Observe the ischemia line on the liver surface, which becomes visible after the resection of the hepatic pedicles.

Use the hook to mark it. Resect the liver parenchyma tissue using the harmonic scalpel while clamping and crushing the liver gradually. Observe the internal hepatic artery, vein, and bile duct.

Resect and divide these pipeline structures. Once bleeding appears, coagulate the bleeding spots on the liver dissection surface immediately using point to point monopole electrocoagulation. Use the right posterior hepatic pedicle as a signpost for intrahepatic parenchyma tissue resection.

Reserve the main posterior hepatic pedicle and dissect the branch of pedicles supplying the tumor. To complete the operation, wash the liver surface so one can see if there are still bleeding spots. Stop the bleeding on the liver dissection surface and remove the tumor specimen from the abdominal cavity.

The operation was completed within 2.5 hours. The intraoperative bleeding volume was 100 milliliters without the blood transfusion and no short-term complications were observed. The carcinoembryonic antigen level post-operation decreased to 110.64 micrograms per liter from the pre-operation level of 1058.69 micrograms per liter.

The chemotherapy treatment was resumed two months after the operation, according to the tumor pathology results. The postoperative CT examination was compared with the preoperative CT and no signs of tumor regrowth were observed. The most important step in the surgical process is the use of the harmonic scalpel.

A good amount of skill is required to avoid damage to vital structures.