LLR was applied for tumors located at the lower edge and lateral segments of the liver that could be resected more easily than posterosuperior segments. With the development of technology and the growing experience of hepatobiliary surgeons, LLR has been expanded to major liver resections, anatomical resections, and donor hepatectomies by skilled surgeons. However, postoperative mortality, mobility and recovery of liver function are associated with major blood loss which is always the main cause of conversion to laparotomy and remains a challenge for surgeons. Pringle first described the method to arrest the hepatic hemorrhage by compression of the porta hepatis and this procedure was widely spread as well as in laparoscopic feild currently. Here, we described a new modified of Pringle maneuver using Bulldog to block vascular during LLR, and compared its effects with traditional pringle maneuver.
With the innovations of laparoscopic technique and specialized equipment , laparoscopic liver resection became the dominating resection surgery approach. December of 2014, laparoscopic hepatectomy was carried out in our department, extracorporeal Pringle maneuver has been applied in most laparoscopic liver resections which need to block the hepatic inflow, cotton tape was the frequently used tourniquet. We used to blocked the hepatic inflow by extracorporeal Pringle maneuver method with cotton tape for its validity , softness and no visible damages for vessel, but it was always difficult for clamping in a two-dimensional view to encircle the hepatoduodenal ligament , and it delayed operation time for freshmen. Bulldog has been widely used in urinary surgery for vascular occlusion, but bulldog in hepatic surgery has rarely been mentioned, this is the first report to formally demonstrate the clinical application in hepatic surgery. However, it is not clear that whether the bulldog for vascular occlusion is useful and easy to implement in laparoscopic hepatectomy. In this study, we will compare the cotton and the bulldog for vascular occlusion during laparoscopic hepatectomy
Study Type
INTERVENTIONAL
Allocation
RANDOMIZED
Purpose
PREVENTION
Masking
TRIPLE
Enrollment
88
Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle manuever.
cotton tourniquet
The 2nd affiliated hospital of Anhui Medical University
Hefei, Anhui, China
Blood loss
the volume of blood loss
Time frame: intraoperative
Liver functional recovery
AST(glutamic oxalacetic transaminase, u/l)
Time frame: up to 7 days after liver resection
Postoperative complication(Rates in different grades)
According to The Clavien-Dindo Classification,https://www.assessurgery.com/clavien-dindo-classification/
Time frame: up to 30 days after liver resection
Mortality rates
the rate of postoperative death
Time frame: up to 30 days after liver resection
Hospital duration after operation (days)
the length of hospital stay
Time frame: up to 30 days after liver resection
Operation time(min)
the during of operation
Time frame: intraoperative
Blood transfusion (times and units)
intraoperative blood transfusion
Time frame: intraoperative
the clamping and declamping time(s)
the clamping and declamping time of using bulldog or cotton
Time frame: intraoperative
Duration of abdominal drain (days)
Duration of abdominal drain
Time frame: up to 14 days after liver resection
Duration to first flatus (days)
Duration to first flatus
Time frame: up to 14 days after liver resection
Comfort questionnaire measures (GCQ) measures by Kolcaba
GCQ measures by Kolcaba, download from http://www.thecomfortline.com/resources/cq.html
Time frame: up to 30 days after liver resection
Intensive care unit stay(days)
Intensive care unit stay in days
Time frame: up to 7 days after liver resection
Liver functional recovery
ALT(glutamic-pyruvic transaminase enzyme,u/l)
Time frame: up to 7 days after liver resection
Liver functional recovery
TB(total bilirubin,μmol/L)
Time frame: up to 7 days after liver resection
Liver functional recovery
ALB(albumin,g/L)
Time frame: up to 7 days after liver resection
Liver functional recovery
TP(total protein,g/L)
Time frame: up to 7 days after liver resection
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