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首页> 外文期刊>Surgical Endoscopy >Modified liver hanging maneuver in laparoscopic major hepatectomy: the learning curve and evolution of indications
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Modified liver hanging maneuver in laparoscopic major hepatectomy: the learning curve and evolution of indications

机译：腹腔镜主要肝切除术中修改的肝挂式机动：学习曲线和适应症的演变

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Background Laparoscopic major hepatectomy is a technically challenging procedure requiring a steep learning curve. The liver hanging maneuver is a useful technique in liver resection, especially for large or invasive tumors, a relative contraindication of the laparoscopic approach. Therefore, this study aimed to evaluate the learning curve for laparoscopic major hepatectomy using the liver hanging maneuver and extended indications. Methods Patients who underwent laparoscopic major hepatectomy using the liver hanging maneuver by a single surgeon from January 2013 and September 2018 were retrospectively reviewed. Our hanging technique involves placing the hanging tape along the inferior vena cava for right-sided hepatectomy or the ligamentum venosum for left-sided hepatectomy. The upper end of the tape was placed at the lateral side of the major hepatic veins. The learning curve for operating time and blood loss was evaluated using the cumulative sum (CUSUM) method. Results Among 53 patients, 18 underwent right hepatectomy, 26 underwent left hepatectomy, and 9 underwent right posterior sectionectomy. CUSUM analysis showed that operative time and blood loss improved after the 30th laparoscopic major hepatectomy. The 53 consecutive patients were divided into two groups (early, patients 1-30; late, patients 31-53). The median operative time was lower in the late group, but the difference was not statistically significant (270 vs. 245 min, p = 0.261). The median blood loss was also significantly lower in the late group (350 vs. 150 ml, p 10 cm) and tumors in proximity to major vessels were significantly higher in the late group (0 vs. 17.4%, p = 0.018; 3.3 vs. 21.7%, p = 0.036; respectively). Conclusion This study shows that laparoscopic major hepatectomy using the modified liver hanging maneuver has a learning curve of 30 cases. After procedure standardization, the indications have gradually been extended to large or invasive tumors.
机译：背景技术腹腔镜主要肝切除术是一种技术上具有挑战性的程序，需要陡峭的学习曲线。肝脏悬垂机动是肝切除术中的一种有用技术，特别是对于大型或侵入性肿瘤，腹腔镜方法的相对禁忌症。因此，本研究旨在使用肝脏悬挂机动和扩展指示来评估腹腔镜主要肝切除术的学习曲线。方法回顾性地审查了从2013年1月和2018年9月的单一外科医生使用肝脏悬垂机动进行腹腔镜主要肝切除术的患者。我们的悬挂式技术涉及将悬挂胶带放在右侧腔静脉中，为右侧肝切除术或左侧肝切除术的韧带毒液。将带的上端放置在主要肝静脉的侧面。使用累积总和（CUSUM）方法评估用于操作时间和血液损失的学习曲线。结果53例患者，18名右肝切除术，26例左侧肝切除术，9例右侧剖面切除术。 CuSum分析表明，第30次腹腔镜主要肝切除术后的手术时间和失血。连续53名患者分为两组（早期，患者1-30岁;晚，患者31-53岁）。后期中位操作时间较低，但差异在统计学上没有统计学意义（270 vs.245分钟，P = 0.261）。晚期（350毫升150mL，P 10cm）中的中位损失也显着降低，后期对主要血管的肿瘤显着较高（0 vs.17.4％，P = 0.018; 3.3 Vs 。21.7％，p = 0.036;分别为0.036）。结论本研究表明，使用改良肝挂机械的腹腔镜主要肝切除术具有30例的学习曲线。在程序标准化之后，适应症逐渐扩展到大或侵入性肿瘤。

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