• Extra-Glissonian approach
• Hepatocellular carcinoma
• Intra-Glissonian approach
• Laparoscopy
• Surgical efficiency
• Surgical safety

• hepatic inflow occlusion
• meta-analysis
• postoperative complication

• HDAC2-ACSS2 axis
• cognitive dysfunction
• gut microbiota
• hepatic ischemia
• reperfusion injury

• Animals
• Mice
• Acetates/metabolism
• Cognitive Dysfunction/etiology
• Cognitive Dysfunction/metabolism
• Dysbiosis/complications
• Gastrointestinal Microbiome
• Liver/metabolism
• Mice, Inbred C57BL
• Reperfusion Injury/complications
• Reperfusion Injury/metabolism

• 81670240 National Natural Science Foundation of China
• 81873467 National Natural Science Foundation of China
• National Natural Science Foundation of China

• Inflow control
• Laparoscopic liver resection
• Pringle maneuver

• Humans
• Liver Transplantation/adverse effects
• Liver Transplantation/methods
• Liver/blood supply
• Reperfusion Injury/etiology
• Reperfusion Injury/metabolism
• Liver Diseases/metabolism
• Immunity, Innate

Laparoscopic liver resection (LLR) has become a safe surgical procedure that needs additional summarization.

To review 4 years of total LLR surgeries, exceeding 1000 cases, which were performed at a single center.

Patients who underwent LLR at West China Hospital of Sichuan University between January 2015 and December 2018 were identified. Surgical details, including the interventional year, category of liver disease, and malignant liver tumors prognosis, were evaluated. The learning curve for LLR was evaluated using the cumulative sum method. The Kaplan-Meier method was used to perform survival analysis.

Ultimately, 1098 patients were identified. Hepatocellular carcinoma (HCC) was the most common disease that led to the need for LLR at the center (n = 462, 42.08%). The average operation time was 216.94 ± 98.51 min. The conversion rate was 1.82% (20/1098). The complication rate was 9.20% (from grade II to V). The 1-year and 3-year overall survival rates of HCC patients were 89.7% and 81.9%, respectively. The learning curve was grouped into two phases for local resection (cases 1-106 and 107-373), three phases for anatomical segmentectomy (cases 1-44, 45-74 and 75-120), and three phases for hemihepatectomy (cases 1-17, 18-48 and 49-88).

LLR may be considered a first-line surgical intervention for liver resection that can be performed safely for a variety of primary, secondary, and recurrent liver tumors and for benign diseases once technical competence is proficiently attained.

• Laparoscopic liver resection
• Single-center experience
• Learning curve
• Liver

• Carcinoma, Hepatocellular/pathology
• Hepatectomy/methods
• Humans
• Laparoscopy/adverse effects
• Laparoscopy/methods
• Length of Stay
• Liver Neoplasms/pathology
• Postoperative Complications/epidemiology
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Retrospective Studies

• Pringle maneuver
• autologous blood transfusion
• autologous salvaged blood
• laparoscopic hepatectomy

• Blood Loss, Surgical/prevention & control
• Female
• Hemostasis, Surgical/methods
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Liver Cirrhosis/complications
• Liver Cirrhosis/surgery
• Liver Function Tests
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Postoperative Complications
• Prognosis
• Propensity Score

• Cirrhosis
• Hepatocellular carcinoma
• Mitogen-activated protein kinase
• Regional ischemic preconditioning

• Hemihepatic vascular inflow occlusion
• Laparoscopic liver resection
• Liver neoplasm
• Pringle maneuver
• Segment 7

• Doctor Funding of Sichuan Academy of Medical Sciences

• biliary tract
• liver transplantation
• living donors

• Adolescent
• Adult
• Aged
• Bile Ducts/surgery
• Biliary Tract Diseases/etiology
• Biliary Tract Diseases/surgery
• Blood Loss, Surgical
• Endoscopy
• Female
• Humans
• Liver Transplantation/adverse effects
• Living Donors
• Male
• Middle Aged
• Postoperative Complications/etiology
• Postoperative Complications/surgery
• Reoperation
• Risk Factors
• Treatment Outcome
• Young Adult

This study was conducted to compare the clinical effects of two techniques used for inflow occlusion during hepatectomy (selective hemihepatic vascular occlusion vs. Pringle maneuver) for the treatment of primary liver cancer.

A total of 63 patients with primary hepatocellular carcinoma who underwent hepatectomy during June 2006 and June 2011 were included in this retrospective study. A total of 26 patients in group A accepted selective hemihepatic vascular occlusion, and 37 patients in group B underwent the Pringle maneuver during hepatectomy. The intraoperative conditions, postoperative liver function recovery, and complication rates were compared between these two groups.

There were no significant differences in intraoperative blood loss, blood transfusion, occlusion time, and postoperative complication rates between group A and group B (P>0.05). However, postoperative serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), and albumin (ALB) in group A were significantly lower than those in group B (P<0.05). Moreover, there were noteworthy differences in peripheral artery pressure and sphygmus (P<0.05).

During hepatectomy, selective hemihepatic vascular occlusion benefits the patients with primary hepatocellular carcinoma by reducing the hepatic damage and improving postoperative hepatic function recovery, compared with the Pringle maneuver.

• Bayes Theorem
• Blood Loss, Surgical/prevention & control
• Blood Transfusion/statistics & numerical data
• Catheter Ablation/methods
• Fibrin Tissue Adhesive/administration & dosage
• Hemostasis, Surgical/methods
• Hepatectomy/adverse effects
• Hepatectomy/methods
• Humans
• Randomized Controlled Trials as Topic
• Suction/instrumentation
• Suction/methods

• 10/4001/11 Department of Health

The high prevalence of hepatitis B virus (HBV) imposes a huge burden of hepatocellular carcinoma (HCC) in Asia. Surgical resection remains an important therapeutic strategy for HCC. Hepatic inflow occlusion, known as the Pringle maneuver, is the most commonly used method of reducing blood loss during liver parenchymal transection. A major issue with this maneuver is ischemia-reperfusion injury to the remnant liver, and the hemodynamic disturbance it induces in the tumor-bearing liver raises an oncological concern. Given the technical advances in living donor liver transplantation, vascular occlusion in liver resection can be avoided in experienced hands. The aim of this study is to compare the perioperative and long-term outcomes of liver resection for HBV-related HCC without versus with hepatic inflow occlusion.

This study will include eligible patients with HBV-related HCC elected for liver resection. Fifty-seven patients will be enrolled in each randomization arm to detect a 20 % difference in the serum level of total bilirubin on postoperative day 5 (80 % power and α = 0.05). The secondary endpoints include procedural parameters, perioperative liver function and inflammatory response, postoperative morbidity and mortality, and long-term outcomes. Patients will be followed for up to 5 years. Data will be statistically analyzed on an intention-to-treat basis.

This prospective randomized controlled trial is designed to compare the perioperative and long-term outcomes of liver resection for HBV-related HCC without versus with vascular occlusion. The clinical implications of these outcomes may change current surgical practice and fill the oncological gaps therein.

Clinicaltrials.gov identifier NCT02563158. Registered on 28 September 2015.

The online version of this article (doi:10.1186/s13063-016-1621-9) contains supplementary material, which is available to authorized users.

• Hepatocellular carcinoma
• Inflammatory response
• Ischemia-reperfusion injury
• Liver resection
• Randomized controlled trial
• Survival
• Vascular occlusion

• Extra-glissonian approach
• Hemihepatic vascular inflow occlusion
• Laparoscopic liver resection
• Liver neoplasm
• Pringle maneuver

• Alanine Transaminase/blood
• Aspartate Aminotransferases/blood
• Blood Loss, Surgical/prevention & control
• Blood Transfusion/statistics & numerical data
• C-Reactive Protein/analysis
• Female
• Hepatectomy/methods
• Humans
• Laparoscopy/methods
• Liver Neoplasms/surgery
• Male
• Middle Aged
• Operative Time
• Postoperative Period
• Retrospective Studies

Though accumulated evidence proved the advantages of laparoscopic hepatectomy, bleeding still remains the most important challenge in clinical practice. Our study aimed to compare the outcomes of Pringle maneuver (PM) and selective hemihepatic vascular occlusion (SHVO) surgeries for patients with liver cavernous hemangioma (LCH).

The SHVO (n = 26; mean age, 42) and PM (n = 78; mean age, 43) surgeries were performed in 104 LCH patients from January 2006 to January 2015. The intraoperative (bleeding, arterial pressure, oxyhemoglobin saturation, etc.) and postoperative parameters (anal exhaust time, complications, blood cell numbers, etc.) were measured and compared between the two groups. Liver function of all these patients was detected by blood test at 1-day preoperation, and at 1, 3, and 5 days postoperation.

Both of the two surgeries were successfully performed without any mortality. The intraoperative systolic arterial pressure and pulse in PM group were much higher than that in SHVO group (P < 0.01). The postoperative liver function parameters such as alanine transaminase (ALT), aspartate transaminase (AST), and total bilirubin (TBIL) increased much more in the PM group than that in the SHVO group compared with preoperation results (P < 0.05). However, there were no statistical differences in intraoperative bleeding, blood transfusion, hepatic inflow occlusion time, oxygen saturation occlusion, anal exhaust time and incidence of complications between the two groups (P > 0.05).

SHVO is safer with less ischemia reperfusion injury than PM surgery for hemangioma resection on patients with LCH.

Blood loss and the requirement of blood transfusions during liver transection have been shown to correlate well with higher morbidity and mortality rates and a worse prognosis. Various devices for liver parenchymal transection have been developed to reduce intraoperative blood loss. The goal of this study is to evaluate the safety and effectiveness of BiClamp® forcep transection compared to a clamp crushing technique in patients undergoing liver resection.

This study will include patients 18 years and older scheduled for hepatectomy with hepatic vascular exclusion who give informed consent. A sample size of 48 patients in each randomization arm will be calculated to detect a difference in the reduction of blood loss of approximately 200 ml (90% power and α = 0.05 (two-tailed)). The primary efficacy endpoint of the trial will be the total intraoperative blood loss based on the randomized dissection technique. The statistical analysis is based on the intention-to-treat population. Patients will be followed up on for three months for complications and adverse events.

This prospective, single-center, randomized controlled, single-blinded, two-group parallel trial is designed to assess the efficacy and safety of BiClamp forcep hepatectomy versus clamp crushing for parenchymal transection during elective hepatic resection.

This trial was registered with Clinicaltrials.gov (identifier: NCT02197481) on 15 July 2014.

Significant hemorrhage together with blood transfusion has negative impact on postoperative morbidity, mortality, and long-term survival of liver resection. Various techniques of vascular occlusion have been developed to reduce intraoperative blood loss. The objective of this study was to compare the outcomes of Pringle maneuver, hemi-hepatic vascular occlusion, and treatment without vascular occlusion used during liver resection.

Data of 574 patients with Hepatitis B virus (HBV)-related hepatocellular carcinoma (HCC), who underwent major hepatectomy between January 2009 to March 2013 by Pringle maneuver (N = 158), hemi-hepatic vascular inflow occlusion (N = 216), or without any vascular occlusion (N = 200), were included in this retrospective study. Perioperative blood transfusion, intraoperative blood loss, and postoperative liver function, and surgical complications were analyzed and compared between the three groups.

There were no significant difference observed in postoperative bilirubin, liver enzyme, and albumin levels between three groups (P>0.05). 5 patients (2.5%) in no occlusion group, 2 (1.3%) in Pringle group, and 8 (3.7%) in hemi-hepatic group had liver failure; but, there were no differences (P>0.05). The overall postoperative complications rate between three groups did not reach significant differences (33.5% vs 34.2% vs 42.6%, respectively; P>0.05). However, significant differences in intraoperative blood loss between no occlusion group (638.2±426.8 ml) and Pringle group (518.0±451.0 ml) or hemi-hepatic group (513.0±366.7 ml) (P<0.01).

Although there were no differences found between three groups regarding postoperative complications rate, no vascular occlusion group had more blood loss than the other two groups during liver resection.