Retrospective Study
Copyright ©The Author(s) 2024. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Aug 27, 2024; 16(8): 2612-2619
Published online Aug 27, 2024. doi: 10.4240/wjgs.v16.i8.2612
Efficiency and safety of laparoscopic left hemihepatectomy: A study of intrathecal vs extrathecal Glissonean pedicle techniques
Li-Min Kang, Lei Xu, Fu-Wei Zhang, Fa-Kun Yu, Li Lang
Li-Min Kang, Lei Xu, Fu-Wei Zhang, Fa-Kun Yu, Department of Hepatobiliary and Pancreatic Surgery, Puer People's Hospital, Puer 665000, Yunnan Province, China
Li Lang, Department of Outpatient, Puer People's Hospital, Puer 665000, Yunnan Province, China
Author contributions: Kang LM, Xu L, Yu FK, Lang L and Zhang FW collected the clinical data; Kang LM and Xu L analyzed the data and wrote the paper; All authors have read and approved the final version to be published.
Institutional review board statement: The study was received and approval by the Institutional Review Board of Puer People's Hospital (Approval No. 2024-001-01).
Informed consent statement: The informed consent was waived from the patients.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: The data that support the findings of this study are available on request from the corresponding author at kanglimin2010@163.com.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Li-Min Kang, MD, PhD, Doctor, Department of Hepatobiliary and Pancreatic Surgery, Puer People’s Hospital, No. 44 Zhenxing Street, Puer 665000, Yunnan Province, China. kanglimin2010@163.com
Received: May 31, 2024
Revised: June 29, 2024
Accepted: July 17, 2024
Published online: August 27, 2024
Processing time: 77 Days and 5.9 Hours
Abstract
BACKGROUND

Selective hemihepatic vascular occlusion is utilized in both right and left hemihepatectomies to preserve blood supply to the intact lobe, maintain hemodynamic stability, and mitigate surgical risks. While this technique encompasses both intrathecal and extrathecal Glissonean pedicle transection methods, there is a lack of systematic comparative reports on these two approaches.

AIM

To retrospectively analyze the clinical data of patients with hepatocellular carcinoma (HCC) undergoing laparoscopic anatomical hepatectomy in our hospital to explore the feasibility, safety, and short- and long-term efficacy of extrathecal and intrathecal Glissonean pedicle transection methods in laparoscopic left hemihepatectomy.

METHODS

A retrospective study was performed to analyze the clinical data of 49 HCC patients who underwent laparoscopic left hemihepatectomy from January 2019 to December 2022 in our hospital. These patients were divided into extrathecal Glissonean pedicle transection (EGP) group (n = 24) and intrathecal Glissonean pedicle transection (IGP) group (n = 25) according to the different approaches used for selective hemihepatic vascular occlusion. The perioperative indicators, liver function indexes, complications, and follow-up findings were compared between these two groups.

RESULTS

The surgeries were smooth in both groups, and no perioperative death was noted. The hepatic pedicle transection time and the operation time were (16.1 ± 2.3) minutes and (129.6 ± 19.0) minutes, respectively, in the EGP group, which were significantly shorter than those in the IGP group [(25.5 ± 2.4) minutes and (184.8 ± 26.0) minutes, respectively], both P < 0.01. There were no significant differences in intraoperative blood loss, time to anal exhaust, hospital stay, drain indwelling time, and postoperative liver function between the two groups (all P > 0.05). The incidence of postoperative complications showed no significant difference [16.67% (4/24) vs 16.0% (4/25), P > 0.05). All the 49 HCC patients were followed up after surgery (range: 11.2-53.3 months; median: 36.4 months). The overall survival rate and disease-free survival rate were not significantly different (both P > 0.05).

CONCLUSION

Both extrathecal and intrathecal Glissonean pedicle approaches are effective and safe hepatic inflow occlusion techniques in laparoscopic left hemihepatectomy for HCC. However, the extrathecal approach simplifies the hepatic pedicle transection, shortens the operation time, and increases the surgical efficiency, making it a more feasible technique.

Keywords: Hepatocellular carcinoma; Laparoscopy; Extra-Glissonian approach; Intra-Glissonian approach; Surgical efficiency; Surgical safety

Core Tip: Selective hemihepatic vascular occlusion is currently applied in both right and left hemihepatectomies to preserve blood supply to the intact lobe, ensure hemodynamic stability, and mitigate surgical risks. However, few studies have compared the extra-Glissonian approach and intra-Glissonian approach in this procedure. The present study explored the feasibility, safety, and short- and long-term efficacy of extrathecal and intrathecal Glisson pedicle approaches in laparoscopic left hemihepatectomy.