Bulldog vs. Cotton Tourniquet in Laparoscopic Hepatectomy for Patients
Study Details
Study Description
Brief Summary
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.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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N/A |
Detailed Description
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 Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Bulldog tourniquet in laparoscopic Hepatectomy The bulldog tourniquet , a reusable vessel occlusion instrument forblocking the liver inflow-blood in laparoscopic liver resection, was uniformly employed in all patients randomized to Bulldog laparoscopic hepatectom group in the present study. |
Procedure: BULLDOG ,A Useful Vascular Occlusion Tourniquet In Laparoscopic Liver Resection
Bulldog is an effectively performed approach for vascular occlusion during laparoscopic hepatectomy than traditional Pringle manuever.
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| Active Comparator: cotton tourniquet in laparoscopic Hepatectomy The cotton tourniquet ,a reusable vessel occlusion instrument for blocking the liver inflow-blood in laparoscopic liver resection |
Procedure: cotton tourniquet
cotton tourniquet
|
Outcome Measures
Primary Outcome Measures
- Blood loss [intraoperative]
the volume of blood loss
Secondary Outcome Measures
- Liver functional recovery [up to 7 days after liver resection]
AST(glutamic oxalacetic transaminase, u/l)
- Postoperative complication(Rates in different grades) [up to 30 days after liver resection]
According to The Clavien-Dindo Classification,https://www.assessurgery.com/clavien-dindo-classification/
- Mortality rates [up to 30 days after liver resection]
the rate of postoperative death
- Hospital duration after operation (days) [up to 30 days after liver resection]
the length of hospital stay
- Operation time(min) [intraoperative]
the during of operation
- Blood transfusion (times and units) [intraoperative]
intraoperative blood transfusion
- the clamping and declamping time(s) [intraoperative]
the clamping and declamping time of using bulldog or cotton
- Duration of abdominal drain (days) [up to 14 days after liver resection]
Duration of abdominal drain
- Duration to first flatus (days) [up to 14 days after liver resection]
Duration to first flatus
- Comfort questionnaire measures (GCQ) measures by Kolcaba [up to 30 days after liver resection]
GCQ measures by Kolcaba, download from http://www.thecomfortline.com/resources/cq.html
- Intensive care unit stay(days) [up to 7 days after liver resection]
Intensive care unit stay in days
- Liver functional recovery [up to 7 days after liver resection]
ALT(glutamic-pyruvic transaminase enzyme，u/l)
- Liver functional recovery [up to 7 days after liver resection]
TB(total bilirubin，μmol/L)
- Liver functional recovery [up to 7 days after liver resection]
ALB(albumin，g/L)
- Liver functional recovery [up to 7 days after liver resection]
TP(total protein，g/L)
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patient who underwent hepatectomy for benign or malignant neoplasm of the liver, and is suitable for laparoscopic liver resection
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Child-Pugh A without portal hypertension
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No portosystemic shunt
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No previous abdominal operation history
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American society of anesthesiology class(ASA): I or II
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Age 18 to 80
Exclusion Criteria:
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Additional intervention to the liver (Radio Frequent Ablation, Percutaneous Ethanol. Injection Therapy or others)
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Emergence hepatectomy
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Previous hepatectomy
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Combined operation for extrahepatic disease
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Vulnerable population (mental retardation, pregnancy)
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | The 2nd affiliated hospital of Anhui Medical University | Hefei | Anhui | China | 230601 |
Sponsors and Collaborators
- hui hou
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
- Ciria R, Cherqui D, Geller DA, Briceno J, Wakabayashi G. Comparative Short-term Benefits of Laparoscopic Liver Resection: 9000 Cases and Climbing. Ann Surg. 2016 Apr;263(4):761-77. doi: 10.1097/SLA.0000000000001413. Review.
- Dua MM, Worhunsky DJ, Hwa K, Poultsides GA, Norton JA, Visser BC. Extracorporeal Pringle for laparoscopic liver resection. Surg Endosc. 2015 Jun;29(6):1348-55. doi: 10.1007/s00464-014-3801-6. Epub 2014 Aug 27.
- Kim WJ, Kim KH, Shin MH, Yoon YI, Lee SG. Totally laparoscopic anatomical liver resection for centrally located tumors: A single center experience. Medicine (Baltimore). 2017 Jan;96(4):e5560. doi: 10.1097/MD.0000000000005560.
- Le B, Matulewicz RS, Eaton S, Perry K, Nadler RB. Comparative analysis of vascular bulldog clamps used in robot-assisted partial nephrectomy. J Endourol. 2013 Nov;27(11):1349-53. doi: 10.1089/end.2013.0367. Epub 2013 Oct 18.
- Maehara S, Adachi E, Shimada M, Taketomi A, Shirabe K, Tanaka S, Maeda T, Ikeda K, Higashi H, Maehara Y. Clinical usefulness of biliary scope for Pringle's maneuver in laparoscopic hepatectomy. J Am Coll Surg. 2007 Dec;205(6):816-8. Epub 2007 Sep 18.
- Rotellar F, Pardo F, Bueno A, Martí-Cruchaga P, Zozaya G. Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique. Langenbecks Arch Surg. 2012 Mar;397(3):481-5. doi: 10.1007/s00423-011-0887-3. Epub 2011 Dec 20.
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