[General Surgery Laparoscopy] Right hemihepatectomy under 4K ultra-high definition

Hepatectomy is to remove local lesions of the liver, including liver tumors, liver trauma, liver abscesses, intrahepatic bile duct stones, liver cysts, etc., using surgical techniques to remove liver segments, liver lobes, and hemihepatocytes while retaining enough to maintain function. of normal liver tissue. The liver has rich blood flow, and effective control of bleeding during surgery is the key to successful liver resection. According to the method of controlling liver bleeding, it is divided into two categories: regular and irregular. Hepatectomy procedures include: hepatic wedge resection, partial hepatectomy, hepatic lobectomy, hemihepatectomy, middle lobectomy, and bilobal resection. Common complications after liver resection include: bleeding, liver failure, bile fistula, infection, etc. Active prevention and correct management of complications after surgery are important links in reducing surgical mortality.

Laparoscopic right hemihepatectomy for the treatment of hepatocellular carcinoma. Because the huge tumor was located in the right liver, an anterior approach was used to minimize the shedding of tumor cells into the blood vessels.

Traditional method

Technology

Before parenchymal transection, the right liver was fully manipulated and the right hepatic vein controlled the liver.

Reduce blood loss.

Unwisely operating on the right side.

Hepatic vein avulsion leads to excessive blood loss.

Prolonged ischemia of the liver caused by hepatoduodenal tube rotation.

Iatrogenic tumor rupture.

Cancer cells spill into the systemic circulation.

Anterior approach.

Contactless isolation technology.

Initial vascular inflow control.

Substantial transection completed.

Complete venous outflow control.

Before operating the right liver.

Reduce shedding of tumor cells into the portal vein during surgery.

What are the effects and sequelae after liver resection?

1. Effects include temporary impairment of metabolic function, hepatic encephalopathy and infection.

Temporary impairment of metabolic function: Liver resection will lead to a decrease in physiological metabolic capacity, but liver function will return to normal, and maintenance and infection prevention are required.

Hepatic encephalopathy: Impaired liver function may cause hepatic encephalopathy, so excessive external stimulation needs to be avoided.

Infection: Infection may occur after surgery, and long-term dressing changes and infection prevention are required.

2. Sequelae include liver failure and gastrointestinal bleeding.

Liver failure: Some patients develop liver insufficiency, even leading to acute liver failure, and the cause needs to be identified and treated.

Gastrointestinal bleeding: Gastrointestinal bleeding after liver resection is mainly bleeding from the upper gastrointestinal tract. Pay attention to the massive bleeding caused by rupture of blood vessels at the bottom of the pylorus.