Document Type : Original Article
Authors
1 Department of Animal Science, College of Animal Science and Technology, Beijing University of Agriculture, Beijing, China
2 Department of Veterinary Surgery, College of Veterinary Medicine, Northeast Agricultural University, Harbin, China
Abstract
This study describes a left hemihepatectomy combined with a right lateral hepatic lobectomy. It compares the inflammatory response associated with laparoscopic hepatectomy (LH group, n = 7) with conventional open hepatectomy (OH group, n = 7). Blood was collected before surgery as well as 1, 2, 3, 5, and 7 days after surgery to determine the white blood cell count and levels of serum cortisol (COR), interleukin-6 (IL-6), and C-reactive protein (CRP). The left hemi-hepatectomy combined with a right lateral hepatic lobectomy was completed in miniature pigs. The average operative time was 139.00 ± 9.07 min, which was longer than that in the OH group (121.67 ± 3.02 min). The length of surgical incision associated with the OH group was 17.93 ± 1.09 cm, significantly longer than that related to the LH group (5.10 ± 0.17 cm). The estimated mean blood loss in the LH group was 136.43 ± 63.24 mL, which was significantly lower than that in the OH group. No severe complications (e.g., massive bleeding, bile leakage, and air embolism) were reported. The CRP levels, COR, and IL-6, increased significantly in the OH group and then slowly returned to their preoperative levels. A postoperative laparoscopic exploration revealed that the incised portion of the liver adhered to the omentum, but no additional abnormalities were observed. These findings indicate that a 4-trocar method for laparoscopic left hemihepatectomy combined with a right lateral hepatic lobectomy is safe and feasible. The inflammatory response for those receiving LH are lower than that for those receiving OH. This porcine model can be used as a research analog for liver disease and regeneration.
Keywords
- Kanazawa A, Tsukamoto T, Shimizu S, et al. Laparoscopic hepatectomy for liver cancer. Dig Dis 2015; 33(5):691-698.
- Chen K, Pan Y, Maher H, et al. Laparoscopic hepatectomy for elderly patients: Major findings based on a systematic review and meta-analysis. Medicine (Baltimore) 2018; 97(30):e11703. doi: 10.1097/MD. 0000000000011703.
- Cherqui D, Soubrane O, Husson E, et al. Laparoscopic living donor hepatectomy for liver transplantation in children. Lancet 2002; 359(9304):392-396.
- Hong SK, Suh KS, Kim HS, et al. Pure 3D laparoscopic living donor right hemihepatectomy in a donor with separate right posterior and right anterior hepatic ducts and portal veins. Surg Endosc 2017; 31(11):4834-4835.
- Au KP, Chok KSH. Minimally invasive donor hepatectomy, are we ready for prime time? World J Gastroenterol 2018; 24(25):2698-2709.
- Eiriksson K, Fors D, Rubertsson S, et al. Laparoscopic left lobe liver resection in a porcine model: a study of the efficacy and safety of different surgical techniques. Surg Endosc 2009; 23:1038-1042.
- Makabe K, Nitta H, Takahara T, et al. Efficacy of occlusion of hepatic artery and risk of carbon dioxide gas embolism during laparoscopic hepatectomy in a pig model. J Hepatobiliary Pancreat Sci 2014; 21(8):592-598.
- Diana M, Usmaan H, Legnèr A, et al. Novel laparoscopic narrow band imaging for real-time detection of bile leak during hepatectomy: proof of the concept in a porcine model. Surg Endosc 2016;30(7):3128-3132.
- Budai A, Fulop A, Hahn O, et al. Animal models for associating liver partition and portal vein ligation for staged hepatectomy (ALPPS): Achievements and future perspectives. Eur Surg Res 2017;58(3-4):140-157.
- Sang JF, Shi XL, Han B, et al. Combined mesenchymal stem cell transplantation and interleukin-1 receptor antagonism after partial hepatectomy. World J Gastroenterol 2016;22(16):4120-4135.
- Compagnon P, Levesque E, Hentati H, et al. An oxygenated and transportable machine perfusion system fully rescues liver grafts exposed to lethal ischemic damage in a pig model of DCD liver transplantation. Transplantation 2017; 101(7):e205-e213. doi: 10.1097/TP.0000000000001764.
- Iguchi K, Hatano E, Nirasawa T, et al. Chronological profiling of plasma native peptides after hepatectomy in pigs: Toward the discovery of human biomarkers for liver regeneration. PLoS ONE 2017; 12: e0167647. doi:10.1371/journal.pone.0167647.
- Ruiz-Tovar J, Oller I, Galindo I, et al. Change in levels of C-reactive protein (CRP) and serum cortisol in morbidly obese patients after laparoscopic sleeve gastrectomy. Obes Surg 2013;23(6):764-769.
- Okholm C, Goetze JP, Svendsen LB, et al. Inflammatory response in laparoscopic vs. open surgery for gastric cancer. Scand J Gastroenterol 2014, 49(9):1027-1034.
- Krog AH, Thorsby PM, Sahba M, et al. Perioperative humoral inflammatory response to laparoscopic versus open aortobifemoral bypass surgery. Scand J Clin Lab Invest 2017,77(2):83-92.
- Mendoza-Sagaon M, Hanly EJ, Talamini MA, et al. Comparison of the stress response after laparoscopic and open cholecystectomy. Surg Endosc 2000;14: 1136-1141.
- Krikri A, Alexopoulos V, Zoumakis E, et al. Laparoscopic vs. open abdominal surgery in male pigs: marked differences in cortisol and catecholamine response depending on the size of surgical incision. Hormones (Athens) 2013;12(2):283-291.
- Jersenius U, Fors D, Rubertsson S, et al. Laparoscopic parenchymal division of the liver in a porcine model: comparison of the efficacy and safety of three different techniques. Surg Endosc 2007; 21:315-320.
- Alcaraz A, Musquera M, Peri L, et al. Feasibility of transvaginal natural orifice transluminal endoscopic surgery-assisted living donor nephrectomy: is kidney vaginal delivery the approach of the future? Eur Urol 2011;59(6):1019-1025.
- Gehrig T, Manzini G, Fonouni H, et al. Comparison of two different transection techniques in liver surgery-an experimental study in a porcine model. Langenbecks Arch Surg 2013; 398(6):909-915.
- Court FG, Wemyss-Holden SA, Morrison CP, et al. Segmental nature of the porcine liver and its potential as a model for experimental partial hepatectomy. Br J Surg 2003; 90(4):440–444.
- Beard RE, Tsung A. Minimally invasive approaches for surgical management of primary liver cancers. Cancer Control 2017;24(3):1073274817729234. doi: 10.1177 /1073274817729234.
- Liu CA, Huang KH, Chen MH, et al. Comparison of the surgical outcomes of minimally invasive and open surgery for octogenarian and older compared to younger gastric cancer patients: a retrospective cohort study. BMC Surg 2017;17:68. doi:10.1186/s12893-017-0265-3.
- Shibata J, Ishihara S, Tada N, et al. Surgical stress response after colorectal resection: a comparison of robotic, laparoscopic, and open surgery. Tech Coloproctol 2015; 19(5):275-280.
- Pohnán R, Ryska M, Kalvach J, et al. Laparoscopic versus open left pancreatectomy: surgical stress response comparison in the porcine model [Czech]. Rozhl Chir 2018; 97(5):234-238.
- Bucur PO, Bekheit M, Audebert C, et al. Modulating portal hemodynamics with vascular ring allows efficient regeneration after partial hepatectomy in a porcine model. Ann Surg 2018; 268(1):134-142.
- Glorioso JM, Mao SA, Rodysill B, et al. Pivotal preclinical trial of the spheroid reservoir bioartificial liver. J Hepatol 2015; 63(2):388-398.
- Athanasiou A, Kontos M, Pikoulis E, et al. Extended hepatectomy using the bipolar tissue sealer: an experimental model of small-for-size syndrome in pigs. J BUON 2016;21(6):1403-1409.
- Fonouni H, Kashfi A, Stahlheber O, et al. Analysis of the biliostatic potential of two sealants in a standardized porcine model of liver resection. Am J Surg 2017; 214(5):945-955.
- Gouda B, Massol J, Fuks D, et al. Minimally-invasive surgery for liver metastases. Minerva Chir 2015; 70:429-436.
- May LR, Mehler SJ. Complications of hepatic surgery in companion animals. Vet Clin North Am Small Anim Pract 2011; 41(5):935-948.
)