To evaluate the safety and efficacy of hepatic portal occlusion with vascular clamp in complex laparoscopic left hemihepatectomy.

Clinical data of 3 patients undergoing laparoscopic left hemihepatectomy in Zhujiang Hospital of Southern Medical University from August 2019 to March 2021 were retrospectively analyzed. The informed consents of all patients were obtained and the local ethical committee approval was received. Among them, 2 patients were female and 1 male, aged 45, 61 and 55 years, respectively. Primary diseases were hepatic hemangioma, hepatolithiasis and hepatocellular carcinoma, respectively. The liver function of 3 patients were Child-Pugh grade A before operation. All patients had history of abdominal hepatobiliary surgery. Intraoperatively, severe liver-abdominal wall adhesion was observed, severe liver-duodenal ligament adhesion was also seen, and the boundary between hepatic hilus and duodenum was unclear. The porta hepatis was occluded with vascular clamp. The total length of vascular clamp was 7.0 cm and the length of clamp opening was 4.5 cm, which was placed through the main operating trocar site. Perioperative conditions of 3 patients were observed.

All 3 patients successfully completed the surgery without conversion to open surgery. For case 1, the operation time was 240 min, intraoperative blood loss was approximately 400 ml, occlusion was performed once and the occlusion time was 14 min. For case 2, the operation time was 230 min, and intraoperative blood loss was approximately 300 ml, occlusion was performed once and the occlusion time was 12 min. For case 3, the operation time was 280 min, intraoperative blood loss was approximately 600 ml, and intraoperative blood transfusion was 400 ml. Twice occlusion was performed due to increased errhysis on the transection plane during hepatectomy, the total occlusion time was 29 min. Postoperatively, liver function of all patients was properly recovered. The length of postoperative hospital stay was 6, 5 and 8 d, respectively. No complications were observed. Postoperative pathological examination showed that case 1 was diagnosed with cavernous hemangioma in the left lobe, case 2 with hepatolithiasis and case 3 with hepatocellular carcinoma in the left lobe.

It is safe and feasible to utilize vascular clamp for inflow occlusion of the liver in laparoscopic hepatectomy. It is mainly suitable for patients undergoing complex left hemihepatectomy who have a history of liver surgery with difficult dissection due to severe porta hepatis adhesion. It can effectively reduce the intraoperative blood loss and is easy to operate.