TECHNICAL REPORT

Harness Traction Technique (HARNESS): Novel Method for Controlling the Transection Plane During Laparoscopic Hepatectomy Osamu Itano, MD, PhD,* Go Oshima, MD, PhD,w Minoru Kitago, MD, PhD,* Keiichi Suzuki, MD, PhD,z Shigeo Hayatsu, MD, PhD,y Masahiro Shinoda, MD, PhD,* Yuta Abe, MD, PhD,* Taizo Hibi, MD, PhD,* Hiroshi Yagi, MD, PhD,* Naruhiko Ikoma, MD,w Satoshi Aiko, MD, PhD,* and Yuko Kitagawa, MD, PhD, FACS*

Abstract: We present our experience using a novel method for controlling the transection plane, which we termed as the Harness Traction Technique (HARNESS) and evaluate its usefulness. From May 2009 to March 2012, laparoscopic hepatectomies using HARNESS were performed on 35 patients. After the superficial hepatic parenchyma on the line was transected at 1 to 2 cm depth, 5 mm tape was placed along the groove of the line and tied to prevent it from slipping off. Tape was tied and pulled using a forceps toward the best direction for minimizing the bleeding, moving the transection point to the appropriate position and creating good tension for parenchymal transection at the transection point. There were no conversions to laparotomy or intraoperative complications. HARNESS is useful for controlling the dissection line during laparoscopic hepatectomy, leading to precise and safe laparoscopic liver parenchymal dissection. Key Words: harness traction technique, laparoscopic hepatectomy, hanging maneuver, laparoscopic anatomic liver resection, hemostasis

(Surg Laparosc Endosc Percutan Tech 2015;25:e117–e121)

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he scope of laparoscopic hepatectomy has been gradually broadened because of technical progress; improved surgical instruments and laparoscopic major hepatectomy has been already performed in a limited number of institutions.1–7 However, reported conversion rates to open surgery were still high, and conversion to laparotomy because of bleeding or positive surgical margin still occurs,1,2,6,7 because of difficulties in controlling the dissection line. For good control of the dissection point, the appropriate positions of trocars are essential. However, it is

Received for publication December 25, 2014; accepted April 6, 2015. From the *Department of Surgery, Keio University, School of Medicine; wDepartment of Surgery, Eiju General Hospital; zDepartment of Surgery, Kitasato Institute Hospital, Tokyo; and yDepartment of Surgery, Saitama National Hospital, Saitama, Japan. Y.K. received money for grants, lectures, for manuscript preparation, patents, and travel. The other authors declare no conflicts of interest. Reprints: Osamu Itano, MD, PhD, Department of Surgery, Keio University, School of Medicine, 35 Shinanomachi, Shinjuku-ku, Tokyo 160-8582, Japan (e-mail: [email protected]). Supplemental Digital Content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal’s Website, www.surgical-laparoscopy.com. Copyright r 2015 Wolters Kluwer Health, Inc. All rights reserved.

Surg Laparosc Endosc Percutan Tech



difficult to standardize the appropriate positions of the trocars because of the physical attributes (fat/thin/deep/tall/ short/thoracic cavity, etc.) of the patients and the position of the liver varies individually. In addition, when opening the transection planes of the liver laparoscopically, the only method available is to push the edge of the liver parenchyma laterally and cranially using laparoscopic retractors, causing the dissection point to go deep into the thoracic cavity. In such situations, the optimal device cannot be used at the proper angle. Occasionally, the device cannot reach the dissection point, leading to failure of hemostasis and an uncontrollable dissection line; this results in positive surgical margin, injury of the remnant-side vessels, postoperative bleeding, and bile leakage. There are several reports about technical devices used to control the transection plane and/or reduce bleeding during laparoscopic hepatectomy8–16; however, more simple and accommodating devices are needed to perform various types of resections. Therefore, we developed a novel method for controlling the transection plane, which we refer to as the “Harness Traction Technique (HARNESS),” for safe and precise dissection in total laparoscopic hepatectomy, especially anatomic resection. Herein, we present our experience using HARNESS and evaluate its usefulness.

METHODS Patients From May 2009 to March 2012, laparoscopic hepatectomies using HARNESS were performed on 29 men and 6 women having a mean age of 65 ± 11 years (range, 46 to 81 y). This is a retrospective study and written informed consent was obtained from the patients before the surgery. We obtained IRB approval for data collection and analysis.

Operative Technique Basic Technique Under general anesthesia, the patient was placed in the supine position with split legs for mobilization of the lateral segment and the left hemilateral position with split legs to switch easily between the supine and left lateral positions. A pneumoperitoneum was established through a 12 mm umbilical port, and this was maintained

Harness Traction Technique (HARNESS): Novel Method for Controlling the Transection Plane During Laparoscopic Hepatectomy.

We present our experience using a novel method for controlling the transection plane, which we termed as the Harness Traction Technique (HARNESS) and ...
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