Hepatic Vein Injuries During Laparoscopic Hepatectomy

Laparoscopic hepatectomy (LH) has now been widely performed in experienced centers. However, hepatic vein injury (HVI) during LH is especially dangerous, because it may cause conversion, air embolization, fatal hemorrhaging, or even death.

Perioperative characteristics of 4 patients who underwent LH suffering HVI were recorded, including 2 for right HVIs, 1 for middle HVI, and 1 for left HVI. Ultrasonic shears was used for liver mobilization. Linear stapler was adopted to cut off hepatic vein. A 4-0 prolene was used to repair HVI.

In case 1 laparoscopic right hemihepatectomy was performed for hepatic hemangioma. The root of right hepatic vein was injured. Repairing time was about 10 minutes and hemorrhaging was about 150 mL. In case 2 laparoscopic segmentectomy for S7 and S8 was performed for hepatic hemangioma. The right hepatic vein was injured. Repairing time was about 8 minutes and hemorrhaging was about 220 mL. In case 3 laparoscopic trisegmentectomy for S2-S4+S5, S8 was performed for hepatic echinococcosis. The middle hepatic vein was injured. Repairing time was about 8 minutes and hemorrhaging was about 110 mL. In case 4 laparoscopic left lateral segmentectomy was performed for hepatocellular carcinoma. The left hepatic vein was injured. Repairing time was about 7 minutes and hemorrhaging was about 80 mL. All the HVIs were successfully repaired by a 4-0 #20 prolene. No complications were observed.

Skillful stitching, experienced surgeons, and smooth cooperation can effectively handle HVI. However, conversion to laparotomy should be performed timely if uncontrolled hemorrhaging occurs, to ensure patients' safety.