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Updated: Sep 16, 2025
Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Short-term effects of modified ultrasonography in laparoscopic anatomical hepatectomy for hepatocellular carcinoma
Xun Wang1, Xuan Meng1, Liming Wang1
1Department of Hepatobiliary Surgery, National Cancer Center/National Clinical Research Center for Cancer/Cancer Hospital, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing 100021, China.
Background And Aims:
Laparoscopic hepatectomy is challenging, and ultrasound guidance is an effective aid but lacks standardization. This study aimed to evaluate a modified approach for laparoscopic ultrasonography to enhance surgical outcomes.
Methods:
Between January 2020 and August 2023, 122 patients who underwent real-time ultrasound-guided laparoscopic anatomical hepatectomy for hepatocellular carcinoma were enrolled and divided into modified and traditional ultrasonography groups. The modified ultrasound application comprised intraoperative protocol-based laparoscopic ultrasonography comprising application scenarios; standardized positions for the surgeon, trocar, and probe; and the resulting standardized sections for various laparoscopic liver resections. Clinical characteristics and perioperative outcomes were compared between the two groups. Subgroup analysis was performed and comprised techniques for modified duct structure identification and portal vein branch puncture; both techniques were used in fluorescence probe-mounted laparoscopic liver resection using negative and positive staining procedures, respectively.
Results:
The traditional and modified groups comprised 64 and 58 patients, respectively. The patients' background characteristics were not significantly different between the groups. Surgical duration (283.4 min vs. 225.1 min; p < 0.001), Pringle maneuver duration (47.4 min vs. 39.5 min; p = 0.014), bleeding volume (258.6 mL vs. 174.8 mL; p = 0.005), overall complication rate (31.3% vs. 15.5%; p = 0.041), and postoperative stay were significantly greater in the traditional vs. modified ultrasonography groups, respectively. The modified method positively affected the number of punctures, success rate of staining, intraoperative bleeding volume, and operation duration.
Conclusions:
Modified ultrasonography improves the safety and effectiveness of laparoscopic hepatectomy. Ultrasonography is pivotal, especially in fluorescence probe-assisted laparoscopic liver resection.
