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Updated: May 3, 2026

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

Published on: June 16, 2023

Scraping Hepatectomy Using Ultrasonic Scalpel for Complex Liver Segment Resection.

Yufeng Li¹, Lei Zhou², Kang Chen¹

¹Department of Hepatobiliary Surgery, The First Affiliated Hospital of Hunan Normal University, Hunan Provincial People's Hospital, Changsha, China.

Annals of Surgical Oncology

|September 20, 2025

Summary

This study introduces an ultrasonic scalpel scraping technique for laparoscopic anatomical liver resection, enhancing safety and vessel integrity during challenging liver surgeries. The method ensures rapid vessel skeletonization in difficult liver segments.

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Last Updated: May 3, 2026

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Area of Science:

Hepatobiliary Surgery
Minimally Invasive Surgery
Surgical Technology

Background:

Laparoscopic anatomical liver resection (LALR) is effective but challenging for segments VII and VIII due to deep location and proximity to major vessels.
Risk of complications like bleeding and CO2 gas embolism exists during LALR of posterior segments.
A novel ultrasonic scalpel scraping technique is proposed for improved hepatic vessel skeletonization in LALR.

Purpose of the Study:

To present and evaluate an innovative ultrasonic scalpel scraping technique for hepatic vessel skeletonization during LALR.
To demonstrate the safety and efficacy of this technique in managing challenging liver resections.
To reduce the risk of complications associated with deep liver segment resection.

Main Methods:

A patient underwent LALR for a segment VIII hepatic mass using a dissecting-first ventral approach.
Intermittent Pringle maneuver was employed for inflow occlusion.
An ultrasonic scalpel was used in a continuously activated scraping motion for parenchyma dissection and vessel skeletonization, with 15-30° angles for vessel separation.
Vessels were skeletonized by gentle scraping, minimizing direct clamping and utilizing ultrasonic energy for coagulation of small vessels and bile ducts.

Main Results:

The procedure involved six cycles of Pringle maneuver with 90 minutes of cumulative clamping time.
Total operative time was 280 minutes with 100 ml blood loss.
The patient was diagnosed with intrahepatic cholangiocarcinoma and experienced no postoperative complications, being discharged 7 days post-surgery.

Conclusions:

The ultrasonic scalpel scraping technique facilitates rapid hepatic vessel skeletonization during LALR.
This method effectively ensures the integrity of major vessels during complex liver resections.
The technique offers a safe and efficient approach for managing challenging liver segments in LALR.