Clinical efficacy of visualization techniques-assisted laparoscopic hepatectomy for treating hepatolithiasis in patients with previous biliary surgery

ZENG Xiao-jun; LI Xin-ci; TAO Hai-su; WANG Junfeng; ZHU Wen; XIANG Nan; ZENG Ning; HU Haoyu; FANG Chihua; YANG Jian

doi:10.19538/j.cjps.issn1005-2208.2024.03.16

Abstract：Objective To evaluate the safety and efficacy of visualization techniques-assisted laparoscopic hepatectomy in the treatment of hepatolithiasis in patients with a history of previous biliary surgery.Methods Clinical data of 50 patients with a history of previous biliary surgery who underwent hepatectomy for hepatolithiasis at Zhujiang Hospital of Southern Medical University between January 2022 and June 2023 were retrospectively collected and divided into laparoscopic hepatectomy(LH)group(n=22)and open hepatectomy(OH)group(n=28).The two groups received the surgical plan by three-dimensional visualization technology before surgery,and the LH group performed anatomical hepatectomy with the help of visualization techniques[indocyanine green(ICG)fluorescence imaging combined with augmented reality navigation(ARN)].The ARN guided the surgery by fusing the 3D model with the laparoscopic scene.The OH group performed routine conventional anatomical hepatectomy without the assistance of visualization techniques.Intraoperative indexes and post-operative complications,stone clearance,and recurrence rates were compared between the two groups.Results There was no significant difference in preoperative baseline characteristics between the two groups.Both groups completed anatomical hepatectomy,with 5 cases(22.7％)in the LH group converted to open surgery.Intraoperative blood loss was significantly lower in the LH group than in the OH group(median 150 mL vs.270 mL,P=0.047).The incidence of postoperative bile leakage was significantly lower(9.1％vs.35.7％,P=0.029),and the length of postoperative hospital stay was shorter(median 8 days vs.11 days,P=0.045)in the LH group.There was no significant difference between the two groups in other indicators such as operation time,intraoperative blood transfusion rate,overall complication rate,and major complication rate(all P＞0.05),and no perioperative death occurred in either group.In terms of efficacy,the intraoperative stone clearance rate was higher in the LH group than in the OH group(77.3％vs.50.0％,P=0.049),and the final stone clearance rate after planned and unplanned postoperative stone removal was similar in the two groups(90.9％vs.89.3％,P=1.000).There were no statistically significant differences in the incidence of recurrent cholangitis or stone recurrence between the two groups during follow-up.Conclusion This study demonstrates that visualization techniques-guided LH is safe and feasible in treating hepatolithiasis with a history of biliary surgery,not only achieving the same stone clearance rate of OH,but also promising to reduce intraoperative blood loss,decrease the incidence of postoperative bile leakage,and shorten postoperative hospital stays,which is worth promoting for clinical application.