Round-the-liver ligation device for laparoscopic hepatectomy
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Solution Overview
Problem
Existing methods for staged hepatectomy, such as ALPPS, face challenges including high risk of bile leakage from liver parenchyma transection and difficulties in maintaining optimal liver tourniquet tightness due to reliance on surgeon experience and lack of precise adjustment mechanisms.
Innovation Solution
The implementation of a completely laparoscopic staged hepatectomy using round-the-liver ligation, which involves a pressure-adjustable liver tightening device with a ratchet mechanism and vernier scale to ensure consistent and adjustable tightness of the liver tourniquet, thereby preventing bile leakage and facilitating precise control of liver ligation.
Engineering Contradictions & Design Principles
Engineering Contradiction Analysis
1Reliability
If round-the-liver ligation is used to block communicating blood flow between hemilivers, then bleeding is reduced and ischemia reperfusion injury is reduced, but bile leakage occurs from transection of liver parenchyma
Solution Approach 1:
The patent extracts and removes the harmful element (liver parenchyma transection) from the surgical approach by using round-the-liver ligation to block blood flow without cutting the liver tissue. This eliminates the source of bile leakage while maintaining the therapeutic effect of reducing bleeding and ischemia reperfusion injury.
Solution Approach 2:
The patent introduces an intermediary mechanism (round-the-liver ligation device) that achieves blood flow blocking without direct liver parenchyma transection. The ligation device acts as a mediator between the surgical goal (blocking blood flow) and the liver tissue, preventing bile leakage by avoiding direct tissue damage.
2Adaptability or versatility
If ALPPS method is used for staged hepatectomy, then liver resection is enabled in patients with compromised liver cirrhosis, but the operation wound surface area is large requiring long recovery
Solution Approach 1:
The patent segments the surgical procedure into two distinct stages: first stage for round-the-liver ligation and blood flow blocking, and second stage for tumor resection. This segmentation allows the liver to regenerate and prepare for the second operation, reducing the need for large wound surfaces and minimizing recovery time while maintaining adaptability for patients with liver cirrhosis.
3Ease of operation
If surgeon experience determines tourniquet tightness, then operation can be performed, but precise adjustment of liver tourniquet tightness is difficult
Solution Approach 1:
The patent incorporates a feedback mechanism through the round-the-liver ligation device that allows real-time monitoring and adjustment of tightness. The device provides tactile and visual feedback to the surgeon, enabling precise control of tourniquet tightness without relying solely on experience, thereby improving both ease of operation and measurement precision.
Data Source
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AI summary
The present invention discloses a completely laparoscopic staged hepatectomy using round-the-liver ligation, which is carried out as follows: (1) a complete laparoscopic operation is performed with general anesthesia using round-the-liver ligation, the branches of the portal vein of the hemiliver to be removed are ligated, meanwhile a tourniquet is used to tighten the connecting part between the right and the left hemilivers to block the communicating blood flow between the hemiliver to be removed and the hemiliver to be reserved, a drainage tube is put into the peritoneal cavity at the hepatic hilus, then close the peritoneal cavity, and the operation is completed; (2) the patient gradually resumes eating after the first operation, and recuperate for 6-15 days to make the volume of the hemiliver to be reserved increase to the expected volume of the future liver remnant, in which the expected volume of the future liver remnant should be at least 30-40% of the standard liver volume; (3) after the volume of the hemiliver to be reserved has increased to the expected volume of the future liver remnant, a complete laparoscopic liver resection is carried out with general anesthesia to remove the diseased hemiliver, and then the patient is nursed to be completely recovered. The invention also discloses a instrument for implementing the completely laparoscopic staged hepatectomy using round-the-liver ligation.