Volume 1 Issue 5 - September 21, 2007
Simplified Hepatic Resection With the Use of a Chang’s Needle
Yuchuan Chang, MD

Dept. Surgery, NCKU Medical Center
Figure 1
Innovation

A Chang’s needle is innovated and designed to facilitate hepatic resections. Our needle consists of a straight, inner needle with a hook near its top to catch the thread and a 15 cm-long, 18-gauge stainless steel sheath (Figure 1).

Background

The liver is an organ fulfilled with blood. Hepatic resections always carry high risks of hepatic ischemic injury induced hepatic failure and intractable bleeding during the operation. Currently used methods for hepatic resection are either difficult in technique to control bleeding or very expensive for the sophisticated machines.

Purpose

We try to simplify the technique, to reduce bleeding, to shorten the training time, and to enable a general surgeon, not the specialist of liver surgery, performing hepatic resections. Chang’s needle is cheaper, simpler, more compact, non-disposable, and easier to use, therefore, more surgeons, more patients in the whole world can have the benefits of this innovation.
Figure 2

Method

When performing a hepatic resection, e.g. right hepatic lobectomy, the Chang’s needle is applied repeatedly along both sides of the division line. The needle is inserted at the surface through the whole thickness of liver parenchyma, where it catches one end of the No.1 thread from below and pulls this end of the thread out of the liver surface. The maneuver is repeated once again 3~5 cm away from the previous insertion to catch the other end of the same thread out of the liver surface (Figure 2).

Figure 3
These two ends of the thread are then tied securely to make a knot and to control the blood flow within this area (Figure 3).

Figure 4
To repeat the above maneuver, two rows of interlocking mattress sutures are eventually made. Then, without using Pringle's maneuver or any other procedures to block the hepatic inflow and backflow, the liver parenchyma can be divided between these two rows of interlocking sutures by a division and clamping method with forceps or electrocautery (Figure 4).


Figure 5
Results

Since September 1997, 88 cases of hepatic resections have been performed without procedure-related mortality or morbidity. There were 53 hepatocellular carcinomas, 4 cholangiocarcinomas, 10 colon metastases, 1 angiomyolipoma, 2 hemangioma, 1 liver trauma and 15 intrahepatic duct stones. Hepatic resections included 12 right lobectomies, 3 tri-segmentectomy, 20 bisegmentect omies, 14 segmentectomies, 13 subsegmentectomies, 5 partial hepatectomies, 18 left lateral segmentectomies and one hepatorrhaphy. Blood loss and operation time are about one third to one half of the conventional methods. This maneuver requires neither inflow nor backflow controls, thus it obviates hilar dissection, spares the complex procedures and management of hepatic vascular exclusion, and avoids the ischemia and reperfusion injury to the remnant liver. In most cases, bleeding during the division of the liver parenchyma was minimal, thus blood transfusion was avoided.

Conclusion

The advantages of this maneuver can be summarized as follows; 1) the use of cheap, simple, and reusable instrument, 2) no need for the use of Rummel tape in Pringle’s maneuver, 3) shortened operation time, 4) reduction or avoidance of blood transfusion in most cases, 5) no need for haemostatic fibrin glue, 6) fewer ischemic and reperfusion injury of the remnant liver, thus simpler postoperative care , 7) lower level of stress for the surgeon during parenchyma transection due to lack of bleeding, 8) shortened training time for surgeons, and 9) an easier maneuver that allows more surgeons to perform hepatic resections.
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