Combination of the right hepatic vein occlusion and pringle maneuver in laparoscopic right posterior sectionectomy: protocol for a prospective non-randomized controlled study using propensity score-matched analysis

Abstract

Introduction: Laparoscopic right posterior hepatectomy, particularly for standard anatomical resection, presents significant technical challenges. Achieving complete exposure of right hepatic vein (RHV) is the critical step in this procedure. To date, there is currently no universally accepted technique to ensure the safe exposure of RHV. To address this gap, this study designs a novel technique involving RHV occlusion and Pringle maneuver for enhancing the safety of RHV exposure in laparoscopic anatomical right posterior hepatectomy (LARPH). A comparative analysis between this innovative approach and traditional technique is performing to investigate the safety and efficacy of this innovative approach. Methods and analysis: This prospective non-randomized controlled trial is being conducted at West China Hospital and Sanya People’s Hospital. Patients undergoing LARPH using the novel technique (double occlusion) will be assigned to the experimental group, while those using the traditional technique (Pringle maneuver only) will be assigned to the control group. Perioperative outcomes and follow-up data will be collected and analyzed. PSM analysis with 1:1 ratio matching will be used to mitigate the potential selection deviation. The primary outcome is intraoperative blood loss. Secondary outcomes include the rate of successful RHV exposure, the incidence of CO₂ embolism, postoperative complications, as well as morbidity and mortality at 30 days and 90 days. Discussion In this study, the outflow occlusion of the target area is innovative adopted: the RHV is selectively occluded in LARPH to control the outflow of S67. Combined with the pringle maneuver, our technique potential has the benefits of reduced the risk of hemorrhage and CO₂ gas embolism. By developing and disseminating standardized protocols based on best practices and evidence from successful cases, this study aims to establish a safe, efficacy, and easily disseminated novel surgical technique. Trial registration: This study has been prospectively registered at Chinese Clinical Trial Registry (https://www.chictr.org.cn/index.html) on May 26, 2023. The identifier is ChiCTR2300071832 and the registry name is “Caudodorsal approach combined with the occlusion of the right hepatic vein and Pringle maneuver in laparoscopic right posterior sectionectomy”.