The application of self-made liver suspension device in 3D laparoscopic non-anatomical resection of liver VI and VII segments tumors

The application of self-made liver suspension device in 3D laparoscopic non-anatomical resection of liver VI and VII segments tumors | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Article The application of self-made liver suspension device in 3D laparoscopic non-anatomical resection of liver VI and VII segments tumors Shengxiong Chen, Xiaoxu Jin, Zijia Hao, Yijun Wang, Chengxu Du, and 2 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-4592506/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective: To investigate the effect of self-made liver suspension device in 3D laparoscopic non-anatomical resection of liver VI and VII segments tumors. Methods: The clinical data of 79 patients who underwent non-anatomical resection of liver VI and VII segments tumors at the Second Hospital of Hebei Medical University from June 2016 to June 2022 were retrospectively analyzed, divided into SDLG group and CLG group. The SDLG group used the self-made liver suspension device for 3D laparoscopic resection, and the CLG group received conventional 3D laparoscopic resection; the clinical data were compared to evaluate the efficacy. Results: The operation time in SDLG group was significantly shorter than that in CLG group, the intraoperative bleeding volume and liver portal blockage time were significantly reduced, and the postoperative complications were alleviated; there was no significant difference in hospital stay, drainage tube removal time, bedside time, and postoperative flatus time. Conclusion: The self-made liver suspension device can shorten the operation time and liver portal blockage time, reduce intraoperative bleeding, alleviate postoperative complications, and improve the safety of non-anatomical resection of liver VI and VII segments tumors. It is worth further clinical promotion. Health sciences/Anatomy Health sciences/Health care 3D laparoscopy Liver VI and VII segments Liver suspension device Malignant tumor Laparoscopic hepatectomy Figures Figure 1 Figure 2 Figure 3 Figure 4 Figure 5 Introduction With the continuous advancement of laparoscopic instruments and techniques, laparoscopic liver resection (LLR) is increasingly used for benign and malignant liver tumors due to its advantage of minimal invasiveness [1, 2]. In recent years, with the development of the internet and endoscopic instruments, laparoscopic liver resection technology has become more popular, and 3D laparoscopy has gradually entered major hospitals and been widely used in clinical practice, especially for complex hepatobiliary pancreatic surgeries [3, 4]. However, the non-anatomical liver segments I, VI, VII, and VIII are located in special positions and difficult to obtain ideal views, with complex anatomical relationships considered to be the main challenges in LLR [5, 6]. Especially when the tumor is closely attached to the inferior vena cava, the hepatic right and middle veins, if the laparoscopic view is not good, the operation is extremely difficult, especially when bleeding occurs during the operation, it is difficult to handle, which increases the surgical risk and the chance of converting to open surgery [7]. To overcome these challenges, new 3D laparoscopic devices have been developed and applied in clinical practice in recent years, especially with the four-way movable 3D lens, compared with the 2D lens lacking depth perception and spatial sense, the 3D laparoscope fully utilizes its 3D stereoscopic imaging effect, especially the 3D lens that can bend in four directions, nearly achieving a surgical field without dead angle [8]. The surgeon can have a more intuitive and clear understanding of the relationships between anatomical structures, organs, and blood vessels during surgical procedures, allowing for the completion of some delicate, directed operations in a laparoscopic setting, such as surgical suture operations, precise vascular anastomosis operations, and gastrointestinal reconstruction operations, where the advantage of the stereoscopic field of vision is more pronounced. The 3D stereoscopic judgment of holding the needle instrument, grasping the needle holder, and tying knots is more precise [9-11]. For laparoscopic left liver surgery, since the surgical field itself is well exposed, the surgery is relatively easy [12]. In recent years, with the accumulation of surgeons' operative experience, the replacement of surgical instruments, and the application of self-made laparoscopic auxiliary devices, the resection of liver segments has nearly become free of contraindications [13, 14]. However, there is still a lack of research on the large-scale use of 3D laparoscopy for non-anatomical liver VI and VII segment tumor resection [15]. For tumors in the non-anatomical liver VI and VII segments, the use of conventional 3D laparoscopy with 3-0 suture lines to retract the liver and expose the tumor causes significant liver damage [16, 17]. This study reviews the clinical data of 79 patients who underwent non-anatomical liver VI and VII segment tumor resection at the Second Hospital of Hebei Medical University from June 2016 to June 2022. It discovered a surgical method that can more fully expose VI and VII segment tumors, namely, the self-made liver suspension device and suspension method, which can control the pulling force during liver exposure and cause less damage to the liver than the conventional 3D laparoscopic method. This study compares the clinical data of patients who underwent non-anatomical liver resection using the self-made liver suspension device and suspension method with those who underwent conventional 3D laparoscopic non-anatomical liver resection to investigate the application effect of the self-made liver suspension device in 3D laparoscopic non-anatomical liver VI and VII segment tumor resection. The self-made liver suspension device with a pulling force more suitable than that of the conventional 3D laparoscopic method fully exposes the VI and VII segment tumors. This study provides theoretical basis for further safe and effective clinical implementation of non-anatomical liver VI and VII segment tumor resection. Methods 1.1 General Data The clinical data of 79 patients who underwent non-anatomical liver VI and VII segment tumor resection at the Second Hospital of Hebei Medical University from June 2016 to June 2022 were retrospectively analyzed. The patients were divided into laparoscopic surgery group (SDLG group, n=45) and conventional laparoscopic surgery group (CLG group, n=34) according to different surgical methods. This study was approved by the ethics committee of the hospital. Patients and their families are asked to sign informed consent forms before surgery. This study complies with the ethical requirements of the Helsinki Declaration. 1.2 Inclusion and exclusion criteria Inclusion criteria: (1) Patients with good general condition and able to tolerate surgical procedures; (2) Diagnosed with benign/malignant tumors of the liver VI and VII segments based on the patient's medical history, clinical manifestations, and imaging examinations; (3) Tumor diameter less than 10 cm; (4) Child Pugh liver function grade A or B; (5) No intrahepatic or distant metastasis, no hepatic vein, portal vein, inferior vena cava, or bile duct tumor thrombosis; (7) No active chronic hepatitis B; (8) No prior interventional, radiation, chemotherapy, or ablation treatment; (9) Patients and their families sign informed consent forms. Exclusion criteria: (1) Tumors with a diameter greater than 10 cm or significantly protruding from the liver surface, occupying a large space in the laparoscope, leaving no sufficient space for surgery, and potentially causing tumor rupture and tumor cell shedding; (2) Patients with high tumor surface tension assessed preoperatively, with a risk of tumor rupture during intraoperative manipulation; (3) Severe cirrhosis patients, requiring sufficient safety margins while preserving as much residual liver as possible; (4) Tumors adjacent to important hepatic pedicles and veins or with portal vein and hepatic vein cancer thrombi; (5) Patients with preoperative indications of tumor rupture; (6) Patients with a history of abdominal surgery; (7) Patients with contraindications to laparoscopic surgery. (8) Patients who underwent mid-operation laparotomy; (9) Patients whose disease progression was discovered during surgery; (10) Patients who had previously undergone hepatic artery embolization, radiation therapy, chemotherapy, and radiofrequency ablation. 1.3 Surgical Methods 1.3.1 Preoperative Preparation Both groups of patients underwent liver function tests and preoperative hematological examinations. Regular supportive treatment was provided to the patients, and contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), electrocardiography (ECG), and echocardiography were used for monitoring, with special monitoring provided through automated 3D liver organ reconstruction for on-site treatment. All patients underwent general anesthesia and tracheal intubation during surgery. An intravenous line was established before anesthesia, and electrocardiographic monitoring instruments were connected. Life signs were evaluated. Anesthetic induction was performed using intravenous general anesthetic drugs, analgesic drugs, and muscle relaxants, so that the patient underwent the following changes within a few minutes: from conscious state to unconsciousness, from respiratory rate of 16-20 breaths per minute to respiratory arrest, with tracheal intubation performed during this process. Tracheal intubation was performed using a laryngoscope or fiberoptic bronchoscope to guide the intubation guidewire or the intubation itself into the patient's mouth until it reached the entrance of the trachea. The tracheal tube was gently inserted through the vocal cords into the trachea after confirming the correct placement of the intubation. The correct placement of the tracheal tube was confirmed through auscultation, observation of respiratory movements, and X-ray examination. After confirming the correct position, the tube is fixed in the patient's mouth to prevent it from falling off or shifting. Connect the tube to the respirator to ensure that the patient receives adequate oxygen supply. During the anesthetic surgery, continuous application of anesthetic drugs is used to maintain a certain level of anesthesia. Monitoring is carried out during the maintenance period to observe the impact of the surgical operation on the patient's life at any time, and treatment and adjustment are carried out as necessary to ensure the safety of the patient's life. After the surgery is over, the patient enters the recovery period and the use of anesthetic drugs is stopped. During the anesthetic recovery, the patient's consciousness gradually recovers, and continuous monitoring of vital signs is carried out, and lactate Ringer's injection and nutrient solution are intravenously infused to maintain the patient's vital signs. 1.3.2 CLG group (conventional laparoscopic group) After anesthesia, the patient is placed in the "big" surgical position. The right shoulder and back are raised with soft pads at an angle of 45-60° to facilitate the dissection of the right liver. The left upper limb is extended and fixed, and the sterile gown is regularly disinfected and laid out (Figure 1A). The 5-hole method is used, and a 10 cm trocar needle is inserted into the right side of the umbilicus above two fingerbreadths in the abdominal rectus muscle area, then a 3D laparoscope lens is used. Under direct vision, a 12 cm trocar needle is placed at the edge of the right axillary anterior rib below 5 cm, and a 5 mm trocar needle is placed at the edge of the right axillary posterior rib below. Insert a 10mm cannula into the suprasternal notch, and a 5mm cannula into the two intercostal spaces above the umbilicus as an aid for placing the trocars. The ultrasonic shears are used to cut the ligaments of the liver cirrhotic flexure, the ligament of the falciform ligament, the right triangular ligament, the ligament of the liver kidney, and the right coronary ligament, completely dissecting the right lobe of the liver. Place the pre-Pringle occlusion band and suture it to the right triangular ligament with 3-0 suture. Then pull it to the left and expose it at an appropriate position on the lateral abdominal wall, fix it to expose the tumor. Use the electrocautery hook to mark the pre-cut line. Wrap the approximately 40cm long portal ligation suture around the first portal area and pull it out through the appropriate position on the lateral rib margin below. The front end of the disposable plastic suction catheter is covered with a 2cm soft tube. The portal ligation suture passes through the soft tube on the front end of the plastic suction catheter, is pulled tight, and the suction catheter is used to block the portal. Intermittently block the first portal for 15 minutes, then relax for 5 minutes. The ultrasonic shears are used to slowly dissect the liver tissue along the pre-cut line. Use the biopsy forceps to cut off the accessory tubes entering the tumor. Enlarge the incision at the suprasternal notch and remove the specimen. Place the specimen in a bag until the entire tumor is removed. During the operation, a 10 or 12-number urinary catheter is used to make a ring-shaped portal ligation band at the first portal area. The urinary catheter itself has elasticity, making it easier to tighten and loosen the ligation band, achieving a reliable first portal ligation effect. Clean the surface of the wound. If there is active bleeding from the liver segment, use electrical spray coagulation or 3-0 or 4-0 suture lines to stop the bleeding. The doctor will use absorbable suture lines to internally suture the liver incision, which may involve suturing at different levels to ensure the incision is fully closed and reduce the risk of bleeding and leakage. After checking for active bleeding or bile leakage, place hemostatic materials on the surface of the liver wound and place two abdominal drainage tubes under the right diaphragm and the liver wound. Finally, the doctor will use absorbable suture lines or skin adhesive to close the skin incision on the abdomen. 1.3.3 Laparoscopic Suspension Device Group (SDLG Group) Because the liver is relatively fragile, suture traction method may not be effective if the traction force is too small, or if it does not produce enough exposure of the VI and VII segments. If the traction force is too great, it may tear the liver, causing unnecessary bleeding. In addition to using a homemade liver suspension device (Figure 1B) and a simple hepatic hilum occlusion device (Figure 1C), the rest of the operation is similar to conventional laparoscopy. The suspension device manufacturing and suspension process are as follows (Figure 1D-H): insert a needle with a thread into the liver and secure it firmly with a plastic hard rod in the middle (we usually cut off about 3-4 cm of disposable plastic suction tube), to prevent slippage. This forms a homemade suspension base, and the thread forms a "T" shape. Place the homemade liver suspension device in the abdomen, and the liver needle is held by a needle holder and inserted from the internal surface of the visceral organ between segments V and VI of the liver, withdrawn from the diaphragmatic surface, and then withdrawn from the left margin of the abdominal wall. The liver needle thread is pulled out, causing the right liver to be pulled towards the left, fully exposing the VI and VII segment tumors. The operation is performed from left to right and caudal to cephalic resection. Use an electrocoagulation hook to draw the pre-resection line. The hepatic pedicle occlusion process is as follows (Figure 1I): Cut the catheter 12 into two segments, leaving a side hole at the reserve end, open the lesser sac, and insert the separation clamp from the posterior end of the splenic flexure behind the inferior vena cava in front of the Winslow foramen, into the lesser sac. Pull the catheter 12 through the Winslow foramen, and the separation clamp extends the tail end into the side hole, with the other end holding it and pulling it out of the side hole to form a circular occlusion device structure surrounding the first hepatic pedicle. Tighten the first hepatic pedicle occlusion belt, occlude the first hepatic pedicle intermittently for 15 minutes, relax for 5 minutes, and use a ultrasonic scalpel to slowly dissect the liver tissue along the pre-cut line (Figure 1J). Use biopsy forceps to cut off the accessory vessels entering the tumor, place the specimen in a bag, and continue to remove the tumor until it is completely removed. Check for no active bleeding or bile leakage after the liver incision, and place hemostatic materials at the wound site. Place two abdominal drainage tubes in the retroperitoneal space on the right side. Make a larger incision under the sternum, remove the specimen, and the suturing method is the same as that of the CLG group. 1.3.4 Postoperative Care Precautions (1) Observation: Closely monitor the patient's vital signs, including blood pressure, heart rate, and respiration. Monitor for signs of postoperative bleeding, infection, or other complications. Remove the tracheal tube when the patient's breathing function has recovered well. (2) Pain management: Provide postoperative analgesia based on the patient's pain level. Give appropriate analgesic drugs in a timely manner to ensure the patient's comfort. (3) Diet: Gradually resume eating according to the doctor's instructions, usually starting with fluid diet and gradually transitioning to soft food and normal diet. Avoid greasy and stimulating food to avoid stimulating the digestive system. (4) Activity: Engage in appropriate activities according to the doctor's instructions, avoiding strenuous exercise and excessive fatigue, but also avoiding prolonged bed rest. You can practice ankle pump exercises on the bed to prevent blood clots. (5) Wound care: Keep the wound clean and dry and change the dressing regularly. Observe the wound healing process and pay attention to preventing infection. (6) Medication: Follow the doctor's instructions to use antibiotics and painkillers properly to prevent infections and relieve pain. (7) Regular follow-up: Regular follow-up after surgery, the doctor evaluates the patient's recovery status and conducts relevant checks as needed to monitor for complications. (8) Medical staff adjust the treatment according to the individual patient's condition. 1.4 Observation Indicators 1.4.1 During surgery, record and statistically analyze the operation time, hepatic pedicle occlusion time, and blood loss during surgery for both groups of patients. Hepatic pedicle occlusion time is mainly clinically referring to the blockage of hepatic blood flow, with the first hepatic pedicle blockage being the most common. The operation will block the first hepatic pedicle according to the actual situation to reduce blood loss. The occlusion time should not exceed 15 minutes per blockage, and the interval between loosening should be more than 5 minutes. 1.4.2 Record the hospitalization time, drainage tube removal time, time of postoperative gas expulsion, and time of getting out of bed after surgery. 1.4.3 After surgery, record the incidence of complications according to the Clavien-Dindo grading standard within 3 months [18]. Common complications of liver tumor resection surgery include pleural effusion, peritoneal effusion, incision liquefaction, bile leakage, incision infection, and incision seroma. 1.5 Statistical processing The data were analyzed using SPSS 26.0 software. Normally distributed quantitative data were expressed as （ ）, and group comparisons were made using t-tests. Categorical data were expressed as cases or percentages (%) and group comparisons were made using chi-square tests. P<0.05 was considered statistically significant. Results 2.1 Comparison of general information between the two groups of patients who underwent liver tumor resection A total of 79 patients who underwent non-anatomical liver VI and VII segment tumor resection were included in this study and divided into the CLG group and the SDLG group. There were 45 patients in the SDLG group, including 19 males and 26 females, with an age range of 34 to 74 years and a mean age of 55.4 ± 10.8 years; there were 34 patients in the CLG group, including 16 males and 18 females, with an age range of 32 to 76 years and a mean age of 55.1 ± 11.2 years. There were no statistically significant differences in age, gender, tumor type, liver function grade, tumor location, BMI, or tumor size between the two groups (P>0.05, as shown in Table 1 and Figure 2), indicating that the two groups had good comparability. Table 1 Comparison of general information between the two groups of patients Group CLG（n=34） SDLG(n=45) t/χ2 P Age (years) 55.12±11.23 55.04±10.83 0.0293 0.9767 Sex 0.1836 0.6683 Men 16 19 Women 18 26 Tumor type 0.1350 0.7133 Benign 15 18 Malignant 19 27 Child grad 0.0041 0.9489 A-level 27 36 B-level 7 9 Tumor cation 0.2493 0.8828 Ⅵ 12 14 Ⅵ/Ⅶ 8 10 Ⅶ 14 21 BMI（kg/㎡） 23.42±1.68 23.16±1.61 0.6921 0.4910 Tumor size （cm） 5.94±1.09 5.88±1.00 0.2046 0.8385 2.2 Comparison of surgical indicators between the SDLG group and the CLG group 2.2.1 Comparison of surgical time, liver pedicle occlusion time, and intraoperative blood loss between the two groups According to the statistics, the surgical time in the SDLG group was significantly shorter than that in the CLG group, and the intraoperative blood loss and liver pedicle occlusion time were significantly lower than those in the CLG group (P<0.05). See Table 2 and Figure 3. Table 2 Comparison of operative time, hepatic pedicle occlusion time, intraoperative blood loss between the two groups Group CLG（n=34） SDLG(n=45) t P operative time（min） 312.05±51.18 261.00±54.03 4.2530 0.0001 hepatic portal occlusion time（min） 27.05±5.79 23.27±5.67 2.9156 0.0046 intraoperative bleeding volume（ml） 267.50±104.43 215.33±76.89 2.5584 0.0125 Figure 3 Comparison of operative time, hepatic pedicle occlusion time, intraoperative blood loss between the two groups 2.2.2 Comparison of hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups There was no statistically significant difference in hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups (P>0.05). See Table 3 and Figure 4. Table 3 Comparison of hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups Group CLG（n=34） SDLG(n=45) t P hospital stay（d） 7.94±1.52 7.71±1.49 0.6573 0.5015 removal time of the drainage tube（d） 3.97±1.19 3.71±0.97 1.0670 0.2893 out-of-bed time（d） 1.65±0.60 1.67±0.60 0.1436 0.8862 postoperative exhaust time（d） 1.97±0.72 1.84±0.74 0.7622 0.4483 Figure 4 Comparison of hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups 2.2.3 Comparison of postoperative complications between the two groups A total of 16 complications occurred in the CLG group, including 5 cases of pleural effusion, 6 cases of peritoneal effusion, 3 cases of bile leakage, 1 case of incision infection, and 1 case of incision liquefaction. A total of 9 complications occurred in the SDLG group, including 2 cases of pleural effusion, 2 cases of peritoneal effusion, 2 cases of bile leakage, 1 case of incision infection, 1 case of incision liquefaction, and 1 case of incision seroma. The incidence of complications in the SDLG group was lower than that in the CLG group, and the difference was statistically significant (P<0.05). See Table 4 and Figure 5. Table 4 Comparison of postoperative complications between the two groups Group CLG（n=34） SDLG(n=45) χ2 P The number of complications 16 9 6.5555 0.0105 Number of complications were not present 19 36 Complication rate 47.06% 20% Figure 5 Comparison of postoperative complications between the two groups Discussion Globally, hepatocellular carcinoma is the most common fatal malignant tumor [ 19 , 20 ]. The treatment of liver cancer includes surgical resection, transplantation, ablation, chemotherapy and embolization, and liver resection is the standard treatment for liver cancer [ 21 , 22 ]. The advancement of surgical techniques over the past 30 years, including preoperative assessment of the residual liver, has improved the safety of liver resection [ 23 ]. In recent years, minimally invasive techniques have been increasingly used in liver surgery. A large number of retrospective analyses have shown that liver metastasis and hepatocellular carcinoma are among the most common indications nowadays [ 24 , 25 ]. The use of LLR is increasing worldwide, but performing LLR on liver segments VI, VII of the right posterior lobe and the caudate lobe remains challenging for surgeons [ 26 , 27 ]. LLR has the advantages of light postoperative pain, fast recovery, and fewer complications [ 28 – 30 ]. Compared with traditional surgery, the advantages of laparoscopic surgery include less damage to healthy tissue, reduced risk of pain and infection, shorter recovery time, and shorter hospital stay [ 31 ]. 3D laparoscopy is the latest development of laparoscopic surgery and has been shown to improve surgical outcomes, reduce errors, enhance spatial awareness, and reduce the time required to complete surgical tasks in a laboratory environment [ 32 , 33 ]. The popularity of 3D technology is gradually increasing, and its advantages are more pronounced in the visualization and distribution of solid organs [ 34 ]. Using 3D technology, surgeons can focus on the specific anatomical structures of a patient's organ and predict the various stages of the operation [ 34 ]. The liver is relatively fragile, and if the traction force is too small when exposing tumors in segments VI and VII, it will not meet the visual requirements for exposing these segments. If the traction force is too great, it is easy to tear the liver and increase the amount of bleeding during the operation. Conventional 3D laparoscopic surgery uses 3 − 0 suture lines to sew a Pringle ligation block to pull the liver and expose the tumor, while this study compares the clinical data of patients who underwent 3D laparoscopic non-anatomical liver resection using a self-made liver suspension device and method with those who underwent conventional 3D laparoscopic non-anatomical liver resection, and the results are as follows: The surgical time in the SDLG group was significantly shorter than that in the CLG group. The intraoperative bleeding volume and portal blockage time in the SDLG group were significantly lower than those in the CLG group. The intraoperative bleeding volume in the SDLG group was reduced, which lowered the incidence of complications such as wound infection and seroma. However, there was no statistically significant difference in the length of stay, the time of removing the drainage tube, the time of getting out of bed, and the time of postoperative flatus between the two groups. The study results show that 3D laparoscopic non-anatomical liver resection for VI and VII segment tumors has the advantages of reducing surgical time and intraoperative bleeding, which are consistent with the current research results [ 35 – 37 ]. In this study, a self-made "T"-shaped liver suspension device was used, which was fully attached to the visceral surface between the V and VI segments of the liver, thus fully exposing the tumor, thereby reducing the surgical time, intraoperative bleeding, and portal blockage time, and subsequently lowering the incidence of postoperative complications. In summary, the use of a self-made liver suspension device reduces surgical time, intraoperative bleeding, and portal blockage time, and reduces complications. It further enhances the safety of non-anatomical resection of liver VI and VII segments tumors and is worth further clinical promotion. Declarations Ethics approval This study was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University. The project name is The application of self-made life suspension device in 3D laparoscopic non anatomical section of life VI and VII segments learners, and the review resolution number is 2023-r345. This study was approved by the ethics committee of the hospital. Patients and their families are asked to sign informed consent forms before surgery. This study complies with the ethical requirements of the Helsinki Declaration. Author Contributions S.X.C. and X.X.J. contributed to the conception and design of the study. Z.J.H. and Y.J.W. performed the data collection and analysis. C.X.D. and X.D.L. contributed to the interpretation of the data. S.X.C. and H.Q.J. drafted the manuscript. All authors critically revised the manuscript for important intellectual content and approved the final version to be published. Conflict of Interest Statement The authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper. Funding This study was supported by the medical science research project of Hebei province. The topic of this study was applied research of self-made liver sling in 3D laparoscopic non-anatomical liver VI, VI/VII, VII tumor resection, foundation no. (No. 20240642) Acknowledgments None. Data availability The datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request. References Liao, K., et al., Laparoscopic Anatomical Versus Non-anatomical hepatectomy in the Treatment of Hepatocellular Carcinoma: A randomised controlled trial. Int J Surg, 2022. 102 : p. 106652. Sun, H., H. Yang, and H. Xu, A commentary on "Laparoscopic Anatomical Versus Non-anatomical hepatectomy in the Treatment of Hepatocellular Carcinoma: A randomised controlled trial" (Int J Surg 2022;102:106652). Int J Surg, 2022. 104 : p. 106783. Kwon, Y., et al., Improved Outcomes of Laparoscopic Liver Resection for Hepatocellular Carcinoma Located in Posterosuperior Segments of the Liver. World J Surg, 2021. 45 (4): p. 1178-1185. Xiao, L., et al., Laparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments. Surg Endosc, 2015. 29 (10): p. 2994-3001. Kim, H.J., et al., Improved outcomes of major laparoscopic liver resection for hepatocellular carcinoma. Surg Oncol, 2020. 35 : p. 470-474. Pan, M. and C. Zhang, [Practice of laparoscopic hepatectomy in primary care facilities in China: surgical planning, surgical techniques and postoperative management]. Nan Fang Yi Ke Da Xue Xue Bao, 2022. 42 (1): p. 156-162. Kawai, T., et al., 3D vision and maintenance of stable pneumoperitoneum: a new step in the development of laparoscopic right hepatectomy. Surg Endosc, 2018. 32 (8): p. 3706-3712. Xiang, L., et al., Prospective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma. Br J Surg, 2016. 103 (13): p. 1895-1901. Currò, G., et al., Three-Dimensional (3D) Versus Two-Dimensional (2D) Laparoscopic Bariatric Surgery: a Single-Surgeon Prospective Randomized Comparative Study. Obes Surg, 2015. 25 (11): p. 2120-4. Koppatz, H.E., et al., Three-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study. Surg Endosc, 2020. 34 (11): p. 4857-4865. Leon, P., et al., 3D Vision Provides Shorter Operative Time and More Accurate Intraoperative Surgical Performance in Laparoscopic Hiatal Hernia Repair Compared With 2D Vision. Surg Innov, 2017. 24 (2): p. 155-161. Hu, M., et al., Robotic versus laparoscopic liver resection in complex cases of left lateral sectionectomy. Int J Surg, 2019. 67 : p. 54-60. Bin, J., Z. Binghai, and H. Sanyuan, Liver Exposure Using Sterile Glove Pouch During Laparoscopic Right Liver Surgery in Hepatocellular Carcinoma Patients. World J Surg, 2016. 40 (4): p. 946-50. Zwart, M.J.W., et al., Performance with robotic surgery versus 3D- and 2D-laparoscopy during pancreatic and biliary anastomoses in a biotissue model: pooled analysis of two randomized trials. Surg Endosc, 2022. 36 (6): p. 4518-4528. Wiboonkhwan, N.A., et al., Perioperative Outcomes of Laparoscopic Liver Resection and Risk Factors for Adverse Events. Surg Laparosc Endosc Percutan Tech, 2022. 32 (3): p. 305-310. Guo, W., et al., Comparison of surgical outcomes among open, laparoscopic, and robotic pancreatoduodenectomy: a single-center retrospective study. BMC Surg, 2022. 22 (1): p. 348. Zhang, Q., et al., Comparative study on protective effect of hydrogen rich saline and adipose-derived stem cells on hepatic ischemia-reperfusion and hepatectomy injury in swine. Biomed Pharmacother, 2019. 120 : p. 109453. Strasberg, S.M., D.C. Linehan, and W.G. Hawkins, The accordion severity grading system of surgical complications. Ann Surg, 2009. 250 (2): p. 177-86. Anwanwan, D., et al., Challenges in liver cancer and possible treatment approaches. Biochim Biophys Acta Rev Cancer, 2020. 1873 (1): p. 188314. Zhao, Y., et al., Influence of Three-Dimensional Visual Reconstruction Technology Combined with Virtual Surgical Planning of CTA Images on Precise Resection of Liver Cancer in Hepatobiliary Surgery. Comput Math Methods Med, 2022. 2022 : p. 4376654. Li, Y., et al., Advances in Nanoliposomes for the Diagnosis and Treatment of Liver Cancer. Int J Nanomedicine, 2022. 17 : p. 909-925. Weber, M., et al., EANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds. Eur J Nucl Med Mol Imaging, 2022. 49 (5): p. 1682-1699. Maki, H. and K. Hasegawa, Advances in the surgical treatment of liver cancer. Biosci Trends, 2022. 16 (3): p. 178-188. Delvecchio, A., et al., Laparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis. HPB (Oxford), 2022. 24 (6): p. 933-941. Schmelzle, M., et al., Laparoscopic liver resection: indications, limitations, and economic aspects. Langenbecks Arch Surg, 2020. 405 (6): p. 725-735. Dogeas, E., S. Tohme, and D.A. Geller, Laparoscopic liver resection: Global diffusion and learning curve. Ann Acad Med Singap, 2021. 50 (10): p. 736-738. Haney, C.M., et al., A systematic review and meta-analysis of randomized controlled trials comparing laparoscopic and open liver resection. HPB (Oxford), 2021. 23 (10): p. 1467-1481. Li, H.J., et al., Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: Systematic review and meta-analysis of propensity score-matched studies. Eur J Surg Oncol, 2023. 49 (4): p. 700-708. Wang, J., et al., Laparoscopic vs. open anatomical hepatectomy for intrahepatic cholangiocarcinoma: A retrospective cohort study. Front Surg, 2022. 9 : p. 1003948. Ziogas, I.A., et al., Laparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: An individual patient data survival meta-analysis. Am J Surg, 2021. 222 (4): p. 731-738. Shaikh, A.R., A.A. Shaikh, and M. Abbasi, Short term outcomes of three dimensional versus two-dimensional laparoscopic cholecystectomy. Pak J Med Sci, 2021. 37 (1): p. 162-166. Bloch, E., et al., The effects of absence of stereopsis on performance of a simulated surgical task in two-dimensional and three-dimensional viewing conditions. Br J Ophthalmol, 2015. 99 (2): p. 240-5. Buia, A., et al., 3D vs. 2D imaging in laparoscopic surgery-an advantage? Results of standardised black box training in laparoscopic surgery. Langenbecks Arch Surg, 2017. 402 (1): p. 167-171. Banchini, F., et al., Laparoscopic dorsal subsegmentectomy 8: Exploit the 3d technology to plan liver resection, and predict intraparenchymal pedicles. A case report. (With video explanation). Int J Surg Case Rep, 2021. 88 : p. 106516. Au, K.P., et al., Impact of Three-Dimensional (3D) Visualization on Laparoscopic Hepatectomy for Hepatocellular Carcinoma. Ann Surg Oncol, 2022. 29 (11): p. 6731-6744. Lim, C., et al., Outcomes after 3D laparoscopic and robotic liver resection for hepatocellular carcinoma: a multicenter comparative study. Surg Endosc, 2021. 35 (7): p. 3258-3266. Ni, Z.K., et al., Precision Liver Resection: Three-Dimensional Reconstruction Combined with Fluorescence Laparoscopic Imaging. Surg Innov, 2021. 28 (1): p. 71-78. Additional Declarations No competing interests reported. Supplementary Files data.xlsx Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. As a division of Research Square Company, we’re committed to making research communication faster, fairer, and more useful. We do this by developing innovative software and high quality services for the global research community. Our growing team is made up of researchers and industry professionals working together to solve the most critical problems facing scientific publishing. Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-4592506","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Article","associatedPublications":[],"authors":[{"id":321473577,"identity":"5dca5a83-9924-4b23-8f57-22c22c40da22","order_by":0,"name":"Shengxiong Chen","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Shengxiong","middleName":"","lastName":"Chen","suffix":""},{"id":321473580,"identity":"a3603c9c-0bde-423a-a9e4-51078ee4b9de","order_by":1,"name":"Xiaoxu Jin","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Xiaoxu","middleName":"","lastName":"Jin","suffix":""},{"id":321473581,"identity":"ba25ecfd-9640-4e56-9ac2-389c3a0eb748","order_by":2,"name":"Zijia Hao","email":"","orcid":"","institution":"Shijiazhuang Hospital of Traditional Chinese Medicine","correspondingAuthor":false,"prefix":"","firstName":"Zijia","middleName":"","lastName":"Hao","suffix":""},{"id":321473584,"identity":"fd752938-e8fc-4679-89a8-3d5d159e74df","order_by":3,"name":"Yijun Wang","email":"","orcid":"","institution":"Shijiazhuang People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Yijun","middleName":"","lastName":"Wang","suffix":""},{"id":321473585,"identity":"9489e4b8-672b-44d5-b836-949da6e200f0","order_by":4,"name":"Chengxu Du","email":"","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":false,"prefix":"","firstName":"Chengxu","middleName":"","lastName":"Du","suffix":""},{"id":321473586,"identity":"8fd01e0d-ad79-43b3-a300-a52d8b440929","order_by":5,"name":"Xiaoding Liu","email":"","orcid":"","institution":"Shahe People’s Hospital","correspondingAuthor":false,"prefix":"","firstName":"Xiaoding","middleName":"","lastName":"Liu","suffix":""},{"id":321473587,"identity":"e8793780-757d-44e1-b557-90ddf9bc34c2","order_by":6,"name":"Huiqing Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA3UlEQVRIiWNgGAWjYBACxmYQ0cAgZ8DAAxFoIFaLMfFaYMoSNxCthbmd+dnDrzus07ez9x7dzMNgI7vhAPOzB/gdxmZuLHsmPXdnz7m02zwMacYbDrCZGxDwi5m0ZNvh3A03csyAWg4nbjjAwyaBXwv7N5CWdIP7b0Ba/hOjhcdM8mPb4QSDGzwgLQeI0lImzdiWbrjhTF7azTkGycYzD7OZ4dVi2H98m+TPNmt5g+Nnj914U2En23e8+Rl+LQ3AgOZhYIZyQUHFjEc5CMiDHPeDoLJRMApGwSgY0QAA38ZKgTXelZQAAAAASUVORK5CYII=","orcid":"","institution":"The Second Hospital of Hebei Medical University","correspondingAuthor":true,"prefix":"","firstName":"Huiqing","middleName":"","lastName":"Jiang","suffix":""}],"badges":[],"createdAt":"2024-06-17 07:36:17","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-4592506/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-4592506/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":60354500,"identity":"d00580a0-2dde-468b-a9e9-b648c6e50ecc","added_by":"auto","created_at":"2024-07-15 23:53:03","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":1351289,"visible":true,"origin":"","legend":"\u003cp\u003eSurgical Positioning, Hepatic Pedicle Ligation Device, and Self-made Liver Suspension Device Used to Suspend the Liver\u003c/p\u003e\n\u003cp\u003e(A) Positioning. (B) Self-made liver suspension device. (C) Hepatic pedicle ligation device. (D-H) Liver suspension process. (I) Hepatic pedicle ligation process. (J) Ultrasonic shears used to remove tumor.\u003c/p\u003e","description":"","filename":"1.png","url":"https://assets-eu.researchsquare.com/files/rs-4592506/v1/ce99ee0c5c02cf49dcbf4500.png"},{"id":60355286,"identity":"b2d59260-b626-48ce-b9d2-0ca942349cf8","added_by":"auto","created_at":"2024-07-16 00:01:03","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":162391,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of general information between the two groups of patients\u003c/p\u003e","description":"","filename":"2.png","url":"https://assets-eu.researchsquare.com/files/rs-4592506/v1/5d40fbc63fe4ba87902e93ab.png"},{"id":60354504,"identity":"7dd4c24f-c087-4514-98b8-299dbad98440","added_by":"auto","created_at":"2024-07-15 23:53:03","extension":"png","order_by":3,"title":"Figure 3","display":"","copyAsset":false,"role":"figure","size":547582,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of operative time, hepatic pedicle occlusion time, intraoperative blood loss between the two groups\u003c/p\u003e","description":"","filename":"3.png","url":"https://assets-eu.researchsquare.com/files/rs-4592506/v1/912b45e5c2dcfc4b7e4c4e46.png"},{"id":60355285,"identity":"333745fc-629a-440e-84ac-171e7e521f49","added_by":"auto","created_at":"2024-07-16 00:01:03","extension":"png","order_by":4,"title":"Figure 4","display":"","copyAsset":false,"role":"figure","size":149194,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups\u003c/p\u003e","description":"","filename":"4.png","url":"https://assets-eu.researchsquare.com/files/rs-4592506/v1/9f2209bec7b98a279ea7e88f.png"},{"id":60354505,"identity":"6958170c-4b0a-4773-9ced-35814fdde645","added_by":"auto","created_at":"2024-07-15 23:53:03","extension":"png","order_by":5,"title":"Figure 5","display":"","copyAsset":false,"role":"figure","size":65196,"visible":true,"origin":"","legend":"\u003cp\u003eComparison of postoperative complications between the two groups\u003c/p\u003e","description":"","filename":"5.png","url":"https://assets-eu.researchsquare.com/files/rs-4592506/v1/1a060359d15f8008ee9391cc.png"},{"id":60355761,"identity":"62ad4d03-2b14-4fa2-bdd0-897ce5104346","added_by":"auto","created_at":"2024-07-16 00:17:07","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":4079084,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-4592506/v1/707ba291-670f-46ec-979b-f4551726d391.pdf"},{"id":60354502,"identity":"931e099d-264e-4ddf-9950-c697f70dacbc","added_by":"auto","created_at":"2024-07-15 23:53:03","extension":"xlsx","order_by":1,"title":"","display":"","copyAsset":false,"role":"supplement","size":23365,"visible":true,"origin":"","legend":"","description":"","filename":"data.xlsx","url":"https://assets-eu.researchsquare.com/files/rs-4592506/v1/5f7d2d9aff2abe99ff981601.xlsx"}],"financialInterests":"No competing interests reported.","formattedTitle":"The application of self-made liver suspension device in 3D laparoscopic non-anatomical resection of liver VI and VII segments tumors","fulltext":[{"header":"Introduction","content":"\u003cp\u003eWith the continuous advancement of laparoscopic instruments and techniques, laparoscopic liver resection (LLR) is increasingly used for benign and malignant liver tumors due to its advantage of minimal invasiveness [1, 2]. In recent years, with the development of the internet and endoscopic instruments, laparoscopic liver resection technology has become more popular, and 3D laparoscopy has gradually entered major hospitals and been widely used in clinical practice, especially for complex hepatobiliary pancreatic surgeries [3, 4]. However, the non-anatomical liver segments I, VI, VII, and VIII are located in special positions and difficult to obtain ideal views, with complex anatomical relationships considered to be the main challenges in LLR [5, 6]. Especially when the tumor is closely attached to the inferior vena cava, the hepatic right and middle veins, if the laparoscopic view is not good, the operation is extremely difficult, especially when bleeding occurs during the operation, it is difficult to handle, which increases the surgical risk and the chance of converting to open surgery [7].\u003c/p\u003e\n\u003cp\u003eTo overcome these challenges, new 3D laparoscopic devices have been developed and applied in clinical practice in recent years, especially with the four-way movable 3D lens, compared with the 2D lens lacking depth perception and spatial sense, the 3D laparoscope fully utilizes its 3D stereoscopic imaging effect, especially the 3D lens that can bend in four directions, nearly achieving a surgical field without dead angle [8]. The surgeon can have a more intuitive and clear understanding of the relationships between anatomical structures, organs, and blood vessels during surgical procedures, allowing for the completion of some delicate, directed operations in a laparoscopic setting, such as surgical suture operations, precise vascular anastomosis operations, and gastrointestinal reconstruction operations, where the advantage of the stereoscopic field of vision is more pronounced. The 3D stereoscopic judgment of holding the needle instrument, grasping the needle holder, and tying knots is more precise [9-11]. For laparoscopic left liver surgery, since the surgical field itself is well exposed, the surgery is relatively easy [12]. In recent years, with the accumulation of surgeons\u0026apos; operative experience, the replacement of surgical instruments, and the application of self-made laparoscopic auxiliary devices, the resection of liver segments has nearly become free of contraindications [13, 14].\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eHowever, there is still a lack of research on the large-scale use of 3D laparoscopy for non-anatomical liver VI and VII segment tumor resection [15]. For tumors in the non-anatomical liver VI and VII segments, the use of conventional 3D laparoscopy with 3-0 suture lines to retract the liver and expose the tumor causes significant liver damage [16, 17]. This study reviews the clinical data of 79 patients who underwent non-anatomical liver VI and VII segment tumor resection at the Second Hospital of Hebei Medical University from June 2016 to June 2022. It discovered a surgical method that can more fully expose VI and VII segment tumors, namely, the self-made liver suspension device and suspension method, which can control the pulling force during liver exposure and cause less damage to the liver than the conventional 3D laparoscopic method. This study compares the clinical data of patients who underwent non-anatomical liver resection using the self-made liver suspension device and suspension method with those who underwent conventional 3D laparoscopic non-anatomical liver resection to investigate the application effect of the self-made liver suspension device in 3D laparoscopic non-anatomical liver VI and VII segment tumor resection. The self-made liver suspension device with a pulling force more suitable than that of the conventional 3D laparoscopic method fully exposes the VI and VII segment tumors. This study provides theoretical basis for further safe and effective clinical implementation of non-anatomical liver VI and VII segment tumor resection.\u003c/p\u003e"},{"header":"Methods","content":"\u003cp\u003e1.1 General Data\u003c/p\u003e\n\u003cp\u003eThe clinical data of 79 patients who underwent non-anatomical liver VI and VII segment tumor resection at the Second Hospital of Hebei Medical University from June 2016 to June 2022 were retrospectively analyzed. The patients were divided into laparoscopic surgery group (SDLG group, n=45) and conventional laparoscopic surgery group (CLG group, n=34) according to different surgical methods. This study was approved by the ethics committee of the hospital. Patients and their families are asked to sign informed consent forms before surgery. This study complies with the ethical requirements of the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e1.2 Inclusion and exclusion criteria\u003c/p\u003e\n\u003cp\u003eInclusion criteria: (1) Patients with good general condition and able to tolerate surgical procedures; (2) Diagnosed with benign/malignant tumors of the liver VI and VII segments based on the patient\u0026apos;s medical history, clinical manifestations, and imaging examinations; (3) Tumor diameter less than 10 cm; (4) Child Pugh liver function grade A or B; (5) No intrahepatic or distant metastasis, no hepatic vein, portal vein, inferior vena cava, or bile duct tumor thrombosis; (7) No active chronic hepatitis B; (8) No prior interventional, radiation, chemotherapy, or ablation treatment; (9) Patients and their families sign informed consent forms.\u003c/p\u003e\n\u003cp\u003eExclusion criteria: (1) Tumors with a diameter greater than 10 cm or significantly protruding from the liver surface, occupying a large space in the laparoscope, leaving no sufficient space for surgery, and potentially causing tumor rupture and tumor cell shedding; (2) Patients with high tumor surface tension assessed preoperatively, with a risk of tumor rupture during intraoperative manipulation; (3) Severe cirrhosis patients, requiring sufficient safety margins while preserving as much residual liver as possible; (4) Tumors adjacent to important hepatic pedicles and veins or with portal vein and hepatic vein cancer thrombi; (5) Patients with preoperative indications of tumor rupture; (6) Patients with a history of abdominal surgery; (7) Patients with contraindications to laparoscopic surgery. (8) Patients who underwent mid-operation laparotomy;\u003c/p\u003e\n\u003cp\u003e(9) Patients whose disease progression was discovered during surgery;\u003c/p\u003e\n\u003cp\u003e(10) Patients who had previously undergone hepatic artery embolization, radiation therapy, chemotherapy, and radiofrequency ablation.\u003c/p\u003e\n\u003cp\u003e1.3 Surgical Methods\u003c/p\u003e\n\u003cp\u003e1.3.1 Preoperative Preparation\u003c/p\u003e\n\u003cp\u003eBoth groups of patients underwent liver function tests and preoperative hematological examinations. Regular supportive treatment was provided to the patients, and contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), electrocardiography (ECG), and echocardiography were used for monitoring, with special monitoring provided through automated 3D liver organ reconstruction for on-site treatment.\u003c/p\u003e\n\u003cp\u003eAll patients underwent general anesthesia and tracheal intubation during surgery. An intravenous line was established before anesthesia, and electrocardiographic monitoring instruments were connected. Life signs were evaluated. Anesthetic induction was performed using intravenous general anesthetic drugs, analgesic drugs, and muscle relaxants, so that the patient underwent the following changes within a few minutes: from conscious state to unconsciousness, from respiratory rate of 16-20 breaths per minute to respiratory arrest, with tracheal intubation performed during this process. Tracheal intubation was performed using a laryngoscope or fiberoptic bronchoscope to guide the intubation guidewire or the intubation itself into the patient\u0026apos;s mouth until it reached the entrance of the trachea. The tracheal tube was gently inserted through the vocal cords into the trachea after confirming the correct placement of the intubation. The correct placement of the tracheal tube was confirmed through auscultation, observation of respiratory movements, and X-ray examination. After confirming the correct position, the tube is fixed in the patient\u0026apos;s mouth to prevent it from falling off or shifting. Connect the tube to the respirator to ensure that the patient receives adequate oxygen supply. During the anesthetic surgery, continuous application of anesthetic drugs is used to maintain a certain level of anesthesia. Monitoring is carried out during the maintenance period to observe the impact of the surgical operation on the patient\u0026apos;s life at any time, and treatment and adjustment are carried out as necessary to ensure the safety of the patient\u0026apos;s life. After the surgery is over, the patient enters the recovery period and the use of anesthetic drugs is stopped. During the anesthetic recovery, the patient\u0026apos;s consciousness gradually recovers, and continuous monitoring of vital signs is carried out, and lactate Ringer\u0026apos;s injection and nutrient solution are intravenously infused to maintain the patient\u0026apos;s vital signs.\u003c/p\u003e\n\u003cp\u003e1.3.2 CLG group (conventional laparoscopic group)\u003c/p\u003e\n\u003cp\u003eAfter anesthesia, the patient is placed in the \u0026quot;big\u0026quot; surgical position. The right shoulder and back are raised with soft pads at an angle of 45-60\u0026deg; to facilitate the dissection of the right liver. The left upper limb is extended and fixed, and the sterile gown is regularly disinfected and laid out (Figure 1A). The 5-hole method is used, and a 10 cm trocar needle is inserted into the right side of the umbilicus above two fingerbreadths in the abdominal rectus muscle area, then a 3D laparoscope lens is used. Under direct vision, a 12 cm trocar needle is placed at the edge of the right axillary anterior rib below 5 cm, and a 5 mm trocar needle is placed at the edge of the right axillary posterior rib below. Insert a 10mm cannula into the suprasternal notch, and a 5mm cannula into the two intercostal spaces above the umbilicus as an aid for placing the trocars. The ultrasonic shears are used to cut the ligaments of the liver cirrhotic flexure, the ligament of the falciform ligament, the right triangular ligament, the ligament of the liver kidney, and the right coronary ligament, completely dissecting the right lobe of the liver. Place the pre-Pringle occlusion band and suture it to the right triangular ligament with 3-0 suture. Then pull it to the left and expose it at an appropriate position on the lateral abdominal wall, fix it to expose the tumor. Use the electrocautery hook to mark the pre-cut line. Wrap the approximately 40cm long portal ligation suture around the first portal area and pull it out through the appropriate position on the lateral rib margin below. The front end of the disposable plastic suction catheter is covered with a 2cm soft tube. The portal ligation suture passes through the soft tube on the front end of the plastic suction catheter, is pulled tight, and the suction catheter is used to block the portal. Intermittently block the first portal for 15 minutes, then relax for 5 minutes. The ultrasonic shears are used to slowly dissect the liver tissue along the pre-cut line. Use the biopsy forceps to cut off the accessory tubes entering the tumor. Enlarge the incision at the suprasternal notch and remove the specimen. Place the specimen in a bag until the entire tumor is removed. During the operation, a 10 or 12-number urinary catheter is used to make a ring-shaped portal ligation band at the first portal area. The urinary catheter itself has elasticity, making it easier to tighten and loosen the ligation band, achieving a reliable first portal ligation effect. Clean the surface of the wound. If there is active bleeding from the liver segment, use electrical spray coagulation or 3-0 or 4-0 suture lines to stop the bleeding. The doctor will use absorbable suture lines to internally suture the liver incision, which may involve suturing at different levels to ensure the incision is fully closed and reduce the risk of bleeding and leakage. After checking for active bleeding or bile leakage, place hemostatic materials on the surface of the liver wound and place two abdominal drainage tubes under the right diaphragm and the liver wound. Finally, the doctor will use absorbable suture lines or skin adhesive to close the skin incision on the abdomen.\u003c/p\u003e\n\u003cp\u003e1.3.3 Laparoscopic Suspension Device Group (SDLG Group)\u003c/p\u003e\n\u003cp\u003eBecause the liver is relatively fragile, suture traction method may not be effective if the traction force is too small, or if it does not produce enough exposure of the VI and VII segments. If the traction force is too great, it may tear the liver, causing unnecessary bleeding. In addition to using a homemade liver suspension device (Figure 1B) and a simple hepatic hilum occlusion device (Figure 1C), the rest of the operation is similar to conventional laparoscopy. The suspension device manufacturing and suspension process are as follows (Figure 1D-H): insert a needle with a thread into the liver and secure it firmly with a plastic hard rod in the middle (we usually cut off about 3-4 cm of disposable plastic suction tube), to prevent slippage. This forms a homemade suspension base, and the thread forms a \u0026quot;T\u0026quot; shape. Place the homemade liver suspension device in the abdomen, and the liver needle is held by a needle holder and inserted from the internal surface of the visceral organ between segments V and VI of the liver, withdrawn from the diaphragmatic surface, and then withdrawn from the left margin of the abdominal wall. The liver needle thread is pulled out, causing the right liver to be pulled towards the left, fully exposing the VI and VII segment tumors. The operation is performed from left to right and caudal to cephalic resection. Use an electrocoagulation hook to draw the pre-resection line. The hepatic pedicle occlusion process is as follows (Figure 1I): Cut the catheter 12 into two segments, leaving a side hole at the reserve end, open the lesser sac, and insert the separation clamp from the posterior end of the splenic flexure behind the inferior vena cava in front of the Winslow foramen, into the lesser sac. Pull the catheter 12 through the Winslow foramen, and the separation clamp extends the tail end into the side hole, with the other end holding it and pulling it out of the side hole to form a circular occlusion device structure surrounding the first hepatic pedicle. Tighten the first hepatic pedicle occlusion belt, occlude the first hepatic pedicle intermittently for 15 minutes, relax for 5 minutes, and use a ultrasonic scalpel to slowly dissect the liver tissue along the pre-cut line (Figure 1J). Use biopsy forceps to cut off the accessory vessels entering the tumor, place the specimen in a bag, and continue to remove the tumor until it is completely removed. Check for no active bleeding or bile leakage after the liver incision, and place hemostatic materials at the wound site. Place two abdominal drainage tubes in the retroperitoneal space on the right side. Make a larger incision under the sternum, remove the specimen, and the suturing method is the same as that of the CLG group.\u003c/p\u003e\n\u003cp\u003e1.3.4 Postoperative Care Precautions\u003c/p\u003e\n\u003cp\u003e(1) Observation: Closely monitor the patient\u0026apos;s vital signs, including blood pressure, heart rate, and respiration. Monitor for signs of postoperative bleeding, infection, or other complications. Remove the tracheal tube when the patient\u0026apos;s breathing function has recovered well. (2) Pain management: Provide postoperative analgesia based on the patient\u0026apos;s pain level. Give appropriate analgesic drugs in a timely manner to ensure the patient\u0026apos;s comfort. (3) Diet: Gradually resume eating according to the doctor\u0026apos;s instructions, usually starting with fluid diet and gradually transitioning to soft food and normal diet. Avoid greasy and stimulating food to avoid stimulating the digestive system. (4) Activity: Engage in appropriate activities according to the doctor\u0026apos;s instructions, avoiding strenuous exercise and excessive fatigue, but also avoiding prolonged bed rest. You can practice ankle pump exercises on the bed to prevent blood clots. (5) Wound care: Keep the wound clean and dry and change the dressing regularly. Observe the wound healing process and pay attention to preventing infection. (6) Medication: Follow the doctor\u0026apos;s instructions to use antibiotics and painkillers properly to prevent infections and relieve pain. (7) Regular follow-up: Regular follow-up after surgery, the doctor evaluates the patient\u0026apos;s recovery status and conducts relevant checks as needed to monitor for complications. (8) Medical staff adjust the treatment according to the individual patient\u0026apos;s condition.\u003c/p\u003e\n\u003cp\u003e1.4 Observation Indicators\u003c/p\u003e\n\u003cp\u003e1.4.1 During surgery, record and statistically analyze the operation time, hepatic pedicle occlusion time, and blood loss during surgery for both groups of patients.\u003c/p\u003e\n\u003cp\u003eHepatic pedicle occlusion time is mainly clinically referring to the blockage of hepatic blood flow, with the first hepatic pedicle blockage being the most common. The operation will block the first hepatic pedicle according to the actual situation to reduce blood loss. The occlusion time should not exceed 15 minutes per blockage, and the interval between loosening should be more than 5 minutes.\u003c/p\u003e\n\u003cp\u003e1.4.2 Record the hospitalization time, drainage tube removal time, time of postoperative gas expulsion, and time of getting out of bed after surgery.\u003c/p\u003e\n\u003cp\u003e1.4.3 After surgery, record the incidence of complications according to the Clavien-Dindo grading standard within 3 months [18]. Common complications of liver tumor resection surgery include pleural effusion, peritoneal effusion, incision liquefaction, bile leakage, incision infection, and incision seroma.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e1.5 Statistical processing\u003c/p\u003e\n\u003cp\u003eThe data were analyzed using SPSS 26.0 software. Normally distributed quantitative data were expressed as\u0026nbsp;（\u003cimg width=\"30\" src=\"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAB4AAAAUCAYAAACaq43EAAAACXBIWXMAAA7EAAAOxAGVKw4bAAAJf0lEQVRIDQF0CYv2AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAQAAAAAAAAAAAAAA/wAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAD/AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAACAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAgAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAAAAAAAP8AAAAAAAAAAQAAAP8AAAAAAAAAAQAAAAAAAAAAAAAAAAAAAAAAAAD/AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAQAAAAAAAAAAAAAAAAAAAAAAAAD/AAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA/wAAAAAAAAD/AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA/wAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAD/AAAAAAAAAAAAAAD/AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAD/AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAP8AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA/wAAAP8AAAAAAAAAAAAAAAAAAAAAAAAAAAQAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAEAAAAAAAAA/wAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA/wAAAAAAAAD/AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAD/AAAAAAAAAAAAAAD/AAAAAAAAAAAAAAAABAAAAAAAAAAAAAAA/wAAAAAAAAAAAAAAAAAAAP8AAAABAAAAAAAAAAAAAAAAAAAAAAAAAP8AAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAABAAAAAAAAAAAAAAAAAAAAAAAAAP8AAAAAAAAAAQAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAAA7hRgBQaPw6AAAAABJRU5ErkJggg==\" alt=\"image\"\u003e）, and group comparisons were made using t-tests. Categorical data were expressed as cases or percentages (%) and group comparisons were made using chi-square tests. P\u0026lt;0.05 was considered statistically significant.\u003c/p\u003e"},{"header":"Results","content":"\u003cp\u003e2.1 Comparison of general information between the two groups of patients who underwent liver tumor resection\u003c/p\u003e\n\u003cp\u003eA total of 79 patients who underwent non-anatomical liver VI and VII segment tumor resection were included in this study and divided into the CLG group and the SDLG group. There were 45 patients in the SDLG group, including 19 males and 26 females, with an age range of 34 to 74 years and a mean age of 55.4 \u0026plusmn; 10.8 years; there were 34 patients in the CLG group, including 16 males and 18 females, with an age range of 32 to 76 years and a mean age of 55.1 \u0026plusmn; 11.2 years. There were no statistically significant differences in age, gender, tumor type, liver function grade, tumor location, BMI, or tumor size between the two groups (P\u0026gt;0.05, as shown in Table 1 and Figure 2), indicating that the two groups had good comparability.\u003c/p\u003e\n\u003cp\u003eTable 1 Comparison of general information between the two groups of patients\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"525\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eCLG（n=34）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003eSDLG(n=45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003et/\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eAge (years)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e55.12\u0026plusmn;11.23\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e55.04\u0026plusmn;10.83\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e0.0293\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e0.9767\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eSex\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e0.1836\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e0.6683\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eMen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eWomen\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e26\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eTumor type\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e0.1350\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e0.7133\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eBenign\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e15\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eMalignant\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eChild grad\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e0.0041\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e0.9489\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eA-level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e27\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eB-level\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e7\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eTumor cation\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e0.2493\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e0.8828\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eⅥ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e12\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eⅥ/Ⅶ\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e8\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e10\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eⅦ\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e14\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e21\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eBMI（kg/㎡）\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e23.42\u0026plusmn;1.68\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e23.16\u0026plusmn;1.61\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e0.6921\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e0.4910\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"25.142857142857142%\" valign=\"top\"\u003e\n \u003cp\u003eTumor size\u0026nbsp;（cm）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e5.94\u0026plusmn;1.09\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.428571428571427%\" valign=\"top\"\u003e\n \u003cp\u003e5.88\u0026plusmn;1.00\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.476190476190476%\" valign=\"top\"\u003e\n \u003cp\u003e0.2046\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"13.523809523809524%\" valign=\"top\"\u003e\n \u003cp\u003e0.8385\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003e\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.2 Comparison of surgical indicators between the SDLG group and the CLG group\u003c/p\u003e\n\u003cp\u003e2.2.1 Comparison of surgical time, liver pedicle occlusion time, and intraoperative blood loss between the two groups\u003c/p\u003e\n\u003cp\u003eAccording to the statistics, the surgical time in the SDLG group was significantly shorter than that in the CLG group, and the intraoperative blood loss and liver pedicle occlusion time were significantly lower than those in the CLG group (P\u0026lt;0.05). See Table 2 and Figure 3.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eTable 2 Comparison of operative time, hepatic pedicle occlusion time, intraoperative blood loss between the two groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"580\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003eCLG（n=34）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003eSDLG(n=45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003eoperative time（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003e312.05\u0026plusmn;51.18\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003e261.00\u0026plusmn;54.03\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e4.2530\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e0.0001\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003ehepatic portal occlusion time（min）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003e27.05\u0026plusmn;5.79\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; 23.27\u0026plusmn;5.67\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e2.9156\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e0.0046\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003eintraoperative bleeding volume（ml）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003e267.50\u0026plusmn;104.43\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003e215.33\u0026plusmn;76.89\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e2.5584\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e0.0125\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFigure 3 Comparison of operative time, hepatic pedicle occlusion time, intraoperative blood loss between the two groups\u003c/p\u003e\n\u003cp\u003e2.2.2 Comparison of hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups\u003c/p\u003e\n\u003cp\u003eThere was no statistically significant difference in hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups (P\u0026gt;0.05). See Table 3 and Figure 4.\u003c/p\u003e\n\u003cp\u003eTable 3 Comparison of hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups\u003c/p\u003e\n\u003ctable border=\"0\" cellspacing=\"0\" cellpadding=\"0\" width=\"580\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003eCLG（n=34）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003eSDLG(n=45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003et\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003ehospital stay（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003e\u0026nbsp; \u0026nbsp; \u0026nbsp; \u0026nbsp;7.94\u0026plusmn;1.52\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003e7.71\u0026plusmn;1.49\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e0.6573\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e0.5015\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003eremoval time of the drainage tube（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003e3.97\u0026plusmn;1.19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003e3.71\u0026plusmn;0.97\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e1.0670\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e0.2893\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003eout-of-bed time（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003e1.65\u0026plusmn;0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003e1.67\u0026plusmn;0.60\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e0.1436\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e0.8862\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"23.316062176165804%\"\u003e\n \u003cp\u003epostoperative exhaust time（d）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.45250431778929%\"\u003e\n \u003cp\u003e\u0026nbsp;1.97\u0026plusmn;0.72\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"23.488773747841105%\"\u003e\n \u003cp\u003e1.84\u0026plusmn;0.74\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"16.06217616580311%\"\u003e\n \u003cp\u003e0.7622\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"14.680483592400691%\"\u003e\n \u003cp\u003e0.4483\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFigure 4 Comparison of hospital stay, drainage tube removal time, ambulation time, and postoperative flatus time between the two groups\u003c/p\u003e\n\u003cp\u003e2.2.3 Comparison of postoperative complications between the two groups\u003c/p\u003e\n\u003cp\u003eA total of 16 complications occurred in the CLG group, including 5 cases of pleural effusion, 6 cases of peritoneal effusion, 3 cases of bile leakage, 1 case of incision infection, and 1 case of incision liquefaction. A total of 9 complications occurred in the SDLG group, including 2 cases of pleural effusion, 2 cases of peritoneal effusion, 2 cases of bile leakage, 1 case of incision infection, 1 case of incision liquefaction, and 1 case of incision seroma. The incidence of complications in the SDLG group was lower than that in the CLG group, and the difference was statistically significant (P\u0026lt;0.05). See Table 4 and Figure 5.\u003c/p\u003e\n\u003cp\u003eTable 4 Comparison of postoperative complications between the two groups\u003c/p\u003e\n\u003ctable border=\"1\" cellspacing=\"0\" cellpadding=\"0\"\u003e\n \u003ctbody\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.07233273056058%\" valign=\"top\"\u003e\n \u003cp\u003eGroup\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.15732368896926%\" valign=\"top\"\u003e\n \u003cp\u003eCLG（n=34）\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.06148282097649%\" valign=\"top\"\u003e\n \u003cp\u003eSDLG(n=45)\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.625678119349004%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026chi;2\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.083182640144667%\" valign=\"top\"\u003e\n \u003cp\u003e\u003cem\u003eP\u003c/em\u003e\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.07233273056058%\" valign=\"top\"\u003e\n \u003cp\u003eThe number of complications\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.15732368896926%\" valign=\"top\"\u003e\n \u003cp\u003e16\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.06148282097649%\" valign=\"top\"\u003e\n \u003cp\u003e9\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.625678119349004%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e6.5555\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.083182640144667%\" rowspan=\"2\" valign=\"top\"\u003e\n \u003cp\u003e0.0105\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"31.714285714285715%\" valign=\"top\"\u003e\n \u003cp\u003eNumber of complications were not present\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"33.42857142857143%\" valign=\"top\"\u003e\n \u003cp\u003e19\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"34.857142857142854%\" valign=\"top\"\u003e\n \u003cp\u003e36\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003ctr\u003e\n \u003ctd width=\"20.07233273056058%\" valign=\"top\"\u003e\n \u003cp\u003eComplication rate\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"21.15732368896926%\" valign=\"top\"\u003e\n \u003cp\u003e47.06%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"22.06148282097649%\" valign=\"top\"\u003e\n \u003cp\u003e20%\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.625678119349004%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003ctd width=\"18.083182640144667%\" valign=\"top\"\u003e\n \u003cp\u003e\u0026nbsp;\u003c/p\u003e\n \u003c/td\u003e\n \u003c/tr\u003e\n \u003c/tbody\u003e\n\u003c/table\u003e\n\u003cp\u003eFigure 5 Comparison of postoperative complications between the two groups\u003c/p\u003e"},{"header":"Discussion","content":"\u003cp\u003eGlobally, hepatocellular carcinoma is the most common fatal malignant tumor [\u003cspan citationid=\"CR19\" class=\"CitationRef\"\u003e19\u003c/span\u003e, \u003cspan citationid=\"CR20\" class=\"CitationRef\"\u003e20\u003c/span\u003e]. The treatment of liver cancer includes surgical resection, transplantation, ablation, chemotherapy and embolization, and liver resection is the standard treatment for liver cancer [\u003cspan citationid=\"CR21\" class=\"CitationRef\"\u003e21\u003c/span\u003e, \u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]. The advancement of surgical techniques over the past 30 years, including preoperative assessment of the residual liver, has improved the safety of liver resection [\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]. In recent years, minimally invasive techniques have been increasingly used in liver surgery. A large number of retrospective analyses have shown that liver metastasis and hepatocellular carcinoma are among the most common indications nowadays [\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e, \u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e]. The use of LLR is increasing worldwide, but performing LLR on liver segments VI, VII of the right posterior lobe and the caudate lobe remains challenging for surgeons [\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e, \u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eLLR has the advantages of light postoperative pain, fast recovery, and fewer complications [\u003cspan additionalcitationids=\"CR29\" citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR30\" class=\"CitationRef\"\u003e30\u003c/span\u003e]. Compared with traditional surgery, the advantages of laparoscopic surgery include less damage to healthy tissue, reduced risk of pain and infection, shorter recovery time, and shorter hospital stay [\u003cspan citationid=\"CR31\" class=\"CitationRef\"\u003e31\u003c/span\u003e]. 3D laparoscopy is the latest development of laparoscopic surgery and has been shown to improve surgical outcomes, reduce errors, enhance spatial awareness, and reduce the time required to complete surgical tasks in a laboratory environment [\u003cspan citationid=\"CR32\" class=\"CitationRef\"\u003e32\u003c/span\u003e, \u003cspan citationid=\"CR33\" class=\"CitationRef\"\u003e33\u003c/span\u003e]. The popularity of 3D technology is gradually increasing, and its advantages are more pronounced in the visualization and distribution of solid organs [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e]. Using 3D technology, surgeons can focus on the specific anatomical structures of a patient's organ and predict the various stages of the operation [\u003cspan citationid=\"CR34\" class=\"CitationRef\"\u003e34\u003c/span\u003e].\u003c/p\u003e \u003cp\u003eThe liver is relatively fragile, and if the traction force is too small when exposing tumors in segments VI and VII, it will not meet the visual requirements for exposing these segments. If the traction force is too great, it is easy to tear the liver and increase the amount of bleeding during the operation. Conventional 3D laparoscopic surgery uses 3\u0026thinsp;\u0026minus;\u0026thinsp;0 suture lines to sew a Pringle ligation block to pull the liver and expose the tumor, while this study compares the clinical data of patients who underwent 3D laparoscopic non-anatomical liver resection using a self-made liver suspension device and method with those who underwent conventional 3D laparoscopic non-anatomical liver resection, and the results are as follows: The surgical time in the SDLG group was significantly shorter than that in the CLG group. The intraoperative bleeding volume and portal blockage time in the SDLG group were significantly lower than those in the CLG group. The intraoperative bleeding volume in the SDLG group was reduced, which lowered the incidence of complications such as wound infection and seroma. However, there was no statistically significant difference in the length of stay, the time of removing the drainage tube, the time of getting out of bed, and the time of postoperative flatus between the two groups. The study results show that 3D laparoscopic non-anatomical liver resection for VI and VII segment tumors has the advantages of reducing surgical time and intraoperative bleeding, which are consistent with the current research results [\u003cspan additionalcitationids=\"CR36\" citationid=\"CR35\" class=\"CitationRef\"\u003e35\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR37\" class=\"CitationRef\"\u003e37\u003c/span\u003e]. In this study, a self-made \"T\"-shaped liver suspension device was used, which was fully attached to the visceral surface between the V and VI segments of the liver, thus fully exposing the tumor, thereby reducing the surgical time, intraoperative bleeding, and portal blockage time, and subsequently lowering the incidence of postoperative complications.\u003c/p\u003e \u003cp\u003eIn summary, the use of a self-made liver suspension device reduces surgical time, intraoperative bleeding, and portal blockage time, and reduces complications. It further enhances the safety of non-anatomical resection of liver VI and VII segments tumors and is worth further clinical promotion.\u003c/p\u003e"},{"header":"Declarations","content":"\u003cp\u003e\u003cstrong\u003eEthics approval\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was approved by the Research Ethics Committee of the Second Hospital of Hebei Medical University. The project name is The application of self-made life suspension device in 3D laparoscopic non anatomical section of life VI and VII segments learners, and the review resolution number is 2023-r345.\u0026nbsp;This study was approved by the ethics committee of the hospital. Patients and their families are asked to sign informed consent forms before surgery. This study complies with the ethical requirements of the Helsinki Declaration.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor Contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eS.X.C. and X.X.J. contributed to the conception and design of the study. \u0026nbsp;Z.J.H. \u0026nbsp; and Y.J.W. performed the data collection and analysis. \u0026nbsp;C.X.D. and X.D.L. contributed to the interpretation of the data. \u0026nbsp;S.X.C. and H.Q.J. drafted the manuscript. \u0026nbsp;All authors critically revised the manuscript for important intellectual content and approved the final version to be published.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConflict of Interest Statement\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no known competing financial interests or personal relationships that could have appeared to influence the work reported in this paper.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThis study was supported by the medical science research project of Hebei province. The topic of this study was applied research of self-made liver sling in 3D laparoscopic non-anatomical liver VI, VI/VII, VII tumor resection, foundation no. (No. 20240642)\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAcknowledgments\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets generated during and/or analysed during the current study are available from the corresponding author on reasonable request.\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eLiao, K., et al., \u003cem\u003eLaparoscopic Anatomical Versus Non-anatomical hepatectomy in the Treatment of Hepatocellular Carcinoma: A randomised controlled trial.\u003c/em\u003e Int J Surg, 2022. \u003cstrong\u003e102\u003c/strong\u003e: p. 106652.\u003c/li\u003e\n\u003cli\u003eSun, H., H. Yang, and H. Xu, \u003cem\u003eA commentary on \u0026quot;Laparoscopic Anatomical Versus Non-anatomical hepatectomy in the Treatment of Hepatocellular Carcinoma: A randomised controlled trial\u0026quot; (Int J Surg 2022;102:106652).\u003c/em\u003e Int J Surg, 2022. \u003cstrong\u003e104\u003c/strong\u003e: p. 106783.\u003c/li\u003e\n\u003cli\u003eKwon, Y., et al., \u003cem\u003eImproved Outcomes of Laparoscopic Liver Resection for Hepatocellular Carcinoma Located in Posterosuperior Segments of the Liver.\u003c/em\u003e World J Surg, 2021. \u003cstrong\u003e45\u003c/strong\u003e(4): p. 1178-1185.\u003c/li\u003e\n\u003cli\u003eXiao, L., et al., \u003cem\u003eLaparoscopic versus open liver resection for hepatocellular carcinoma in posterosuperior segments.\u003c/em\u003e Surg Endosc, 2015. \u003cstrong\u003e29\u003c/strong\u003e(10): p. 2994-3001.\u003c/li\u003e\n\u003cli\u003eKim, H.J., et al., \u003cem\u003eImproved outcomes of major laparoscopic liver resection for hepatocellular carcinoma.\u003c/em\u003e Surg Oncol, 2020. \u003cstrong\u003e35\u003c/strong\u003e: p. 470-474.\u003c/li\u003e\n\u003cli\u003ePan, M. and C. Zhang, \u003cem\u003e[Practice of laparoscopic hepatectomy in primary care facilities in China: surgical planning, surgical techniques and postoperative management].\u003c/em\u003e Nan Fang Yi Ke Da Xue Xue Bao, 2022. \u003cstrong\u003e42\u003c/strong\u003e(1): p. 156-162.\u003c/li\u003e\n\u003cli\u003eKawai, T., et al., \u003cem\u003e3D vision and maintenance of stable pneumoperitoneum: a new step in the development of laparoscopic right hepatectomy.\u003c/em\u003e Surg Endosc, 2018. \u003cstrong\u003e32\u003c/strong\u003e(8): p. 3706-3712.\u003c/li\u003e\n\u003cli\u003eXiang, L., et al., \u003cem\u003eProspective cohort study of laparoscopic and open hepatectomy for hepatocellular carcinoma.\u003c/em\u003e Br J Surg, 2016. \u003cstrong\u003e103\u003c/strong\u003e(13): p. 1895-1901.\u003c/li\u003e\n\u003cli\u003eCurr\u0026ograve;, G., et al., \u003cem\u003eThree-Dimensional (3D) Versus Two-Dimensional (2D) Laparoscopic Bariatric Surgery: a Single-Surgeon Prospective Randomized Comparative Study.\u003c/em\u003e Obes Surg, 2015. \u003cstrong\u003e25\u003c/strong\u003e(11): p. 2120-4.\u003c/li\u003e\n\u003cli\u003eKoppatz, H.E., et al., \u003cem\u003eThree-dimensional versus two-dimensional high-definition laparoscopy in transabdominal preperitoneal inguinal hernia repair: a prospective randomized controlled study.\u003c/em\u003e Surg Endosc, 2020. \u003cstrong\u003e34\u003c/strong\u003e(11): p. 4857-4865.\u003c/li\u003e\n\u003cli\u003eLeon, P., et al., \u003cem\u003e3D Vision Provides Shorter Operative Time and More Accurate Intraoperative Surgical Performance in Laparoscopic Hiatal Hernia Repair Compared With 2D Vision.\u003c/em\u003e Surg Innov, 2017. \u003cstrong\u003e24\u003c/strong\u003e(2): p. 155-161.\u003c/li\u003e\n\u003cli\u003eHu, M., et al., \u003cem\u003eRobotic versus laparoscopic liver resection in complex cases of left lateral sectionectomy.\u003c/em\u003e Int J Surg, 2019. \u003cstrong\u003e67\u003c/strong\u003e: p. 54-60.\u003c/li\u003e\n\u003cli\u003eBin, J., Z. Binghai, and H. Sanyuan, \u003cem\u003eLiver Exposure Using Sterile Glove Pouch During Laparoscopic Right Liver Surgery in Hepatocellular Carcinoma Patients.\u003c/em\u003e World J Surg, 2016. \u003cstrong\u003e40\u003c/strong\u003e(4): p. 946-50.\u003c/li\u003e\n\u003cli\u003eZwart, M.J.W., et al., \u003cem\u003ePerformance with robotic surgery versus 3D- and 2D-laparoscopy during pancreatic and biliary anastomoses in a biotissue model: pooled analysis of two randomized trials.\u003c/em\u003e Surg Endosc, 2022. \u003cstrong\u003e36\u003c/strong\u003e(6): p. 4518-4528.\u003c/li\u003e\n\u003cli\u003eWiboonkhwan, N.A., et al., \u003cem\u003ePerioperative Outcomes of Laparoscopic Liver Resection and Risk Factors for Adverse Events.\u003c/em\u003e Surg Laparosc Endosc Percutan Tech, 2022. \u003cstrong\u003e32\u003c/strong\u003e(3): p. 305-310.\u003c/li\u003e\n\u003cli\u003eGuo, W., et al., \u003cem\u003eComparison of surgical outcomes among open, laparoscopic, and robotic pancreatoduodenectomy: a single-center retrospective study.\u003c/em\u003e BMC Surg, 2022. \u003cstrong\u003e22\u003c/strong\u003e(1): p. 348.\u003c/li\u003e\n\u003cli\u003eZhang, Q., et al., \u003cem\u003eComparative study on protective effect of hydrogen rich saline and adipose-derived stem cells on hepatic ischemia-reperfusion and hepatectomy injury in swine.\u003c/em\u003e Biomed Pharmacother, 2019. \u003cstrong\u003e120\u003c/strong\u003e: p. 109453.\u003c/li\u003e\n\u003cli\u003eStrasberg, S.M., D.C. Linehan, and W.G. Hawkins, \u003cem\u003eThe accordion severity grading system of surgical complications.\u003c/em\u003e Ann Surg, 2009. \u003cstrong\u003e250\u003c/strong\u003e(2): p. 177-86.\u003c/li\u003e\n\u003cli\u003eAnwanwan, D., et al., \u003cem\u003eChallenges in liver cancer and possible treatment approaches.\u003c/em\u003e Biochim Biophys Acta Rev Cancer, 2020. \u003cstrong\u003e1873\u003c/strong\u003e(1): p. 188314.\u003c/li\u003e\n\u003cli\u003eZhao, Y., et al., \u003cem\u003eInfluence of Three-Dimensional Visual Reconstruction Technology Combined with Virtual Surgical Planning of CTA Images on Precise Resection of Liver Cancer in Hepatobiliary Surgery.\u003c/em\u003e Comput Math Methods Med, 2022. \u003cstrong\u003e2022\u003c/strong\u003e: p. 4376654.\u003c/li\u003e\n\u003cli\u003eLi, Y., et al., \u003cem\u003eAdvances in Nanoliposomes for the Diagnosis and Treatment of Liver Cancer.\u003c/em\u003e Int J Nanomedicine, 2022. \u003cstrong\u003e17\u003c/strong\u003e: p. 909-925.\u003c/li\u003e\n\u003cli\u003eWeber, M., et al., \u003cem\u003eEANM procedure guideline for the treatment of liver cancer and liver metastases with intra-arterial radioactive compounds.\u003c/em\u003e Eur J Nucl Med Mol Imaging, 2022. \u003cstrong\u003e49\u003c/strong\u003e(5): p. 1682-1699.\u003c/li\u003e\n\u003cli\u003eMaki, H. and K. Hasegawa, \u003cem\u003eAdvances in the surgical treatment of liver cancer.\u003c/em\u003e Biosci Trends, 2022. \u003cstrong\u003e16\u003c/strong\u003e(3): p. 178-188.\u003c/li\u003e\n\u003cli\u003eDelvecchio, A., et al., \u003cem\u003eLaparoscopic versus open liver resection for hepatocellular carcinoma in elderly patients: a propensity score matching analysis.\u003c/em\u003e HPB (Oxford), 2022. \u003cstrong\u003e24\u003c/strong\u003e(6): p. 933-941.\u003c/li\u003e\n\u003cli\u003eSchmelzle, M., et al., \u003cem\u003eLaparoscopic liver resection: indications, limitations, and economic aspects.\u003c/em\u003e Langenbecks Arch Surg, 2020. \u003cstrong\u003e405\u003c/strong\u003e(6): p. 725-735.\u003c/li\u003e\n\u003cli\u003eDogeas, E., S. Tohme, and D.A. Geller, \u003cem\u003eLaparoscopic liver resection: Global diffusion and learning curve.\u003c/em\u003e Ann Acad Med Singap, 2021. \u003cstrong\u003e50\u003c/strong\u003e(10): p. 736-738.\u003c/li\u003e\n\u003cli\u003eHaney, C.M., et al., \u003cem\u003eA systematic review and meta-analysis of randomized controlled trials comparing laparoscopic and open liver resection.\u003c/em\u003e HPB (Oxford), 2021. \u003cstrong\u003e23\u003c/strong\u003e(10): p. 1467-1481.\u003c/li\u003e\n\u003cli\u003eLi, H.J., et al., \u003cem\u003eLaparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: Systematic review and meta-analysis of propensity score-matched studies.\u003c/em\u003e Eur J Surg Oncol, 2023. \u003cstrong\u003e49\u003c/strong\u003e(4): p. 700-708.\u003c/li\u003e\n\u003cli\u003eWang, J., et al., \u003cem\u003eLaparoscopic vs. open anatomical hepatectomy for intrahepatic cholangiocarcinoma: A retrospective cohort study.\u003c/em\u003e Front Surg, 2022. \u003cstrong\u003e9\u003c/strong\u003e: p. 1003948.\u003c/li\u003e\n\u003cli\u003eZiogas, I.A., et al., \u003cem\u003eLaparoscopic versus open hepatectomy for intrahepatic cholangiocarcinoma: An individual patient data survival meta-analysis.\u003c/em\u003e Am J Surg, 2021. \u003cstrong\u003e222\u003c/strong\u003e(4): p. 731-738.\u003c/li\u003e\n\u003cli\u003eShaikh, A.R., A.A. Shaikh, and M. Abbasi, \u003cem\u003eShort term outcomes of three dimensional versus two-dimensional laparoscopic cholecystectomy.\u003c/em\u003e Pak J Med Sci, 2021. \u003cstrong\u003e37\u003c/strong\u003e(1): p. 162-166.\u003c/li\u003e\n\u003cli\u003eBloch, E., et al., \u003cem\u003eThe effects of absence of stereopsis on performance of a simulated surgical task in two-dimensional and three-dimensional viewing conditions.\u003c/em\u003e Br J Ophthalmol, 2015. \u003cstrong\u003e99\u003c/strong\u003e(2): p. 240-5.\u003c/li\u003e\n\u003cli\u003eBuia, A., et al., \u003cem\u003e3D vs. 2D imaging in laparoscopic surgery-an advantage? Results of standardised black box training in laparoscopic surgery.\u003c/em\u003e Langenbecks Arch Surg, 2017. \u003cstrong\u003e402\u003c/strong\u003e(1): p. 167-171.\u003c/li\u003e\n\u003cli\u003eBanchini, F., et al., \u003cem\u003eLaparoscopic dorsal subsegmentectomy 8: Exploit the 3d technology to plan liver resection, and predict intraparenchymal pedicles. A case report. (With video explanation).\u003c/em\u003e Int J Surg Case Rep, 2021. \u003cstrong\u003e88\u003c/strong\u003e: p. 106516.\u003c/li\u003e\n\u003cli\u003eAu, K.P., et al., \u003cem\u003eImpact of Three-Dimensional (3D) Visualization on Laparoscopic Hepatectomy for Hepatocellular Carcinoma.\u003c/em\u003e Ann Surg Oncol, 2022. \u003cstrong\u003e29\u003c/strong\u003e(11): p. 6731-6744.\u003c/li\u003e\n\u003cli\u003eLim, C., et al., \u003cem\u003eOutcomes after 3D laparoscopic and robotic liver resection for hepatocellular carcinoma: a multicenter comparative study.\u003c/em\u003e Surg Endosc, 2021. \u003cstrong\u003e35\u003c/strong\u003e(7): p. 3258-3266.\u003c/li\u003e\n\u003cli\u003eNi, Z.K., et al., \u003cem\u003ePrecision Liver Resection: Three-Dimensional Reconstruction Combined with Fluorescence Laparoscopic Imaging.\u003c/em\u003e Surg Innov, 2021. \u003cstrong\u003e28\u003c/strong\u003e(1): p. 71-78.\u003c/li\u003e\n\u003c/ol\u003e"}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"3D laparoscopy, Liver VI and VII segments, Liver suspension device, Malignant tumor, Laparoscopic hepatectomy","lastPublishedDoi":"10.21203/rs.3.rs-4592506/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-4592506/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective:\u003c/strong\u003e To investigate the effect of self-made liver suspension device in 3D laparoscopic non-anatomical resection of liver VI and VII segments tumors.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods:\u003c/strong\u003e The clinical data of 79 patients who underwent non-anatomical resection of liver VI and VII segments tumors at the Second Hospital of Hebei Medical University from June 2016 to June 2022 were retrospectively analyzed, divided into SDLG group and CLG group. The SDLG group used the self-made liver suspension device for 3D laparoscopic resection, and the CLG group received conventional 3D laparoscopic resection; the clinical data were compared to evaluate the efficacy.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults:\u003c/strong\u003e The operation time in SDLG group was significantly shorter than that in CLG group, the intraoperative bleeding volume and liver portal blockage time were significantly reduced, and the postoperative complications were alleviated; there was no significant difference in hospital stay, drainage tube removal time, bedside time, and postoperative flatus time.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusion:\u003c/strong\u003e The self-made liver suspension device can shorten the operation time and liver portal blockage time, reduce intraoperative bleeding, alleviate postoperative complications, and improve the safety of non-anatomical resection of liver VI and VII segments tumors. It is worth further clinical promotion.\u003c/p\u003e","manuscriptTitle":"The application of self-made liver suspension device in 3D laparoscopic non-anatomical resection of liver VI and VII segments tumors","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2024-07-15 23:52:58","doi":"10.21203/rs.3.rs-4592506/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"61b32b1b-5383-4bd5-bb88-a5791bd75ab3","owner":[],"postedDate":"July 15th, 2024","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[{"id":33986380,"name":"Health sciences/Anatomy"},{"id":33986381,"name":"Health sciences/Health care"}],"tags":[],"updatedAt":"2024-07-15T23:53:01+00:00","versionOfRecord":[],"versionCreatedAt":"2024-07-15 23:52:58","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-4592506","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-4592506","identity":"rs-4592506","version":["v1"]},"buildId":"qtupq5eGEP_6zYnWcrvyt","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}