Lin's clamp revisited: A safe model for training in liver resection

SummaryBackgroundIn 1973, Lin described a simplified technique of hepatic resection using his clamp and crush method. It allowed regional vascular control to reduce blood loss during parenchymal transection. This technique was aimed at avoiding hilar dissection and vascular clamping, thereby preventing ischemic–reperfusion injury of the remnant liver.AimsThe objective of our study is to report our experience with Lin's technique and discuss its applicability.MethodsThe perioperative outcomes of patients who underwent hepatic resection with or without Lin's technique were analyzed. Multiple variables were also used to statistically compare outcomes between patients with a cirrhotic liver and a noncirrhotic one and results of performance by junior surgeons (JSs) and an experienced surgeon (ES).ResultsThe perioperative outcome in patients undergoing hepatectomy with Lin's technique (N = 18) showed a significantly shorter transection time, lower blood loss, and shorter hospital stay as compared with patients undergoing hepatectomy without Lin's clamp (N = 17). Lin's technique was adopted in 29 patients. Eleven and 18 cases were operated on by the JSs and ES, respectively. The transection time was significantly longer in the JS group. Thirteen patients had a noncirrhotic liver whereas 16 patients had cirrhosis. There was no statistically significant difference in the perioperative outcomes between cases operated on by the JS and ES and between cases of patients with cirrhosis and those without cirrhosis. There was no incidence of hepatic failure within 90 days.ConclusionLin's technique offers less blood loss, a shorter transection time, and a shorter hospital stay. The application of Lin's technique avoids the need for hilar vascular isolation and hilar clamping. JSs can perform hepatectomy with outcomes comparable to those produced by ESs by applying Lin's technique