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Wang Z, Tao H, Wang J, Zhu Y, Lin J, Fang C, Yang J. Laparoscopic right hemi-hepatectomy plus total caudate lobectomy for perihilar cholangiocarcinoma via anterior approach with augmented reality navigation: a feasibility study. Surg Endosc 2023; 37:8156-8164. [PMID: 37653158 DOI: 10.1007/s00464-023-10397-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 08/13/2023] [Indexed: 09/02/2023]
Abstract
BACKGROUND Right hemi-hepatectomy plus total caudate lobectomy is the appropriate procedure for type IIIa or partial type II pCCA. However, the laparoscopic implementation of this procedure remains technically challenging, especially hilar vascular dissection and en bloc resection of the total caudate lobe. Augmented reality navigation can provide intraoperative navigation to enhance visualization of invisible hilar blood vessels and guide the parenchymal transection plane. METHODS Eleven patients who underwent laparoscopic right hemi-hepatectomy plus total caudate lobectomy from January 2021 to January 2023 were enrolled in this study. Augmented reality navigation technology and the anterior approach were utilized in this operation. Routine operative and short-term postoperative outcomes were assessed to evaluate the feasibility of the novel navigation method in this operation. RESULTS Right hemi-hepatectomy plus total caudate lobectomy was successfully performed in all 11 enrolled patients. Among the 11 patients, the mean operation time was 454.5 ± 25.0 min and the mean estimated blood loss was 209.1 ± 56.1 ml. Negative surgical margins were achieved in all patients. The postoperative course of all the patients was uneventful, and the mean length of postoperative hospital stay was 10.5 ± 1.2 days. CONCLUSION Laparoscopic right hemi-hepatectomy plus total caudate lobectomy via the anterior approach may be feasible and safe for pCCA with the assistance of augmented reality navigation.
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Affiliation(s)
- Zhuangxiong Wang
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Haisu Tao
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Junfeng Wang
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Yilin Zhu
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Jinyu Lin
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China
| | - Chihua Fang
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
| | - Jian Yang
- Department of Hepatobiliary Surgery I, General Surgery Center, Zhujiang Hospital, Southern Medical University, Guangzhou, China.
- Guangdong Provincial Clinical and Engineering Center of Digital Medicine, Guangzhou, China.
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Dokmak S, Aussilhou B, Rebai W, Cauchy F, Belghiti J, Soubrane O. Up-to-down open and laparoscopic liver hanging maneuver: an overview. Langenbecks Arch Surg 2020; 406:19-24. [PMID: 32743680 DOI: 10.1007/s00423-020-01945-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2020] [Accepted: 07/21/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The liver hanging maneuver (LHM) was described by Belghiti et al. to facilitate liver resection and is done classically by creating a space between the caudate lobe and the inferior vena cava starting on the edge of caudate lobe and extending cranially, in a para-caval fashion, towards the space between the right and middle hepatic veins. LHM facilitates liver transection, guides anatomical resections, decreases blood loss, facilitates harvesting of the liver graft in live donors, and also has oncological advantages. STUDY DESIGN We describe a new approach named "up-to-down" to perform LHM in open and laparoscopic liver resections. This approach was mainly used in obese patients, in laparoscopic liver resections and in cases of failure of the classic approach. The advantages/disadvantages, complications, and different modalities of LHM are also summarized. RESULTS The peritoneal layer between the liver capsule and the infrahepatic vena cava is opened, and a short blind dissection is initiated on the right anterolateral aspect of the inferior vena cava to the left of the hepatic vein of segment VI. The suprahepatic vena cava is exposed, and the space between the right and middle hepatic veins and the vena cava is created by gentle dissection. A 16-Fr nasogastric tube is positioned in the space between the right and middle hepatic vein, pointing inferiorly, and pushed downwards, in a para-caval manner caudally until it is seen inferiorly. The results of this approach are given. CONCLUSION LHM facilitates liver resection, and many variations have been described worldwide in open and laparoscopic liver surgery. The up-to-down approach should be part of the surgical armamentarium in order to offer a safer way to achieve LHM in some patients.
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Affiliation(s)
- Safi Dokmak
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris VII, Clichy, France.
| | - Béatrice Aussilhou
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris VII, Clichy, France
| | - Wael Rebai
- Department of digestive surgery, Hospital La Rabta, Tunis, Tunisia
| | - François Cauchy
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris VII, Clichy, France
| | - Jacques Belghiti
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris VII, Clichy, France
| | - Olivier Soubrane
- Department of HPB Surgery and Liver Transplantation, Beaujon Hospital, University Paris VII, Clichy, France
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Dondossola D, Ghidini M, Grossi F, Rossi G, Foschi D. Practical review for diagnosis and clinical management of perihilar cholangiocarcinoma. World J Gastroenterol 2020; 26:3542-3561. [PMID: 32742125 PMCID: PMC7366054 DOI: 10.3748/wjg.v26.i25.3542] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/31/2019] [Revised: 06/05/2020] [Accepted: 06/18/2020] [Indexed: 02/06/2023] Open
Abstract
Cholangiocarcinoma (CCC) is the most aggressive malignant tumor of the biliary tract. Perihilar CCC (pCCC) is the most common CCC and is burdened by a complicated diagnostic iter and its anatomical location makes surgical approach burden by poor results. Besides its clinical presentation, a multimodal diagnostic approach should be carried on by a tertiary specialized center to avoid miss-diagnosis. Preoperative staging must consider the extent of liver resection to avoid post-surgical hepatic failure. During staging iter, magnetic resonance can obtain satisfactory cholangiographic images, while invasive techniques should be used if bile duct samples are needed. Consistently, to improve diagnostic potential, bile duct drainage is not necessary in jaundice, while it is indicated in refractory cholangitis or when liver hypertrophy is needed. Once resecability criteria are identified, the extent of liver resection is secondary to the longitudinal spread of CCC. While in the past type IV pCCC was not considered resectable, some authors reported good results after their treatment. Conversely, in selected unresectable cases, liver transplantation could be a valuable option. Adjuvant chemotherapy is the standard of care for resected patients, while neoadjuvant approach has growing evidences. If curative resection is not achieved, radiotherapy can be added to chemotherapy. This multistep curative iter must be carried on in specialized centers. Hence, the aim of this review is to highlight the main steps and pitfalls of the diagnostic and therapeutic approach to pCCC with a peculiar attention to type IV pCCC.
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Affiliation(s)
- Daniele Dondossola
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi of Milan, Milan 20122, Italy
| | - Michele Ghidini
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Francesco Grossi
- Medical Oncology Unit, Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico, Milan 20122, Italy
| | - Giorgio Rossi
- General and Liver Transplant Surgery Unit, Fondazione IRCCS Ca' Granda, Ospedale Maggiore Policlinico, Milan 20122, Italy
- Department of Pathophysiology and Transplantation, Università degli Studi of Milan, Milan 20122, Italy
| | - Diego Foschi
- Department of Biomedical and Clinical Sciences "Luigi Sacco", L. Sacco Hospital, Università degli Studi of Milan, Milan 20157, Italy
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Application of Laparoscopic Radical Resection for Type III and IV Hilar Cholangiocarcinoma Treatment. Gastroenterol Res Pract 2020; 2020:1506275. [PMID: 32184814 PMCID: PMC7060852 DOI: 10.1155/2020/1506275] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2019] [Accepted: 12/26/2019] [Indexed: 02/07/2023] Open
Abstract
Background This study is aimed at investigating the feasibility and safety of the laparoscopic radical resection for treating type III and IV hilar cholangiocarcinoma (III/IV Hilar C). Methods Six patients with III/IV Hilar C were enrolled in our hospital. All patients underwent total laparoscopic surgery, including basic surgery (laparoscopic gallbladder, hilar bile duct, and common bile duct resection and hepatoduodenal ligament lymph node dissection) combined with left hepatic and caudate lobe resection/portal resection. The tumor size, operation time, intraoperative blood loss, and postoperative complications were observed. The follow-up of the patients after discharge was recorded. Results Surgery was successfully completed in 6 patients. We found that the tumor size of 6 patients ranged from 1.5 to 3.6 cm, with 4 lymph nodes. The operation time was 540-660 minutes, and the blood loss was 300-500 ml. One patient developed bile leakage after surgery, healed within 2 weeks after drainage. The postoperative hospital stay was 16 (13-24) days. There were 4 cases of negative bile duct margin tumor, 1 case was positive, and 1 case was not reported. All 6 patients were discharged smoothly without perioperative death. Regular examinations were conducted every 3 months after discharge, and the median duration was 7 months. Only 1 patient had a marginal dysplasia, and 5 patients had no obvious signs of recurrence. Conclusions Application of laparoscopic radical resection for III/IV Hilar C is safe and feasible and has good short-term efficacy with adequate preoperative evaluation, appropriate case selection, and precise operative strategy.
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Nayak SB, Surendran S, Nelluri VM, Kumar N, Aithal AP. A South Indian Cadaveric Study About the Relationship of Hepatic Segment of Inferior Vena Cava with the Liver. J Clin Diagn Res 2016; 10:AC04-7. [PMID: 27656424 DOI: 10.7860/jcdr/2016/19892.8295] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Accepted: 05/24/2016] [Indexed: 12/20/2022]
Abstract
INTRODUCTION Inferior Vena Cava (IVC) is the largest vein of the body. It runs vertically upwards in the abdomen, behind the liver. Its course is very constant in relation to liver. However, the amount of liver parenchyma related to it can vary from person to person. The data regarding its course and relations may be very useful to radiologists and surgeons during surgical treatment procedures for Budd-Chiari syndrome, liver carcinoma, liver transplant, venous cannulations and many other clinical procedures. AIM Aim of this study was to document the incidence of straight and curved course of IVC in relation to liver and also to note the pattern in which the liver tissue was related to the IVC. MATERIALS AND METHODS In the current study, 95 adult cadaveric livers were observed; specifically to study the course/direction of the hepatic segment of IVC in relation to the liver. The extent of liver tissue related to various aspects of IVC was also studied. The course of the IVC was classified as straight and curved; and the relationship of liver parenchyma to the IVC was classified into 6 categories. The data was expressed as percentage incidence. RESULTS In 78.94% cases, the IVC had a straight course in relation to the liver; whereas in 21.06% cases, it had a left sided curve (concavity of the curve towards the caudate lobe) in its course. In 6.31% cases, IVC travelled in a tunnel, being encircled by the liver parenchyma all around; in 36.84% cases, it was covered by liver parenchyma on front and sides so that only posterior surface of IVC was visible; in 3.15% cases it was covered by liver tissue on front, sides and also partly on posterior aspect; in 50.52% of cases, its anterior surface, sides and left edge of the posterior surface was covered by liver tissue; and in 3.15% cases it was covered only from the front by the liver tissue. CONCLUSION The data being reported here might be useful for surgeons while planning and executing various hepatic surgeries and also to the radiologists in planning and performing venous cannulation and therapeutic procedures. Since in many livers, the curvature of IVC was associated with enlarged caudate lobe, the curved IVC could hint about the increase in the volume of caudate lobe or liver itself.
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Affiliation(s)
- Satheesha B Nayak
- Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Sudarshan Surendran
- Associate Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Venu Madhav Nelluri
- Senior Grade Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Naveen Kumar
- Assistant Professor, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
| | - Ashwini P Aithal
- Lecturer, Department of Anatomy, Melaka Manipal Medical College (Manipal Campus) Manipal University , Manipal, Karnataka, India
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