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Liao K, Yu F, Cao L, Wang B, Li X, Wang X, Li J, Fan Y, Chen J, Zheng S. Laparoscopic Glissonian pedicle versus hilar dissection approach hemihepatectomy: A prospective, randomized controlled trial. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2022; 29:629-640. [PMID: 35224875 DOI: 10.1002/jhbp.1129] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/26/2021] [Revised: 12/14/2021] [Accepted: 01/19/2022] [Indexed: 11/11/2022]
Affiliation(s)
- Ke‐Xi Liao
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Fan Yu
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
- The Third Hospital of Mianyang Sichuan Mental Health Center Mianyang 621000 Sichuan China
| | - Li Cao
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Bao‐Lin Wang
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Xue‐Song Li
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Xiao‐Jun Wang
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Jian‐Wei Li
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Yu‐Dong Fan
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Jian Chen
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
| | - Shu‐Guo Zheng
- Institute of Hepatobiliary Surgery First Affiliated Hospital Army Medical University Gaotanyan Road 30 Shapingba District, Chongqing 400038 China
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The Applications of 3D Imaging and Indocyanine Green Dye Fluorescence in Laparoscopic Liver Surgery. Diagnostics (Basel) 2021; 11:diagnostics11122169. [PMID: 34943406 PMCID: PMC8700092 DOI: 10.3390/diagnostics11122169] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/01/2021] [Revised: 11/19/2021] [Accepted: 11/21/2021] [Indexed: 02/06/2023] Open
Abstract
Laparoscopic liver resections have gained widespread popularity among hepatobiliary surgeons and is nowadays performed for both standard and more complex hepatectomies. Given the increased technical challenges, preoperative planning and intraoperative guidance is pivotal in laparoscopic surgery to safely carry out complex and oncologically safe hepatectomies. Modern tools can help both preoperatively and intraoperatively and allow surgeons to perform more precise hepatectomies. Preoperative 3D reconstructions and printing as well as augmented reality can increase the knowledge of the specific anatomy of the case and therefore plan the surgery accordingly and tailor the procedure on the patient. Furthermore, the indocyanine green retention dye is an increasingly used tool that can nowadays improve the precision during laparoscopic hepatectomies, especially when considering anatomical resection. The use of preoperative modern imaging and intraoperative indocyanine green dye are key to successfully perform complex hepatectomies such as laparoscopic parenchymal sparing liver resections. In this narrative review, we discuss the aspects of preoperative and intraoperative tools that are nowadays increasingly used in experienced hepatobiliary centers.
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Parenchymal Sparing Anatomical Liver Resections With Full Laparoscopic Approach: Description of Technique and Short-term Results. Ann Surg 2021; 273:785-791. [PMID: 31460879 DOI: 10.1097/sla.0000000000003575] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022]
Abstract
OBJECTIVE The aim of this study was to describe laparoscopic anatomical parenchymal sparing liver resections for hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM) and report the short-term outcomes. BACKGROUND Anatomical resections (ARs) have better oncological outcomes compared to partial resections in patients with HCC, and some suggest should be performed also for CRLM as micrometastasis occurs through the intrahepatic structures. Furthermore, remnant liver ischemia after partial resections has been associated with worse oncological outcomes. Few experiences on laparoscopic anatomical resections have been reported and no data on limited AR exist. METHODS We performed a retrospective analysis of 86 patients undergoing full laparoscopic anatomical parenchymal sparing resections with preoperative surgical simulation and standardized procedures. RESULTS A total of 55 patients had HCC, whereas 31 had CRLM with a median of 1 lesion and a size of 30 mm. During preoperative three-dimensional (3D) simulation, a median resection volume of 120 mL was planned. Sixteen anatomical subsegmentectomies, 56 segmentectomies, and 14 sectionectomies were performed. Concordance between preoperative 3D simulation and intraoperative resection was 98.7%. Two patients were converted, and 7 patients experienced complications. Subsegmentectomies had comparable blood loss (166 mL, P = 0.59), but longer operative time (426 min, P = 0.01) than segmentectomies (blood loss 222 mL; operative time 355 min) and sectionectomies (blood loss 120 mL; operative time 295 min). R0 resection and margin width remained comparable among groups. CONCLUSIONS A precise preoperative planning and a standardized surgical technique allow to pursue the oncological quality of AR enhancing the safety of the parenchyma sparing principle, reducing surgical stress through a laparoscopic approach.
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Morimoto M, Tomassini F, Berardi G, Mori Y, Shirata C, Abu Hilal M, Asbun HJ, Cherqui D, Gotohda N, Han HS, Kato Y, Rotellar F, Sugioka A, Yamamoto M, Wakabayashi G. Glissonean approach for hepatic inflow control in minimally invasive anatomic liver resection: A systematic review. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:51-65. [PMID: 33528877 DOI: 10.1002/jhbp.908] [Citation(s) in RCA: 20] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/28/2020] [Revised: 01/14/2021] [Accepted: 01/27/2021] [Indexed: 12/13/2022]
Abstract
BACKGROUND The Glissonean approach has been widely validated for both open and minimally invasive anatomic liver resection (MIALR). However, the possible advantages compared to the conventional hilar approach are still under debate. The aim of this systematic review was to evaluate the application of the Glissonean approach in MIALR. METHODS A systematic review of the literature was conducted on PubMed and Ichushi databases. Articles written in English or Japanese were included. From 2,390 English manuscripts evaluated by title and abstract, 43 were included. Additionally, 23 out of 463 Japanese manuscripts were selected. Duplicates were removed, including the most recent manuscript. RESULTS The Glissonean approach is reported for both major and minor MIALR. The 1st, 2nd and 3rd order divisions of both right and left portal pedicles can be reached following defined anatomical landmarks. Compared to the conventional hilar approach, the Glissonean approach is associated with shorter operative time, lower blood loss, and better peri-operative outcomes. CONCLUSIONS Glissonean approach is safe and feasible for MIALR with several reported advantages compared to the conventional hilar approach. Clear knowledge of Laennec's capsule anatomy is necessary and serves as a guide for the dissection. However, the best surgical approach to be performed depends on surgeon experience and patients' characteristics. Standardization of the Glissonean approach for MIALR is important.
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Affiliation(s)
- Mamoru Morimoto
- Department of Gastroenterological Surgery, Nagoya City University Graduate School of Medical Science, Nagoya, Japan
| | - Federico Tomassini
- Department of Oncological and Emergency Surgery, Policlinico Casilino, Rome, Italy
| | - Giammauro Berardi
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini hospital of Rome, Rome, Italy
| | - Yasuhisa Mori
- Department of Surgery and Oncology, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Chikara Shirata
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Mohammed Abu Hilal
- Department of Surgery, Instituto Fondazione Poliambulanza, Brescia, Italy
| | - Horacio J Asbun
- Hepato-Biliary and Pancreas Surgery - Miami Cancer Institute, Miami, FL, USA
| | - Daniel Cherqui
- Hepatobiliary Center, Paul Brousse Hospital, Paris, France
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan
| | - Ho-Seong Han
- Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
| | - Yutaro Kato
- Department of Surgery, Fujita Health University, Aichi, Japan
| | - Fernando Rotellar
- HPB and Liver Transplant Unit, Clínica Universidad de Navarra, Pamplona, Spain
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University, Aichi, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
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Xiao L, Wang Z, Zhou L. "Liver parenchyma dissecting-first" method facilitates the Glissonean pedicle approach in anatomical laparoscopic hepatolobectomy. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:940. [PMID: 32953740 PMCID: PMC7475421 DOI: 10.21037/atm-20-4674] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
Background Anatomical laparoscopic hepatolobectomy (ALH) is a difficult and challenging operation, and avoiding massive hemorrhage during parenchyma transection remains one of its major concern. Glissonean pedicle approach (GPA) has achieved great success in open liver surgery due to its simplicity and reproducibility, but it is difficult to apply in ALH for the limited vision and motion. We thus aimed to introduce a modified method to facilitate the GPA in ALH. Methods In this retrospective study, in 15 patients who underwent ALH (at least 2 couinaud segments), the liver parenchyma was dissected at first (LPDF) adequately under intermittent total inflow control to reveal the Glissonean pedicle (GP) sufficiently for safe and precise transection. The technical details of LPDF for different types of hepatolobectomy and a modified laparoscopic Pringle maneuver are described, and the surgical outcomes are reviewed. Results LPDF was applied in all patients, and intraoperative blood transfusion was not needed. LPDF facilitated GPA in ALH without any severe morbidity or mortality. Conclusions LPDF is a safe and effective technique, it reduces the difficulties in inflow occlusion in GPA and can promote the application of ALH. Further clinical control trails are needed to validate the superiority of LPDF compared with GPA in ALH.
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Affiliation(s)
- Liang Xiao
- Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Zhiming Wang
- Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China
| | - Ledu Zhou
- Department of Liver Surgery, Xiangya Hospital, Central South University, Changsha, China
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Influence of the Glissonean Pedicle Transection Approach in Spiegel Lobe-Preserving Left Hepatectomy on Spiegel Lobe Volume and Remnant Liver Functions. World J Surg 2020; 44:3079-3085. [PMID: 32347350 DOI: 10.1007/s00268-020-05548-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
BACKGROUND The extrahepatic surgical technique in liver resection can be divided into glissonean pedicle transection and glissonean separated transection approaches. In this study, we compared remnant liver function and liver regeneration involving the Spiegel lobe between these two approaches regarding Spiegel lobe-preserving left hepatectomy. METHODS We enrolled 31 patients who underwent Spiegel lobe-preserving left hepatectomy for malignant hepatobiliary diseases between April 2008 and January 2020. The postoperative Spiegel lobe volume was measured using a volume analyzer at 3 and 6 months postoperatively. RESULTS Of the 31 patients, 22 and 9 were included in the glissonean separated transection and glissonean pedicle transection groups, respectively. There was no significant between-group difference in the preoperative Spiegel lobe volume. However, the volumes at 3 and 6 months postoperatively were significantly larger in the glissonean pedicle transection group than in the glissonean transection group (29.92 mL vs. 13.00 mL; P < 0.001 and 28.43 mL vs. 15.01 mL; P < 0.001, respectively). There was no significant between-group difference in postoperative remnant liver function. CONCLUSIONS The postoperative Spiegel lobe volume was larger, and liver regeneration was better with the glissonean pedicle transection approach because of transection for Spiegel branch of the portal vein. It is desirable to preserve Spiegel branch in possible cases when surgeons select the glissonean separated transection approach based on the location and size of the tumors.
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Chen TH, Yang HR, Jeng LB, Hsu SC, Hsu CH, Yeh CC, Yang MD, Chen WTL. Laparoscopic Liver Resection: Experience of 436 Cases in One Center. J Gastrointest Surg 2019; 23:1949-1956. [PMID: 30421118 DOI: 10.1007/s11605-018-4023-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2018] [Accepted: 10/18/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND To report experience of laparoscopic liver resection (LLR) in one center. METHODS We retrospectively reviewed 436 consecutive LLRs in 411 patients between December 2010 and December 2016. On the basis of the 2008 Louisville Statement, we divided the 436 cases into two groups: Simple Group (n = 203) and Difficult Group (n = 233). RESULTS The indications were HCC (n = 194), colorectal cancer liver metastasis (n = 156), benign tumors (n = 62), hepatolithiasis (n = 2), and other malignant lesions (n = 22). The median tumor size was 24 mm (range 3 to 130). Procedures of LLR included wedge resection (n = 230), one segmentectomy (n = 8), two segmentectomies (n = 12), left lateral sectionectomy (n = 75), right hepatectomy (n = 52), left hepatectomy (n = 31), extended right hepatectomy (n = 2), extended left hepatectomy (n = 5), central bisectionectomy (n = 3), right posterior sectionectomy (n = 12), and right anterior sectionectomy (n = 6). The median operative time was 228 min (range 9-843) and median blood loss was 150 ml (range 2-3500). Twenty-five cases required blood transfusion (5.7%). Conversion to open surgery was required in six cases (1.4%). The mean length of stay was 6.4 ± 2.9 days. Overall complication rate was 9.4% and major complication rate was 5%. One patient died of liver failure on the thirtieth postoperative day after a right hepatectomy. We had higher median blood loss (200 vs. 100 ml; p < 0.001), higher transfusion rate (8.2 vs. 2.9%; p = 0.020), longer median operative time (297 vs. 164 min; p < 0.001), higher conversion rate (2.6 vs. 0%; p = 0.021), higher complication rate (14.2 vs. 3.9%; p < 0.001), and longer mean postoperative hospital stay (6.8 ± 2.9 vs. 5.9 ± 3.0 days; p < 0.001) in the Difficult Group. CONCLUSIONS Laparoscopic liver resection is safe for selected patients in the Difficult Group. On the basis of the 2008 Louisville Statement, selection criteria of LLR are helpful to predict the difficulty of the operation and the postoperative outcomes of LLR.
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Affiliation(s)
- Te-Hung Chen
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Horng-Ren Yang
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Long-Bin Jeng
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan. .,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan.
| | - Shih-Chao Hsu
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chia-Hao Hsu
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Chun-Chieh Yeh
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - Mei-Due Yang
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
| | - William Tzu-Liang Chen
- School of Medicine, China Medical University, No.2, Yude Rd., North Dist, Taichung City, 404, Taiwan.,Department of Surgery, China Medical University Hospital, China Medical University, Taichung, Taiwan
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López-Ben S, Ranea A, Albiol MT, Falgueras L, Castro E, Casellas M, Codina-Barreras A, Figueras J. Evolution of laparoscopic surgery in a high volume hepatobiliary unit: 150 consecutive pure laparoscopic hepatectomies. Cir Esp 2017; 95:261-267. [PMID: 28583725 DOI: 10.1016/j.ciresp.2017.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2016] [Revised: 04/17/2017] [Accepted: 04/26/2017] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Compared to other surgical areas, laparoscopic liver resection (LLR) has not been widely implemented and currently less than 20% of hepatectomies are performed laparoscopically worldwide. The aim of our study was to evaluate the feasibility, and the ratio of implementation of LLR in our department. METHODS We analyzed a prospectively maintained database of 749 liver resections performed during the last 10-year period in a single centre. RESULTS A total of 150 (20%) consecutive pure LLR were performed between 2005 and 2015. In 87% of patients the indication was the presence ofprimary or metastatic liver malignancy. We performed 30 major hepatectomies (20%) and (80%) were minor resections, performed in all liver segments. Twelve patients were operated twice and 2 patients underwent a third LLR. The proportion of LLR increased from 12% in 2011 to 62% in the last year. Conversion rate was 9%. Overall morbidity rate was 36% but only one third were classified as severe. The 90-day mortality rate was 1%. Median hospital stay was 4 days and the rate of readmissions was 6%. CONCLUSIONS The implementation of LLR has been fast with morbidity and mortality comparable to other published series. In the last 2 years more than half of the hepatectomies are performed laparoscopically in our centre.
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Affiliation(s)
- Santiago López-Ben
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España.
| | - Alejandro Ranea
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - M Teresa Albiol
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Laia Falgueras
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Ernesto Castro
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Margarida Casellas
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Antoni Codina-Barreras
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
| | - Joan Figueras
- Unidad Hepatobiliopancreática, Servicio de Cirugía Digestiva, Hospital Universitari de Girona Dr. Josep Trueta, Gerona, España
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Abstract
OBJECTIVE To perform a systematic review of worldwide literature on laparoscopic liver resections (LLR) and compare short-term outcomes against open liver resections (OLR) by meta-analyses. SUMMARY BACKGROUND DATA There are no updated pooled data since 2009 about the current status and short-term outcomes of LLR worldwide. PATIENTS AND METHODS All English language publications on LLR were screened. Descriptive worldwide data and short-term outcomes were obtained. Separate analyses were performed for minor-only and major-only resection series, and series in which minor/major resections were not differentiated. Apparent case duplications were excluded. RESULTS A set of 463 published manuscripts were reviewed. One hundred seventy-nine single-center series were identified that accounted for 9527 LLR cases worldwide. Minor-only, major-only, and combined major-minor series were 61, 18, and 100, respectively, including 32, 8, and 43 comparative series, respectively. Of the total 9527 LLR cases reported, 6190 (65%) were for malignancy and 3337 (35%) were for benign indications. There were 37 deaths reported (mortality rate = 0.4%). From the meta-analysis comparing case-matched LLR to OLR (N = 2900 cases), there was no increased mortality and significantly less complications, transfusions, blood loss, and hospital stay observed in LLR vs OLR. CONCLUSIONS This is the largest review of LLR available to date with over 9000 cases published. It confirms growing safety when performed in selected patients and by trained surgeons, and suggests that LLR may offer improved patient short-term outcomes compared with OLR. Improved levels of evidence, standardized reporting of outcomes, and assuring proper training are the next challenges of laparoscopic liver surgery.
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Coelho FF, Perini MV, Kruger JAP, Lupinacci RM, Makdissi FF, D'Albuquerque LAC, Cecconello I, Herman P. Video assisted resections. Increasing access to minimally invasive liver surgery? Rev Col Bras Cir 2015; 42:318-24. [DOI: 10.1590/0100-69912015005009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/03/2015] [Indexed: 01/27/2023] Open
Abstract
Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.
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Chen H, Wang F, Deng F, Zhen Z, Lai EC, Lau WY. Laparoscopic Right Hemihepatic Vascular Inflow Occlusion by Lowering of the Hilar Plate. J Laparoendosc Adv Surg Tech A 2014; 24:833-6. [PMID: 25264715 DOI: 10.1089/lap.2014.0082] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023] Open
Affiliation(s)
- Huanwei Chen
- Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, Guang Dong, The People's Republic of China
| | - Fengjie Wang
- Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, Guang Dong, The People's Republic of China
| | - Feiwen Deng
- Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, Guang Dong, The People's Republic of China
| | - Zuojun Zhen
- Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, Guang Dong, The People's Republic of China
| | - Eric C.H. Lai
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, The People's Republic of China
- Department of Surgery, Pamela Youde Nethersole Eastern Hospital, Hong Kong, SAR, The People's Republic of China
| | - Wan Yee Lau
- Department of Liver Surgery, The First People's Hospital of Foshan, Foshan, Guang Dong, The People's Republic of China
- Faculty of Medicine, The Chinese University of Hong Kong, Shatin, New Territories, Hong Kong SAR, The People's Republic of China
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Cho A, Yamamoto H, Kainuma O, Muto Y, Yanagibashi H, Tonooka T, Masuda T. Laparoscopy in the management of hilar cholangiocarcinoma. World J Gastroenterol 2014; 20:15153-15157. [PMID: 25386064 PMCID: PMC4223249 DOI: 10.3748/wjg.v20.i41.15153] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/28/2013] [Revised: 01/10/2014] [Accepted: 06/23/2014] [Indexed: 02/06/2023] Open
Abstract
The use of minimally invasive surgery has become widely accepted in many gastrointestinal fields, even in patients with malignancy. However, performing laparoscopic resection for the treatment of hilar cholangiocarcinoma is still not universally accepted as an alternative approach to open surgery, and only a limited number of such procedures have been reported due to the difficulty of performing oncologic resection and the lack of consensus regarding the adequacy of this approach. Laparoscopy was initially limited to staging, biopsy and palliation. Recent technological developments and improvements in endoscopic procedures have greatly expanded the applications of laparoscopic liver resection and lymphadenectomy, and some reports have described the use of laparoscopic or robot-assisted laparoscopic resection for hilar cholangiocarcinoma as being feasible and safe in highly selected cases, with the ability to obtain an adequate surgical margin. However, the benefits of major laparoscopic surgery have yet to be conclusively proven, and carefully selecting patients is essential for successfully performing this procedure.
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Chen YJ, Zhen ZJ, Chen HW, Lai ECH, Deng FW, Li QH, Lau WY. Laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach. Hepatobiliary Pancreat Dis Int 2014; 13:508-12. [PMID: 25308361 DOI: 10.1016/s1499-3872(14)60293-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
BACKGROUND With advances in technology, laparoscopic liver resection is widely accepted. Laparoscopic liver resection under hemihepatic vascular inflow occlusion has advantages over the conventional total hepatic inflow occlusion using the Pringle's maneuver, especially in patients with cirrhosis. METHOD From November 2011 to August 2012, eight consecutive patients underwent laparoscopic liver resection under hemihepatic vascular inflow occlusion using the lowering of hilar plate approach with biliary bougie assistance. RESULTS The types of liver resection included right hepatectomy (n=1), right posterior sectionectomy (n=1), left hepatectomy and common bile duct exploration (n=1), segment 4b resection (n=1), left lateral sectionectomy (n=2), and wedge resection (n=2). Four patients underwent right and 4 left hemihepatic vascular inflow occlusion. Four patients had cirrhosis. The mean operation time was 176.3 minutes. The mean time taken to achieve hemihepatic vascular inflow occlusion was 24.3 minutes. The mean duration of vascular inflow occlusion was 54.5 minutes. The mean intraoperative blood loss was 361 mL. No patient required blood transfusion. Postoperatively, one patient developed bile leak which healed with conservative treatment. No postoperative liver failure and mortality occurred. The mean hospital stay of the patients was 7 days. CONCLUSION Our technique of hemihepatic vascular inflow vascular occlusion using the lowering of hilar plate approach was safe, and it improved laparoscopic liver resection by minimizing blood loss during liver parenchymal transection.
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Affiliation(s)
- Ying-Jun Chen
- Department of Liver Surgery, The First People's Hospital of Foshan, Foshan 528000, China.
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Extrahepatic Glissonean approach for laparoscopic major liver resection (with video). JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2013; 20:141-4. [PMID: 23001193 DOI: 10.1007/s00534-012-0559-x] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Although recent technological developments and improved endoscopic procedures have further spread the application of laparoscopic liver resection, laparoscopic major liver resection remains a highly specialized field because there are major technical difficulties, such as hilar dissection and pedicle control. The entire length of the primary branches of the Glissonean pedicle and the origin of the secondary branches are located outside the liver. In contrast, the trunks of the secondary branches and more peripheral branches run inside the liver. The right, left, anterior, or posterior Glissonean pedicle can thus be tied and divided en bloc extrahepatically during open anatomical liver resection. Each Glissonean pedicle can be easily and safely encircled and divided en bloc extrahepatically during laparoscopic anatomical liver resection using an Endo Retract Maxi or Endo Mini-Retract. This report describes a novel technique by which the extrahepatic Glissonean approach appears to be both feasible and safe for the performance of laparoscopic major liver resection.
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Tomishige H, Morise Z, Kawabe N, Nagata H, Ohshima H, Kawase J, Arakawa S, Yoshida R, Isetani M. Caudal approach to pure laparoscopic posterior sectionectomy under the laparoscopy-specific view. World J Gastrointest Surg 2013; 5:173-177. [PMID: 23977419 PMCID: PMC3750128 DOI: 10.4240/wjgs.v5.i6.173] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/27/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.
METHODS: Points of the procedure are: (1) Patients are put in left lateral position and posterior sector is not mobilized; (2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection; (3) Dissection of inferior vena cava (IVC) anterior wall behind the liver is started from caudal. Simultaneously, liver transection is performed to search right hepatic vein (RHV) from caudal; (4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial, exposing the surfaces of IVC and RHV. Since the remnant liver sinks down, the cutting surface is well-opend; and (5) After the completion of transection, dissection of the resected liver from retroperitoneum is easily performed using the gravity. This approach was performed for a 63 years old woman with liver metastasis close to RHV.
RESULTS: RHV exposure is required for R0 resection of the lesion. Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space, the use of specific characteristics of laparoscopic hepatectomy, such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning, made the complete RHV exposure during the liver transection easy to perform. The operation time was 341 min and operative blood loss was
1356 mL. Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.
CONCLUSION: The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.
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Recent progress in laparoscopic liver resection. Clin J Gastroenterol 2013; 6:8-15. [DOI: 10.1007/s12328-012-0352-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Accepted: 12/18/2012] [Indexed: 02/07/2023]
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Cho A, Yamamoto H, Kainuma O, Ota T, Park S, Yanagibashi H, Arimitsu H, Ikeda A, Souda H, Nabeya Y, Takiguchi N, Nagata M. Arantius' ligament approach for the left extrahepatic Glissonean pedicle in pure laparoscopic left hemihepatectomy. Asian J Endosc Surg 2012; 5:187-90. [PMID: 23095298 DOI: 10.1111/j.1758-5910.2012.00139.x] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
Abstract
INTRODUCTION Laparoscopic hemihepatectomy has not yet become widely accepted because of the technical difficulties in controlling each Glissonean pedicle laparoscopically. MATERIALS AND SURGICAL TECHNIQUE The subjects in the present study included 12 patients who underwent laparoscopic left hemihepatectomy between August 2007 and June 2011. Arantius' ligament was divided. Retracting the caudal stump of the ligament revealed a space between the left Glissonean pedicle and the liver parenchyma. The left Glissonean pedicle could be easily encircled by using an Endo Retract Maxi. No Glissonean injuries, including bleeding or biliary leakage, occurred in any of the 12 patients. DISCUSSION Therefore, the Arantius' ligament approach for the left extrahepatic Glissonean pedicle appears to be feasible and safe for successfully performing pure laparoscopic left hemihepatectomy.
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Affiliation(s)
- Akihiro Cho
- Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, Chiba, Japan.
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18
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Hepatectomy based on the tumor hemodynamics for hepatocellular carcinoma: a comparison among the hybrid and pure laparoscopic procedures and open surgery. Surg Endosc 2012; 27:610-7. [DOI: 10.1007/s00464-012-2499-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/23/2012] [Accepted: 07/11/2012] [Indexed: 12/22/2022]
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Rotellar F, Pardo F, Benito A, Martí-Cruchaga P, Zozaya G, Pedano N. A novel extra-glissonian approach for totally laparoscopic left hepatectomy. Surg Endosc 2012; 26:2617-22. [PMID: 22447286 DOI: 10.1007/s00464-012-2242-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2011] [Accepted: 02/27/2012] [Indexed: 12/17/2022]
Abstract
INTRODUCTION We describe a novel extra-glissonian approach (EGA) for totally laparoscopic left hepatectomy. Published techniques for totally laparoscopic left hepatectomy generally involve the selective ligation of the vascular and biliary elements of the left pedicle. The laparoscopic dissection of these structures can be tedious, difficult, and dangerous. The EGA has proven useful in open surgery for major hepatectomies. We feel that this approach could be even more useful in the laparoscopic context. METHODS We describe an extra-glissonian laparoscopic technique in which the left pedicle is isolated extraparenchymally, detaching the left hilar plate, with particular attention to preserving the branch for segment I. The left portal triad is encircled with a cotton tape and transected with an endostapler. This is performed totally extraparenchymally without damaging the surrounding parenchyma. RESULTS This EGA technique for laparoscopic left hepatectomy follows by laparoscopy the same steps and recommendations that make the EGA safe and effective in open surgery. CONCLUSIONS The EGA for LLH can be performed as described in open surgery, therefore offering the same advantages.
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Affiliation(s)
- Fernando Rotellar
- Department of General and Abdominal Surgery, University Clinic of Navarre, University of Navarre, Avda.Pio XII n°36 Pamplona, Spain.
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20
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Ji B, Wang Y, Wang G, Liu Y. Curative resection of hepatocellular carcinoma using modified Glissonean pedicle transection versus the Pringle maneuver: a case control study. Int J Med Sci 2012; 9:843-52. [PMID: 23155358 PMCID: PMC3498749 DOI: 10.7150/ijms.4870] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 10/15/2012] [Indexed: 01/28/2023] Open
Abstract
OBJECTIVE The Glissonean pedicle transection method of liver resection has been found to shorten operative time and minimize intraoperative bleeding during liver segmentectomy. We have compared the feasibility, effectiveness, and safety of the Glissonean pedicle transection method with the Pringle maneuver in patients undergoing selective curative resection of large hepatocellualr carcinoma (HCC). METHODS Eligible patients with large (> 5 cm) nodular HCC (n = 50) were assigned to undergo curative hepatectomy using the Glissonean pedicle transection method (n = 25) or the Pringle maneuver (n = 25). Partial interruption of the infrahepatic inferior vena cava was incorporated to further reduce bleeding from liver transection. The primary outcome measure was postoperative changes in liver function from baseline. Secondary outcomes included operating time, volume of intraoperative blood loss/transfusion, and time to resolution of ascites. RESULTS The two groups were comparable in age, sex, site and size of the liver tumor, segment or lobe intended to be resected, and liver function reserve, and the results were not significant statistically. All patients underwent successful major hepatectomies using the assigned method, with the extent of major hepatectomy comparable in the two groups (P = 0.832). The Glissonean approach was associated with shorter hepatic inflow interruption (30.0 ± 12.0 min vs. 45.0 ± 13.0 min, P < 0.001), lower volume of blood loss (145.0 ± 20.0 mL vs. 298.0 ± 109.0 mL, P < 0.001), reduced requirement for transfusion (0.0 ± 0.0 mL vs. 200.0 ± 109.0 mL, P < 0.0001), and more rapid resolution of ascites (9.5 ± 1.2 d vs. 15.3 ± 2.4 d, P < 0.001). Postoperative liver function measures were comparable in the two groups, and the results were not significant statistically. CONCLUSION The Glissonean pedicle transection method is a feasible, effective, and safe technique for hepatic inflow control during the curative resection of large nodular HCCs.
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Affiliation(s)
- Bai Ji
- Department of Hepatobiliary and Pancreatic Surgery, the First Hospital, Jilin University, China
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21
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Abstract
Whereas in other fields of surgery minimally invasive techniques have replaced the open surgery approach, liver resection is still a domain of conventional surgery. However, it is internationally emerging that laparoscopic hepatic surgery will become more important by conceptional improvements. This article describes the technical aspects of laparoscopic liver resection, in particular the procedure with respect to the individual liver segments. The advantages and disadvantages of the minimally invasive technique and also the indications for laparoscopic liver resection will be discussed.
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Cho A, Yamamoto H, Kainuma O, Souda H, Ikeda A, Takiguchi N, Nagata M. Safe and feasible extrahepatic Glissonean access in laparoscopic anatomical liver resection. Surg Endosc 2010; 25:1333-6. [PMID: 20872017 DOI: 10.1007/s00464-010-1358-6] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2010] [Accepted: 09/02/2010] [Indexed: 12/13/2022]
Abstract
BACKGROUND Although recent technological developments and improved endoscopic procedures have further spread the application of laparoscopic liver resection, laparoscopic anatomical liver resection still presents major technical difficulties, such as pedicle control. METHODS Subjects comprised 27 patients who underwent laparoscopic anatomical liver resection using an extrahepatic Glissonean pedicle transaction between August 2005 and February 2010. RESULTS A total of 61 Glissonean pedicles could be encircled en bloc extrahepatically, as planned. No serious complications, including major bleeding or injury of the portal triad, were encountered during procedures. CONCLUSIONS Extrahepatic Glissonean access seems to be feasible and safe for laparoscopic anatomical resection of the liver.
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Affiliation(s)
- Akihiro Cho
- Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, 666-2 Nitonachou, Chuouku, Chiba 260-8717, Japan.
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Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc 2009; 24:246. [PMID: 19688384 DOI: 10.1007/s00464-009-0667-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
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24
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Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A, Tohma T, Matsumoto I. Laparoscopic major hepato-biliary-pancreatic surgery: formidable challenge to standardization. ACTA ACUST UNITED AC 2009; 16:705-10. [PMID: 19629373 DOI: 10.1007/s00534-009-0144-0] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 02/07/2023]
Abstract
INTRODUCTION Although laparoscopic colorectal or gastric surgery has become widely accepted as a superior alternative to conventional open surgery, the surgical management of hepato-biliary-pancreatic disease has traditionally involved open surgery. Recently, many reports have described laparoscopic partial liver resection, lateral segmentectomy, and distal pancreatectomy. However, laparoscopic major hepato-biliary-pancreatic surgery, such as hepatic lobectomy and pancreaticoduodenectomy, has not been widely developed because of technical difficulties. METHODS We describe our experience with laparoscopic major hepato-biliary-pancreatic surgery, including right hepatectomy using hilar Glissonean pedicle transaction, and pylorus-preserving pancreaticoduodenectomy. CONCLUSION Although our experience is limited, and randomized study is necessary to elucidate the appropriate indications for and effects of the present procedures, we believe that laparoscopic major hepato-biliary-pancreatic surgery can be feasible, safe, and effective in highly selected patients, and that it will be one of the standard therapeutic options for carefully selected patients with hepato-biliary-pancreatic disease.
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Affiliation(s)
- Akihiro Cho
- Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, 666-2 Nitonachou, Chuouku, Chiba, 260-8717, Japan.
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25
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Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A, Tohma T, Matsumoto I. Comparison of laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy for periampullary disease. Am J Surg 2009; 198:445-9. [PMID: 19342003 DOI: 10.1016/j.amjsurg.2008.12.025] [Citation(s) in RCA: 98] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/20/2008] [Revised: 11/20/2008] [Accepted: 12/02/2008] [Indexed: 12/14/2022]
Abstract
BACKGROUND Although many reports have described laparoscopic pancreatic surgery, pancreaticoduodenectomy (PD) has not been widely accepted. The present study aimed to compare laparoscopy-assisted and open pylorus-preserving pancreaticoduodenectomy (PPPD) to investigate the feasibility, safety, and tumor clearance. METHODS Fifteen patients with periampullary disease underwent laparoscopy-assisted PPPD, in which resection was performed laparoscopically and the reconstruction was performed through a small midline incision. These patients were compared with 15 patients who, during the same period, underwent conventional open PPPD. RESULTS Mean operative time and mean blood loss were similar between groups. No significant differences in the incidence of complications or hospital stay were noted between groups. Surgical margin and number of lymph nodes found in the resected specimen did not differ between groups. CONCLUSIONS Laparoscopy-assisted PPPD is on the same level with conventional open surgery in terms of perioperative outcomes or treatment efficacy.
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Affiliation(s)
- Akihiro Cho
- Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, Chiba, Japan.
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26
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A totally laparoscopic pylorus-preserving pancreaticoduodenectomy and reconstruction. Surg Today 2009; 39:359-62. [PMID: 19319649 DOI: 10.1007/s00595-008-3853-0] [Citation(s) in RCA: 19] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/12/2008] [Accepted: 09/18/2008] [Indexed: 10/21/2022]
Abstract
Although many reports have described laparoscopic pancreatic surgery, laparoscopic pancreaticoduodenectomy (PD) has not been widely employed because of technical difficulties. This paper describes a totally laparoscopic pylorus-preserving PD performed for an intraductal papillary-mucinous neoplasm. After the laparoscopic resection, an end-to-side pancreaticojejunostomy including duct-to-mucosa anastomosis without a stenting tube, an approximation of the pancreas stump and jejunal wall, an end-to-side hepaticojejunostomy, and an end-to-side duodenojejunostomy were performed intracorporeally. The patient recovered without any complications and was discharged on the 14th postoperative day. The surgical margin was free of neoplastic changes. Although the experience is limited and the appropriate indications must await future studies, this case indicates that a laparoscopic pylorus-preserving PD can be feasible, safe, and effective in highly selected patients.
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Machado MAC, Makdissi FF, Surjan RC, Herman P, Teixeira AR, C Machado MC. Laparoscopic resection of left liver segments using the intrahepatic Glissonian approach. Surg Endosc 2009; 23:2615-9. [PMID: 19296173 DOI: 10.1007/s00464-009-0423-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2008] [Revised: 10/17/2008] [Accepted: 01/12/2009] [Indexed: 12/28/2022]
Abstract
BACKGROUND Recent advances in laparoscopic techniques have resulted in growing indications for laparoscopic hepatectomy. However, this procedure has not been widely developed, and anatomic segmental liver resection is not currently performed due to difficulty controlling the segmental Glissonian pedicles laparoscopically. This study aimed to report a novel technique for laparoscopic anatomic resection of left liver segments using the intrahepatic Glissonian approach based on small incisions according to anatomic landmarks such as Arantius' and round ligaments. METHODS Nine consecutive patients underwent laparoscopic liver resection using the intrahepatic Glissonian technique from April 2007 to June 2008. Five patients underwent laparoscopic bisegmentectomy 2-3, one laparoscopic left hemihepatectomy, two resections of segment 3, and one resection of segment 4. RESULTS One patient required a blood transfusion. The mean operation time was 180 min (range, 120-300 min), and the median hospital stay was 3 days (range, 1-5 days). No patient had postoperative signs of liver failure or bile leakage. No postoperative mortality was observed. CONCLUSION The main advantage of the intrahepatic Glissonian procedure over other techniques is the possibility of gaining a rapid and precise access to the left Glissonian sheaths facilitating left hemihepatectomy, bisegmentectomy 2-3, and individual resections of segments 2, 3, and 4. The authors believe that the intrahepatic Glissonian technique facilitates laparoscopic liver resection and may increase the development of segment-based laparoscopic liver resection.
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Affiliation(s)
- M A C Machado
- Department of Gastroenterology, University of São Paulo, Rua Evangelista Rodrigues, 407-05463-000, Sao Paulo, Brazil.
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A simple technique for large tumor removal during laparoscopic liver resection. Surg Laparosc Endosc Percutan Tech 2009; 18:589-91. [PMID: 19098666 DOI: 10.1097/sle.0b013e3181809e8d] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Experience with laparoscopic liver resections has increased in recent years, and so have the number of patients operated on by minimally invasive techniques. Specimen extraction is an important step of laparoscopic liver resection. The size of the specimen is usually a limitation for the use of laparoscopy. The aim of this paper is to describe a new technique combining Pfannenstiel suprapubic incision and obstetric forceps to remove a large specimen from laparoscopic liver resections. The present technique allows an expeditious extraction of intact specimens, even huge ones, through a standard suprapubic Pfannenstiel incision. This technique has additional functional and cosmetic advantages over other techniques of specimen retrieval. We believe that the described technique is feasible, can be easily and rapidly performed, and facilitates laparoscopic liver resection by reducing the technical difficulties for specimen removal and may also be used in other abdominal laparoscopic interventions that deal with large surgical specimens.
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Chang TT, Corvera CU. Caudate split for open and laparoscopic liver resections. J Am Coll Surg 2009; 207:e7-9. [PMID: 19183523 DOI: 10.1016/j.jamcollsurg.2008.09.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2008] [Revised: 08/30/2008] [Accepted: 09/03/2008] [Indexed: 12/07/2022]
Affiliation(s)
- Tammy T Chang
- Department of Surgery, University of California, San Francisco, San Francisco, San Francisco, CA, USA
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30
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Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc 2008; 23:906-8. [DOI: 10.1007/s00464-008-0257-6] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2008] [Revised: 10/25/2008] [Accepted: 11/15/2008] [Indexed: 12/29/2022]
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Cho A, Yamamoto H, Nagata M, Takiguchi N, Shimada H, Kainuma O, Souda H, Gunji H, Miyazaki A, Ikeda A, Matsumoto I. Total laparoscopic resection of the gallbladder together with the gallbladder bed. ACTA ACUST UNITED AC 2008; 15:585-8. [PMID: 18987927 DOI: 10.1007/s00534-008-1363-5] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2008] [Accepted: 03/20/2008] [Indexed: 02/06/2023]
Abstract
Patients with carcinoma of the gallbladder that is preoperatively diagnosed by radiology do not undergo laparoscopic resection, because such surgery is thought to worsen the prognosis of gallbladder carcinoma. However, the prognosis for patients with incidental T2 gallbladder carcinoma who are treated laparoscopically is reportedly no worse than that for patients undergoing conventional surgery. We successfully performed total laparoscopic resection of the gallbladder together with the gallbladder bed without any complications. We believe that this procedure represents a valid therapeutic option for carefully selected patients with T2 carcinoma of the gallbladder.
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Affiliation(s)
- Akihiro Cho
- Division of Gastroenterological Surgery, Chiba Cancer Center Hospital, 666-2 Nitonachou, Chiba, 260-8717, Japan
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Machado MA, Martins AC, Machado MC. Isolation of right main and sectional portal pedicles for liver resection without hepatotomy or inflow occlusion. J Am Coll Surg 2008; 207:787-8; author reply 788-9. [PMID: 18954799 DOI: 10.1016/j.jamcollsurg.2008.08.023] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2008] [Accepted: 08/21/2008] [Indexed: 11/26/2022]
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Machado MAC, Makdissi FF, Galvão FH, Machado MCC. Intrahepatic Glissonian approach for laparoscopic right segmental liver resections. Am J Surg 2008; 196:e38-42. [PMID: 18614140 DOI: 10.1016/j.amjsurg.2007.10.027] [Citation(s) in RCA: 80] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2007] [Revised: 10/19/2007] [Accepted: 10/23/2007] [Indexed: 12/17/2022]
Abstract
BACKGROUND Experience with laparoscopic procedures and recent advances in laparoscopic devices have created an evolving interest in the application of these techniques to liver resection. However, laparoscopic liver resection has not been widely developed and anatomical segmental liver resection is not currently performed due to difficulty to control segmental Glissonean pedicles laparoscopically. METHODS Seven consecutive patients underwent laparoscopic liver resection using an intrahepatic Glissonian approach from April 2007 to September 2007. Three patients underwent laparoscopic bisegmentectomy 6-7 and 4 patients underwent laparoscopic right hemihepatectomy. RESULTS Blood transfusion was required in 1 patient. Mean operation time was 460 minutes (range 300-630 minutes). The median hospital stay was 5 days (range 3-8 days). One patient developed bile leakage that was treated conservatively. No patient had postoperative signs of liver failure. No postoperative mortality was observed. CONCLUSIONS The main advantage over other techniques is the possibility to gain a rapid and precise access to the right posterior and anterior sheaths facilitating right hemihepatectomy, and right anterior and posterior sectionectomies. We believe that the described technique facilitates laparoscopic liver resection by reducing the technical difficulties in pedicle control and may increase the development of segment-based laparoscopic liver resections.
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Affiliation(s)
- Marcel Autran C Machado
- Department of Gastroenterology, University of São Paulo, Rua Evangelista Rodrigues 407, 05463-000 São Paulo, Brazil.
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