The impact of using a 4K 3D surgical microscope during associated liver partition and portal vein ligation for hepatocellular carcinoma treatment: A case report with operative video.
Int J Surg Case Rep 2021;
85:106195. [PMID:
34280880 PMCID:
PMC8318913 DOI:
10.1016/j.ijscr.2021.106195]
[Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/03/2021] [Revised: 07/09/2021] [Accepted: 07/09/2021] [Indexed: 12/22/2022] Open
Abstract
Introduction
Associated liver partition and portal vein ligation for staged hepatectomy (ALPPS) is complicated by bile leakage or liver failure, especially in patients with hepatocellular carcinoma (HCC). Precise surgical performance supported by high quality intraoperative surgical visualization is essential to prevent mortality. Therefore, we aimed to investigate, for the first time, the effects of introducing a surgical microscope (ORBEYE™) intraoperatively during a stage I ALPPS.
Presentation of case
The patient was a 77-year-old male patient with a 9-cm right hepatic lobe HCC. 4K-3D surgical microscope-assisted ALPPS was performed to manage the insufficient future liver remnant following right lobectomy. Hilar dissection was performed first; thereafter, the right portal vein was ligated, and the right hepatic artery and right hepatic vein were encircled by surgical tape. The parenchyma was split along the ischemic demarcation line with indocyanine green (ICG) fluorescence navigation using the microscope. The remnant liver volume and function increased without postoperative complications.
Discussion
Laparoscopic approach for ALPPS benefits from enhanced intraoperative visualization in a deep, narrow operative field. However, a laparoscopic procedure requires an experienced learning curve and a longer operation time, whereas using the 4 K 3D digital microscope requires no technical demand. Secondly, it provided an excellent operative view during ALPPS.
Conclusions
To our knowledge, this is the first report on the intraoperative application of the ORBEYE™ surgical microscope in hepatic surgery with 4K3D imaging and ICG-fluorescence navigation, which minimized the invasiveness of ALPPS and ensured high safety and precision.
ALPPS enhances future liver remnant hypertrophy.
ALPPS enables tumor resection 4–6 weeks earlier than portal vein embolization.
Precision in surgery requires high-quality intraoperative visualization.
Accurate visualization is needed to prevent mortality after ALPPS in HCC patients.
We demonstrate ALPPS with 4K3D microscopy system with ICG-fluorescence navigation.
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