1
|
Ingallinella S, Aldrighetti L, Marino R, Ratti F. Indocyanine green (ICG)-guided robotic resection for liver adenoma: combined technologies for precision surgery. Updates Surg 2024; 76:1105-1108. [PMID: 38639875 DOI: 10.1007/s13304-024-01840-4] [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: 09/30/2023] [Accepted: 03/24/2024] [Indexed: 04/20/2024]
Abstract
HCA resection is crucial to prevent bleeding and malignant transformation. The aim of this study was to enhance the precision of tumor resection in hepatocellular adenoma (HCA) through the combination of intraoperative ultrasound (IOUS) and indocyanine green (ICG) fluorescence imaging. ICG was intravenously injected 24 h before surgery, enabling positive staining of HCA nodules. IOUS guided the parenchymal transection performed using the RoboLap approach. IOUS combined with ICG effectively demarcated lesions, allowing precision surgery while sparing healthy liver tissue. Intraoperative frozen examination further validated the potential of ICG to identify previously undetected lesions. The study showed promising advantages of ICG in HCA resections, potentially reducing the risk of recurrence and malignant transformation. The combined robotic and laparoscopic approach improved the feasibility of parenchymal-sparing surgery, offering a cautious assessment of HCA lesions.
Collapse
Affiliation(s)
- Sara Ingallinella
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy
| | - Rebecca Marino
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy
| | - Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, Milan, Italy.
- Faculty of Medicine, University Vita-Salute San Raffaele, 20132, Milan, Italy.
| |
Collapse
|
2
|
Piccolo G, Barabino M, Santambrogio R, Lecchi F, Di Gioia G, Opocher E, Bianchi PP. Correlation Between Indocyanine Green Fluorescence Patterns and Grade of Differentiation of Hepatocellular Carcinoma: A Western Prospective Cohort Study. Surg Innov 2023; 30:770-778. [PMID: 36840625 DOI: 10.1177/15533506231157171] [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] [Indexed: 02/26/2023]
Abstract
Background. Most of the available evidence on the use of indocyanine green (ICG) fluorescence in clinical practice consists of articles published by surgeons of the Asian-Pacific area. We performed a prospective cohort study to assess the patterns of ICG fluorescence in Western hepatocellular carcinoma (HCC) counterparts.Methods. From April 2019 to January 2022, a total of 31 consecutive patients who underwent laparoscopic liver resection (LLR) for superficial HCC were enrolled in this prospective study. All patients underwent laparoscopic staging with both laparoscopic ultrasound (LUS) and ICG fluorescence imaging.Results. A total of 38 hepatocellular carcinomas (HCCs) were enrolled: 23 superficial (surfacing at the liver's Glissonian capsule), 5 exophytic, 5 shallow (<8 mm from the hepatic surface) and 5 deep (>10 mm from the hepatic surface). The detection rate with preoperative imaging (abdominal CT/MRI), LUS, ICG fluorescence and combined modalities (ICG and LUS) was 97.4%, 94.9%, 89.7% and 100%, respectively. The five deep seated lesions underwent ultrasound-guided laparoscopic thermal ablation. The other 33 HCCs were treated with minimally invasive liver resection. Intraoperative ultrasound patterns were registered for each single nodule resected. The ICG fluorescence pattern was classified in two types: total fluorescence (all the tumoral tissue showed strong and homogeneous fluorescence), n = 9/33 (27.3%), and non-total fluorescence (partial and rim fluorescence), n = 24/33 (72.7%). There was a statistical correlation between ICG patterns and grade of differentiation. Almost all lesions with uniform fluorescence pattern were well-differentiated HCCs (G1-G2), while partial and rim-type fluorescence pattern were more common among moderately and poorly differentiated HCCs (G3-G4) (88.9% vs 11.1%, 37.5% vs 62.5%, P = .025, respectively).Conclusions. ICG fluorescence imaging could be used to identify early the grade of HCC, ie intraoperatively, thus influencing the intraoperative treatment.
Collapse
Affiliation(s)
- Gaetano Piccolo
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matteo Barabino
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Francesca Lecchi
- General Surgery Residency Program, University of Milan, Milan, Italy
| | - Giulio Di Gioia
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Enrico Opocher
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Paolo Pietro Bianchi
- General Surgery Unit, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| |
Collapse
|
3
|
Tripke V, Sommer N. An update on liver surgery - a new terminology and modern techniques. Innov Surg Sci 2023; 8:197-201. [PMID: 38510365 PMCID: PMC10949114 DOI: 10.1515/iss-2023-0032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2023] [Accepted: 12/08/2023] [Indexed: 03/22/2024] Open
Abstract
Liver surgery is the cornerstone of the curative treatment of malignant liver tumors. However, the liver anatomy is very complex, and liver surgery is still associated with relevant morbidity despite many technical advances. The Brisbane nomenclature is used worldwide to classify liver resection. However, this nomenclature has several limitations as multiple terms are used for the same type of resection. Non-anatomical resections, multiple resections, and combined bilio-vascular resections were not mentioned. Therefore, new terminologies have been proposed for the precise and simple classification of liver resection. Furthermore, in recent years, many technical innovations have been introduced in liver surgery, such as 3D imaging systems and indocyanine green fluorescence, for better preoperative and intraoperative identification of tumor localization and critical vascular structures. Minimally invasive techniques are used more frequently in liver surgery. Potential benefits include less intraoperative blood loss, less pain, and a shorter hospital stay. The implementation of robotic systems also has an impact on liver surgery, and the number of cases reported in the literature is constantly increasing. The potential benefits of robotic liver resection over laparoscopic liver resection will be the subject of future studies.
Collapse
Affiliation(s)
- Verena Tripke
- Department of General, Visceral and Transplantation Surgery, University Medical Center of the Johannes Gutenberg University, Mainz, Germany
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie CAJC, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany
| | - Nils Sommer
- Department of General, Visceral, Thoracic and Vascular Surgery, University Hospital Bonn, Bonn, Germany
- Chirurgische Arbeitsgemeinschaft Junge Chirurgie CAJC, Deutsche Gesellschaft für Allgemein- und Viszeralchirurgie, Berlin, Germany
| |
Collapse
|
4
|
Ratti F, Ferrero A, Guglielmi A, Cillo U, Giuliante F, Mazzaferro V, De Carlis L, Ettorre GM, Gruttadauria S, Di Benedetto F, Ercolani G, Valle RD, Belli A, Jovine E, Ravaioli M, Aldrighetti L. Ten years of Italian mini-invasiveness: the I Go MILS registry as a tool of dissemination, characterization and networking. Updates Surg 2023; 75:1457-1469. [PMID: 37488408 DOI: 10.1007/s13304-023-01597-2] [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: 07/11/2023] [Accepted: 07/15/2023] [Indexed: 07/26/2023]
Abstract
Purposes of this study are to evaluate the main changes that have occurred in the Italian MILS activity in the last decade in terms of indications, approaches and outcomes as reported in the national registry and to provide specific details on the main areas of development of MILS. Data from patients undergoing minimally invasive liver resections at centers included in the I Go MILS Registry from its start-up (November 2014) to March 2023 were analyzed for the purposes of this study. The registry is intention-to-treat and prospective. Global recruitment trends stratified by indication to surgery and type of approach were analysed. 7413 MILS procedures were performed across all centers (median number of procedures per center: 63). Years (2020-2023) displayed a significantly higher proportion of treated patients diagnosed with hepatocellular carcinoma (HCC) (38.2% vs. 28.9% and 33.9%, p < 0.001) and cholangiocarcinoma (6.7% vs. 6.5% and 4.2%, p < 0.001) compared to the preceding triennial periods. Additionally, technical complexity demonstrated an increased prominence in Years (2019-2023) with a significantly higher percentage of grade III cases compared to the earlier periods (39.3% vs. 21.7% and 25.6%, p < 0.001). Annual case trends focusing on laparoscopic and robotic techniques demonstrated a steadily increase in the use of these techniques for complex case mix of indications. Overall, attitude and attention to MILS approach has evolved, so that currently indications to hepatic mini-invasiveness have expanded and surgical technique has been refined: Areas mainly involved in increasing growth trends are hepatocellular carcinoma, possible applications of MILS in transplant setting, intrahepatic cholangiocarcinoma and robotic approach.
Collapse
Affiliation(s)
- Francesca Ratti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy.
- Vita-Salute San Raffaele University, Milan, Italy.
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital Umberto I, Turin, Italy
| | - Alfredo Guglielmi
- Department of Surgery, Division of General and Hepatobiliary Surgery, School of Medicine, University of Verona, Verona, Italy
| | - Umberto Cillo
- General Surgery 2-Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Padua, Padua, Italy
| | - Felice Giuliante
- Hepatobiliary Surgery Unit, Fondazione "Policlinico Universitario A. Gemelli" IRCCS, Università Cattolica del Sacro Cuore, Rome, Italy
| | - Vincenzo Mazzaferro
- Hepato-Pancreatic-Biliary Surgery and Liver Transplantation, Fondazione IRCCS Istituto Nazionale Tumori, Milan, Italy
| | - Luciano De Carlis
- Department of General Surgery and Transplantation, ASST Grande Ospedale Metropolitano Niguarda, Milan, Italy
- School of Medicine and Surgery, University of Milan-Bicocca, Milan, Italy
| | - Giuseppe Maria Ettorre
- Department of General and Hepatobiliary and Pancreatic Surgery, Liver Transplantation Service, San Camillo-Forlanini Hospital, Rome, Italy
| | - Salvatore Gruttadauria
- Department for the Treatment and Study of Abdominal Diseases and Abdominal Transplantation, Istituto di Ricovero e Cura a Carattere Scientifico-Istituto Mediterraneo per i Trapianti e Terapie ad alta specializzazione (IRCCS-ISMETT), University of Pittsburgh Medical Center (UPMC), Palermo, Italy
| | - Fabrizio Di Benedetto
- Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia, Modena, Italy
| | - Giorgio Ercolani
- Department of Medical and Surgical Sciences-DIMEC, Alma Mater Studiorum - University of Bologna, Bologna, Italy
- Department of General and Oncologic Surgery, Morgagni-Pierantoni Hospital, Ausl Romagna, Forlì, Italy
| | | | - Andrea Belli
- Department of Abdominal Oncology, Division of Hepatopancreatobiliary Surgical Oncology, National Cancer Center-IRCCS-G. Pascale, Naples, Italy
| | - Elio Jovine
- Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Bologna, Italy
- Department of General Surgery, IRCCS, Azienda Ospedaliero-Universitaria di Bologna, Maggiore Hospital, Bologna, Italy
| | - Matteo Ravaioli
- Hepatobiliary and Transplant Unit, Policlinico Sant'Orsola IRCCS, University of Bologna, Bologna, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery Division, IRCCS San Raffaele Hospital, Via Olgettina 60, 20132, Milan, Italy
- Vita-Salute San Raffaele University, Milan, Italy
| |
Collapse
|
5
|
Patel I, Rehman S, McKay S, Bartlett D, Mirza D. Use of Near-Infrared Fluorescence Techniques in Minimally Invasive Surgery for Colorectal Liver Metastases. J Clin Med 2023; 12:5536. [PMID: 37685603 PMCID: PMC10488819 DOI: 10.3390/jcm12175536] [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: 07/17/2023] [Revised: 08/04/2023] [Accepted: 08/12/2023] [Indexed: 09/10/2023] Open
Abstract
Colorectal liver metastases (CRLM) afflict a significant proportion of patients with colorectal cancer (CRC), ranging from 25% to 30% of patients throughout the course of the disease. In recent years, there has been a surge of interest in the application of near-infrared fluorescence (NIRF) imaging as an intraoperative imaging technique for liver surgery. The utilisation of NIRF-guided liver surgery, facilitated by the administration of fluorescent dye indocyanine green (ICG), has gained traction in numerous medical institutions worldwide. This innovative approach aims to enhance lesion differentiation and provide valuable guidance for surgical margins. The use of ICG, particularly in minimally invasive surgery, has the potential to improve lesion detection rates, increase the likelihood of achieving R0 resection, and enable anatomically guided resections. However, it is important to acknowledge the limitations of ICG, such as its low specificity. Consequently, there has been a growing demand for the development of tumour-specific fluorescent probes and the advancement of camera systems, which are expected to address these concerns and further refine the accuracy and reliability of intraoperative fluorescence imaging in liver surgery. While NIRF imaging has been extensively studied in patients with CRLM, it is worth noting that a significant proportion of published research has predominantly focused on the detection of hepatocellular carcinoma (HCC). In this study, we present a comprehensive literature review of the existing literature pertaining to intraoperative fluorescence imaging in minimally invasive surgery for CRLM. Moreover, our analysis places specific emphasis on the techniques employed in liver resection using ICG, with a focus on tumour detection in minimal invasive surgery (MIS). Additionally, we delve into recent developments in this field and offer insights into future perspectives for further advancements.
Collapse
Affiliation(s)
- Ishaan Patel
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Saad Rehman
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Siobhan McKay
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
- Royal North Shore Hospital, Reserve Road, St Leonards, Sydney, NSW 2065, Australia
| | - David Bartlett
- Liver Unit, Queen Elizabeth Hospital, Third Floor Nuffield House, Mindelsohn Way, Birmingham B15 2TH, UK
| | - Darius Mirza
- Hon Professor of HPB and Transplant Surgery, University of Birmingham, Edgbaston, Birmingham B15 2TH, UK
| |
Collapse
|
6
|
Serednicki WA, Hołówko W, Major P, Małczak P, Pędziwiatr M. Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review. Wideochir Inne Tech Maloinwazyjne 2023; 18:213-223. [PMID: 37680740 PMCID: PMC10481434 DOI: 10.5114/wiitm.2022.124088] [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: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 09/09/2023] Open
Abstract
Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.
Collapse
Affiliation(s)
- Wojciech A. Serednicki
- Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wacław Hołówko
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Małczak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| |
Collapse
|
7
|
Fujiyama Y, Wakabayashi T, Mishima K, Al-Omari MA, Colella M, Wakabayashi G. Latest Findings on Minimally Invasive Anatomical Liver Resection. Cancers (Basel) 2023; 15:cancers15082218. [PMID: 37190146 DOI: 10.3390/cancers15082218] [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: 01/31/2023] [Revised: 03/19/2023] [Accepted: 03/25/2023] [Indexed: 05/17/2023] Open
Abstract
Minimally invasive liver resection (MILR) is being widely utilized owing to recent advancements in laparoscopic and robot-assisted surgery. There are two main types of liver resection: anatomical (minimally invasive anatomical liver resection (MIALR)) and nonanatomical. MIALR is defined as a minimally invasive liver resection along the respective portal territory. Optimization of the safety and precision of MIALR is the next challenge for hepatobiliary surgeons, and intraoperative indocyanine green (ICG) staining is considered to be of considerable importance in this field. In this article, we present the latest findings on MIALR and laparoscopic anatomical liver resection using ICG at our hospital.
Collapse
Affiliation(s)
- Yoshiki Fujiyama
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Taiga Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Kohei Mishima
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
- Institute for Research against Digestive Cancer (IRCAD), 67091 Strasbourg, France
| | - Malek A Al-Omari
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Marco Colella
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| | - Go Wakabayashi
- Department of Surgery, Ageo Central General Hospital, Saitama 362-8588, Japan
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama 362-8588, Japan
| |
Collapse
|
8
|
Laparoscopic Microwave Ablation: Which Technologies Improve the Results. Cancers (Basel) 2023; 15:cancers15061814. [PMID: 36980701 PMCID: PMC10046461 DOI: 10.3390/cancers15061814] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2023] [Revised: 03/13/2023] [Accepted: 03/14/2023] [Indexed: 03/19/2023] Open
Abstract
Liver resection is the best treatment for hepatocellular carcinoma (HCC) when resectable. Unfortunately, many patients with HCC cannot undergo liver resection. Percutaneous thermoablation represents a valid alternative for inoperable neoplasms and for small HCCs, but it is not always possible to accomplish it. In cases where the percutaneous approach is not feasible (not a visible lesion or in hazardous locations), laparoscopic thermoablation may be indicated. HCC diagnosis is commonly obtained from imaging modalities, such as CT and MRI, However, the interpretation of radiological images, which have a two-dimensional appearance, during the surgical procedure and in particular during laparoscopy, can be very difficult in many cases for the surgeon who has to treat the tumor in a three-dimensional environment. In recent years, more technologies have helped surgeons to improve the results after ablative treatments. The three-dimensional reconstruction of the radiological images has allowed the surgeon to assess the exact position of the tumor both before the surgery (virtual reality) and during the surgery with immersive techniques (augmented reality). Furthermore, indocyanine green (ICG) fluorescence imaging seems to be a valid tool to enhance the precision of laparoscopic thermoablation. Finally, the association with laparoscopic ultrasound with contrast media could improve the localization and characteristics of tumor lesions. This article describes the use of hepatic three-dimensional modeling, ICG fluorescence imaging and laparoscopic ultrasound examination, convenient for improving the preoperative surgical preparation for personalized laparoscopic approach.
Collapse
|
9
|
Zhou Y, Zhang C, Wang Y, Yu J, Wang D, Ma J. Effects of indocyanine green fluorescence imaging of laparoscopic anatomic liver resection for HCC: a propensity score-matched study. Langenbecks Arch Surg 2023; 408:51. [PMID: 36662263 DOI: 10.1007/s00423-023-02781-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2022] [Accepted: 12/12/2022] [Indexed: 01/21/2023]
Abstract
BACKGROUND Recently, indocyanine green (ICG) fluorescence imaging has been increasingly used in laparoscopic anatomic liver resection. The aim of this study was to investigate the efficacy of ICG-guided laparoscopic anatomic liver resection in hepatocellular carcinoma (HCC) compared with traditional laparoscopic anatomic liver resection. METHODS A retrospective study was performed on patients with pathologically diagnosed HCC who successfully underwent laparoscopic anatomical liver resection from January 2019 to December 2021. The outcomes were compared between the two groups before and after the propensity score matching (PSM). RESULTS A total of 110 patients were included in this study, including 50 patients in the ICG-guided group and 60 patients in the traditional group. Compared with the traditional group, the ICG-guided group had a shorter operative duration (P = 0.040), less intraoperative blood loss (P = 0.044), a lower incidence of postoperative complications (P = 0.023), and a shorter postoperative hospitalisation (P < 0.001). After PSM, significant differences remained between the two groups for the duration of postoperative hospitalisation (P = 0.018) and postoperative complications (P = 0.042). There was no significant difference in the recurrence rate between the two groups before and after PSM. CONCLUSION Laparoscopic anatomic liver resection guided by ICG fluorescence imaging can reduce the duration of postoperative hospitalisation for patients and the incidence of postoperative complications. However, it has no impact on the long-term outcome of patients.
Collapse
Affiliation(s)
- Yi Zhou
- Department of Hepatic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province, Hefei, 230001, China
| | - Chuanhai Zhang
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Yifan Wang
- Department of Hepatic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province, Hefei, 230001, China
| | - Jihai Yu
- Department of Hepatic Surgery, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Di Wang
- Department of Intensive Care Medicine, The First Affiliated Hospital of USTC, Division of Life Sciences and Medicine, University of Science and Technology of China, Hefei, 230001, Anhui, China
| | - Jinliang Ma
- Department of Hepatic Surgery, Anhui Provincial Hospital Affiliated to Anhui Medical University, Anhui Province, Hefei, 230001, China.
| |
Collapse
|
10
|
Huber T, Huettl F, Hanke LI, Vradelis L, Heinrich S, Hansen C, Boedecker C, Lang H. Leberchirurgie 4.0 - OP-Planung, Volumetrie, Navigation und Virtuelle
Realität. Zentralbl Chir 2022; 147:361-368. [DOI: 10.1055/a-1844-0549] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
ZusammenfassungDurch die Optimierung der konservativen Behandlung, die Verbesserung der
bildgebenden Verfahren und die Weiterentwicklung der Operationstechniken haben
sich das operative Spektrum sowie der Maßstab für die Resektabilität in Bezug
auf die Leberchirurgie in den letzten Jahrzehnten deutlich verändert.Dank zahlreicher technischer Entwicklungen, insbesondere der 3-dimensionalen
Segmentierung, kann heutzutage die präoperative Planung und die Orientierung
während der Operation selbst, vor allem bei komplexen Eingriffen, unter
Berücksichtigung der patientenspezifischen Anatomie erleichtert werden.Neue Technologien wie 3-D-Druck, virtuelle und augmentierte Realität bieten
zusätzliche Darstellungsmöglichkeiten für die individuelle Anatomie.
Verschiedene intraoperative Navigationsmöglichkeiten sollen die präoperative
Planung im Operationssaal verfügbar machen, um so die Patientensicherheit zu
erhöhen.Dieser Übersichtsartikel soll einen Überblick über den gegenwärtigen Stand der
verfügbaren Technologien sowie einen Ausblick in den Operationssaal der Zukunft
geben.
Collapse
Affiliation(s)
- Tobias Huber
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Florentine Huettl
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Laura Isabel Hanke
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Lukas Vradelis
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Stefan Heinrich
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Christian Hansen
- Fakultät für Informatik, Otto von Guericke Universität
Magdeburg, Magdeburg, Deutschland
| | - Christian Boedecker
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| | - Hauke Lang
- Klinik für Allgemein-, Viszeral- und Transplantationschirurgie,
Universitätsmedizin Mainz, Mainz, Deutschland
| |
Collapse
|
11
|
Banchini F, Luzietti E, Palmieri G, Bonfili D, Romboli A, Conti L, Capelli P. Laparoscopic Resection of Synchronous Liver Metastasis Involving the Left Hepatic Vein and the Common Trunk Bifurcation: A Strategy of Parenchyma-Sparing Resection with Left Sectionectomy and 4a Subsegmentectomy by Arantius Approach. Healthcare (Basel) 2022; 10:healthcare10030517. [PMID: 35326995 PMCID: PMC8950909 DOI: 10.3390/healthcare10030517] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 03/05/2022] [Accepted: 03/09/2022] [Indexed: 11/29/2022] Open
Abstract
When colorectal cancer presents with liver metastasis, hepatic resection remains the most important factor in prolonging survival, and new paradigms have been proposed to augment resectability. An adequate liver remnant and vascularisation are the only limits in complex liver resection, and parenchyma-sparing surgery is a strategy for minimising the complications, preserving liver function, and allowing patients to undergo further liver resection. The laparoscopic approach represents a new challenge, especially when lesions are located in the superior or posterior part of the liver. We discuss the case of an 81-year-old patient with a single synchronous liver metastasis involving the left hepatic vein and leaning into the middle hepatic vein at the common trunk, where we performed a simultaneous laparoscopic colonic resection with a left sectionectomy extended to segment 4a. The strategic approach to the Arantius ligament by joining the left and middle hepatic vein allowed us to avoid a major liver hepatectomy, preserve the liver parenchyma, reduce complications, enhance patient recovery, and perform the entire procedure by laparoscopy. Our example suggests that the Arantius approach to the left hepatic vein and the common trunk could be a feasible approach to consider in laparoscopic surgery for lesions located in their proximity.
Collapse
Affiliation(s)
- Filippo Banchini
- Department of General Surgery, Guglielmo da Saliceto Hospital, 29100 Piacenza, Italy; (E.L.); (G.P.); (A.R.); (L.C.); (P.C.)
- Correspondence:
| | - Enrico Luzietti
- Department of General Surgery, Guglielmo da Saliceto Hospital, 29100 Piacenza, Italy; (E.L.); (G.P.); (A.R.); (L.C.); (P.C.)
| | - Gerardo Palmieri
- Department of General Surgery, Guglielmo da Saliceto Hospital, 29100 Piacenza, Italy; (E.L.); (G.P.); (A.R.); (L.C.); (P.C.)
| | - Deborah Bonfili
- Department of General Surgery, Università degli Studi di Parma, 43100 Parma, Italy;
| | - Andrea Romboli
- Department of General Surgery, Guglielmo da Saliceto Hospital, 29100 Piacenza, Italy; (E.L.); (G.P.); (A.R.); (L.C.); (P.C.)
| | - Luigi Conti
- Department of General Surgery, Guglielmo da Saliceto Hospital, 29100 Piacenza, Italy; (E.L.); (G.P.); (A.R.); (L.C.); (P.C.)
| | - Patrizio Capelli
- Department of General Surgery, Guglielmo da Saliceto Hospital, 29100 Piacenza, Italy; (E.L.); (G.P.); (A.R.); (L.C.); (P.C.)
| |
Collapse
|
12
|
Liu F, Wei Y, Li B. ASO Author Reflections: Pure Laparoscopic Right Upper Transversal Hepatectomy. Ann Surg Oncol 2022; 29:2978-2979. [DOI: 10.1245/s10434-022-11353-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/07/2022] [Accepted: 01/08/2022] [Indexed: 11/18/2022]
|