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Giannone F, Cassese G, Del Basso C, Alagia M, Palucci M, Sangiuolo F, Panaro F. Robotic versus laparoscopic liver resection for difficult posterosuperior segments: a systematic review with a meta-analysis of propensity-score matched studies. Surg Endosc 2025; 39:64-76. [PMID: 39623177 DOI: 10.1007/s00464-024-11428-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/23/2024] [Accepted: 11/11/2024] [Indexed: 12/25/2024]
Abstract
BACKGROUND The outcomes of minimally invasive liver surgery for posterosuperior segments (PS) are still debated. Since the results of ongoing trials focusing on the results of laparoscopic liver resection (LLR) and robotic liver resection (RLR) in this setting are still awaited, the best evidence currently comes from retrospective propensity-score matched (PSM) studies. The aim of this meta-analysis was to assess the outcomes of RLR for difficult located lesions and to provide evidence for its use in clinical practice. METHODS A systematic review with meta-analysis was conducted to evaluate the safety and efficacy of LLR and RLR for PS segments. The Medline, Embase and Web of Science Library electronic databases were searched to identify available research published up to June 2024. RESULTS Five studies with a total of 2907 patients (RLR: n = 1084; LLR: n = 1823) were included in the meta-analysis. The RLR group had less estimated blood loss (EBL) (MD: - 88.3, 95% CI - 144.2-- 32.3; p = 0.012), fewer blood transfusions (OR 0.70, 95% CI 0.39-0.80, p = 0.033), and a shorter operative time (MD - 27.3, 95% CI - 49.4-- 5.1; p = 0.027). No differences in postoperative morbidity, mortality and R1 resection rates were observed. CONCLUSION RLR for lesions in the PS segments are safe and effective, and may have superior surgical outcomes than LLR.
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Affiliation(s)
- Fabio Giannone
- Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Gianluca Cassese
- Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
- HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy.
- Department of Health Sciences, School of Medicine, University of Eastern Piedmont "Amedeo Avogadro", Alessandria, Italy.
| | - Celeste Del Basso
- Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Mariantonietta Alagia
- Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Marco Palucci
- Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Federico Sangiuolo
- Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
| | - Fabrizio Panaro
- Division of Hepato-Pancreato-Biliary, Oncologic and Robotic Surgery, Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- HPB and Robotic Surgery Research Unit, Department of Research and Innovation (DAIRI), Azienda Ospedaliero-Universitaria SS. Antonio e Biagio e Cesare Arrigo, Alessandria, Italy
- Department of Health Sciences, School of Medicine, University of Eastern Piedmont "Amedeo Avogadro", Alessandria, Italy
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Liang B, Peng Y, Yang W, Yang Y, Li B, Wei Y, Liu F. Robotic versus laparoscopic liver resection for posterosuperior segments: a systematic review and meta-analysis. HPB (Oxford) 2024; 26:1089-1102. [PMID: 38955633 DOI: 10.1016/j.hpb.2024.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/03/2024] [Revised: 05/23/2024] [Accepted: 06/12/2024] [Indexed: 07/04/2024]
Abstract
BACKGROUND Minimally invasive hepatectomy for difficult lesions located in posterosuperior segments (segments I, IVa, VII and VIII) remains challenging. The value of robotic liver resection (RLR) compared with laparoscopic liver resection (LLR) for posterosuperior segments is controversial. Therefore, we performed this meta-analysis to validate the safety and efficacy of RLR in posterosuperior segments. METHODS The Medline, Embase, Web of Science, and Cochrane Library electronic databases were searched to identify available research published up to October 2023. Statistical analysis was performed with RevMan software version 5.3. RESULTS Six studies with a total of 2289 patients (RLR: n = 749; LLR: n = 1540) were included in this meta-analysis. The RLR group had less intraoperative blood loss (WMD = -119.54 ml, 95% CI: -178.89 to -60.19, P < 0.0001), fewer blood transfusions (OR = 0.56, 95% CI: 0.39 to 0.80, P = 0.001), a lower conversion rate (OR = 0.37, 95% CI: 0.23 to 0.61, P < 0.0001), and a shorter operative time (WMD = -27.16 min, 95% CI: -35.95 to -18.36, P < 0.00001). DISCUSSION Compared with LLR, RLR for lesions in the posterosuperior segments could be safe and effective, and it has superior surgical outcomes.
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Affiliation(s)
- Bin Liang
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yufu Peng
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Wugui Yang
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yubo Yang
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bo Li
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yonggang Wei
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Fei Liu
- Division of Liver Surgery, Department of General Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China.
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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: 4] [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.
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Santambrogio R, D'Alessandro V, Iacob G, Zappa MA. Fluorescence and Ultrasound-guided Laparoscopic Resection of Caudate Lobe for Hepatocellular Carcinoma Located in the Retrocaval Portion. Surg Laparosc Endosc Percutan Tech 2021; 31:812-814. [PMID: 34231539 DOI: 10.1097/sle.0000000000000970] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/02/2021] [Accepted: 05/14/2021] [Indexed: 11/26/2022]
Abstract
BACKGROUND Contrast-enhanced intraoperative ultrasonography (CEIOUS) and indocyanine green fluorescence were interesting tool for the visualization of intrahepatic neoplastic nodules. The combinations of the 2 technologies could increase tumor detection and the radicality of resection, allowing the use of a pure laparoscopic approach. METHODS The patient was an 81-year-old man with a history of hypertension and treated hepatitis C infection, with a sustained serological response from 2018, previously undergoing laparotomic resection for hepatocellular carcinoma (HCC) in segment 8.During his regular hepatological follow-up, a 25 mm nodule was detected in segment 1, in a retrocaval position. Considering clinical presentation, good liver function (Child A5-MELD 8) and imaging, pure laparoscopic resection of the caudate lobe was performed using fluorescence imaging and CEIOUS navigation guidance. RESULTS The operation last for 205 minutes. Blood loss was 100 mL and no blood transfusion was required. She resumed diet on the next day and was discharged 4 days after the operation. Histopathologic examination showed 27 mm HCC with a clear margin. Contrast computed tomography scan performed 3 months after the operation showed no recurrence of the disease. CONCLUSIONS A laparoscopic isolated caudate resection for HCC located in the retrocaval portion of the cirrhotic liver seems to be feasible in selected patients and fluorescence imaging and CEIOUS navigation guidance could guarantee a safe and successful surgery.
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Piccolo G, Barabino M, Diana M, Lo Menzo E, Epifani AG, Lecchi F, Santambrogio R, Opocher E. Application of Indocyanine Green Fluorescence as an Adjuvant to Laparoscopic Ultrasound in Minimally Invasive Liver Resection. J Laparoendosc Adv Surg Tech A 2021; 31:517-523. [PMID: 33651631 DOI: 10.1089/lap.2020.0895] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/13/2023] Open
Abstract
Background: Indocyanine green (ICG) fluorescence imaging has been extensively used in a variety of applications in visceral surgery. In minimally invasive liver resections, the detection of small superficial hepatic lesions using an intravenous injection of ICG before surgery represents a promising application. Methods: We analyzed 18 consecutive patients who underwent laparoscopic liver resection for superficial malignant tumors, namely 11 patients with hepatocellular carcinoma (HCC), 5 patients with colorectal liver metastases (CRLM), 1 patient with intrahepatic cholangiocarcinoma (ICC), and 1 patient with thyroid cancer metastasis, using ICG fluorescence as an adjuvant tool to intraoperative laparoscopic ultrasound (LUS). Results: An optimal ICG 15-minute clearance retention rate (R15 < 10%) and ICG plasma disappearance rate (<18%/minute) were present in 11 patients (61.1%) and in 14 patients (77.7%), respectively. Liver tumors were 29 in total, including 14 HCCs (48.3%), 13 CRLMs (44.8%), 1 ICC (3.4%), and 1 thyroid cancer metastasis (3.4%). Twenty-nine tumors (100%) were correctly visualized with ICG/fluorescence, as compared with 21 tumors identified with LUS (72.4%). After complete liver mobilization, ICG staining allowed to identify more superficial lesions (early HCC and small CRLM) in posterolateral segments (Segments 6 and 7) as compared with LUS (14 versus 10 lesions). In addition, in segments usually treated laparoscopically (e.g., left lateral segments), ICG was superior to LUS (10 versus 6 lesions) to identify superficial early HCC in patients with macronodular cirrhosis. Conclusions: ICG visual feedback might substitute the tactile feedback of the hand and might in some cases act as a "booster" of LUS for superficial hepatic lesions.
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Affiliation(s)
- Gaetano Piccolo
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Matteo Barabino
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Michele Diana
- IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
- IHUStrasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- iCube Laboratory, Photonics for Health, University of Strasbourg, Strasbourg, France
| | - Emanuele Lo Menzo
- Unit of Minimally Invasive Surgery, Department of General Surgery, The Bariatric and Metabolic Institute, Cleveland Clinic Florida, Weston, Florida, USA
| | - Angelo Gabriele Epifani
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | - Francesca Lecchi
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
| | | | - Enrico Opocher
- Unit of HepatoBilioPancreatic and Digestive Surgery, Department of Health Sciences, San Paolo Hospital, University of Milan, Milan, Italy
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Current role of intraoperative ultrasonography in hepatectomy. Surg Today 2021; 51:1887-1896. [PMID: 33394137 DOI: 10.1007/s00595-020-02219-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2020] [Accepted: 11/02/2020] [Indexed: 12/22/2022]
Abstract
Hepatectomy had a high mortality rate in the previous decade because of inadequate techniques, intraoperative blood loss, liver function reserve misdiagnoses, and accompanying postoperative complications. However, the development of several modalities, including intraoperative ultrasonography (IOUS), has made hepatectomy safer. IOUS can provide real-time information regarding the tumor position and vascular anatomy of the portal and hepatic veins. Systematic subsegmentectomy, which leads to improved patient outcomes, can be performed by IOUS in open and laparoscopic hepatectomy. Although three-dimensional (3D) computed tomography and gadoxetic acid-enhanced magnetic resonance imaging have been widely used, IOUS and contrast-enhanced IOUS are important modalities for risk analyses and making decisions regarding resectability and operative procedures because of the vital anatomical information provided and high sensitivity for liver tumors, including "disappearing" liver metastases. Intraoperative color Doppler ultrasonography can be used to delineate the vascular anatomy and evaluate the blood flow volume and velocity in hepatectomy patients and recipients of deceased- and living-donor liver transplantation after vessel reconstruction and liver positioning. For liver surgeons, IOUS is an essential technique to perform highly curative hepatectomy safely, although recent advances have also been made in virtual modalities, such as real-time virtual sonography with 3D visualization.
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Laparoscopic posterior segmental resections: How I do it: Tips and pitfalls. Int J Surg 2020; 82S:178-186. [DOI: 10.1016/j.ijsu.2020.06.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/01/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
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Abstract
Laparoscopic liver surgery has gained wide acceptance resulting in a paradigm shift of liver surgery. Technical innovations and accumulation of surgeon's experience have allowed laparoscopic liver resection (LLR) to become an effective procedure with favorable peri- and post-operative outcomes. Through the overall process of LLR, liver parenchymal transection remains the most critical step with the aim of minimizing blood loss and secures the appropriate cutting line, i.e., securing major vessels and obtaining adequate surgical margin clearance for malignancies. Multiple preoperative imaging modalities and intraoperative ultrasonography findings may contribute to the best determination of the appropriate cutting line during the LLR; however, technical expertise in minimizing and controlling bleeding during liver parenchymal transection is still a challenge for safe LLR, and therefore represents a major concern for hepatobiliary surgeons. Along with the historical fact that the technique of liver parenchymal transection itself is chosen according to surgeon's preference and "savoir-faire", the best technical modality in laparoscopic liver parenchymal transection remains to be determined. However, better understanding the technical issue may serve a contribution to the standardization of LLR. This review article therefore focuses on the technical aspects of the laparoscopic liver parenchymal transection.
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Affiliation(s)
- Tomoaki Yoh
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
| | - François Cauchy
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
| | - Olivier Soubrane
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
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Jia C, Li H, Wen N, Chen J, Wei Y, Li B. Laparoscopic liver resection: a review of current indications and surgical techniques. Hepatobiliary Surg Nutr 2018; 7:277-288. [PMID: 30221155 DOI: 10.21037/hbsn.2018.03.01] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Laparoscopic liver resection (LLR) has been the most impressive development in the field of liver surgery in recent two decades. Technical innovations and experience accumulation have made LLR a safe and effective procedure with faster postoperative recovery. Despite the fast spreading of the procedure, details regarding the indications, oncological outcomes and technical essentials were still disputable. To address these issues, two international consensus conferences were hold to update the knowledge in this field. The statements of the both conferences were not conclusive and more high-quality researches are required. In this article, we reviewed the development and the current state of LLR. Indications, outcomes, surgical techniques and devices used in LLR were also discussed.
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Affiliation(s)
- Chenyang Jia
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Hongyu Li
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ningyuan Wen
- College of Clinical Medicine, Sichuan University, Chengdu 610065, China
| | - Junhua Chen
- Department of General surgery, Chengdu First People's Hospital, Chengdu 610200, China
| | - Yonggang Wei
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Bo Li
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, China
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Liu F, Li Q, Wei Y, Li B. Laparoscopic Versus Open Liver Resection for Difficult Lesions: A Meta-Analysis. J Laparoendosc Adv Surg Tech A 2018; 28:1428-1436. [PMID: 29878858 DOI: 10.1089/lap.2018.0227] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Abstract
Background: The value of laparoscopic liver resection (LLR) for difficult lesions (located in segments I, IVa, VII, and VIII) is still controversial nowadays. The aim of this study was to summarize quantitatively the evidence related to this issue. Materials and Methods: Two investigators independently searched the Medline, Embase, Science Citation Index Expanded, and Cochrane Library databases for eligible studies published before December 2017. The RevMan 5.3 software was utilized for statistical meta-analysis. Weighted mean differences (WMDs) and odds ratios (ORs) were calculated for continuous and dichotomous variables, respectively. Results: Five studies with a total number of 638 patients were included in the present meta-analysis, with 274 patients in the LLR group and 364 in the open liver resection (OLR) group. The LLR did not increase the operative time (WMD 12.42 minutes; 95% confidence interval [CI] -8.54 to 33.38 minutes; P = .25) or blood transfusion requirement (OR 0.81; 95% CI 0.40-1.64; P = .57) compared with OLR. Conversely, LLR was associated with significantly lower intraoperative blood loss (WMD -140.57 mL; 95% CI -203.39 to -77.76 mL; P < .001), shorter hospital stay (WMD -2.88 days; 95% CI -4.84 to -0.92 days; P = .004), and lower overall morbidity (OR 0.43; 95% CI 0.28-0.65; P < .001). The oncologic outcomes of R0 resection rate, surgical margin, and tumor recurrence were comparable in the two groups. Conclusion: LLR for difficult lesions in selected patients is safe, technically feasible, and advantageous when performed by experienced surgeons.
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Affiliation(s)
- Fei Liu
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Qin Li
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Yonggang Wei
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
| | - Bo Li
- Department of Liver Surgery and Liver Transplantation Center, West China Hospital, Sichuan University, Chengdu, Sichuan Province, China
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El-Gendi A, El-Shafei M, El-Gendi S, Shawky A. Laparoscopic Versus Open Hepatic Resection for Solitary Hepatocellular Carcinoma Less Than 5 cm in Cirrhotic Patients: A Randomized Controlled Study. J Laparoendosc Adv Surg Tech A 2017; 28:302-310. [PMID: 29172949 DOI: 10.1089/lap.2017.0518] [Citation(s) in RCA: 56] [Impact Index Per Article: 7.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022] Open
Abstract
BACKGROUND Current literature is lacking level 1 evidence for surgical and oncologic outcomes of hepatocellular carcinoma (HCC) undergoing laparoscopic versus open hepatectomy. Aim was to compare feasibility, safety, and surgical and oncologic efficiency of laparoscopic versus open liver resection (OLR) in management of solitary small (<5 cm) peripheral HCC in Child A cirrhotic patients. METHODS Patients were randomly assigned to either OLR group (25 patients) or laparoscopic liver resection (LRR) group (LRR: 25 patients). All were treated with curative intent aiming at achieving R0 resection using radiofrequency-assisted technique. RESULTS LLR had significantly less operative time (120.32 ± 21.58 versus 146.80 ± 16.59 minutes, P < .001) and shorter duration of hospital stay (2.40 ± 0.58 versus 4.28 ± 0.79 days, P < .001), with comparable overall complications (25 versus 28%, P = .02). LLR had comparative resection time (66.56 ± 23.80 versus 59.56 ± 14.74 minutes, P = .218), amount of blood loss (250 versus 230 mL, P = .915), transfusion rate (P = 1.00), and R0 resection rate when compared with OLR. After median follow-up of 34.43 (31.67-38.60) months, LLR achieved similar adequate oncological outcome of OLR, no local recurrence, with no significant difference in early recurrence or number of de novo lesions (P = .49). One-year and 3-year disease free survival (DFS) rates, 88% and 59%, in the LLR were comparable to corresponding rates of 84% and 54% in OLR (P = .9). CONCLUSION LLR is superior to the OLR with significantly shorter duration of hospital stay and does not compromise the oncological outcomes.
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Affiliation(s)
- Ahmed El-Gendi
- 1 Department of Surgery, Alexandria University , Alexandria, Egypt
| | - Mohamed El-Shafei
- 2 Department of Diagnostic and Interventional Radiology, Alexandria University , Alexandria, Egypt
| | - Saba El-Gendi
- 3 Department of Pathology, Faculty of Medicine, Alexandria University , Alexandria, Egypt
| | - Ahmed Shawky
- 1 Department of Surgery, Alexandria University , Alexandria, Egypt
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Laparoscopic parenchymal sparing resections in segment 8: techniques for a demanding and infrequent procedure. Surg Endosc 2017; 32:2012-2019. [PMID: 29075968 DOI: 10.1007/s00464-017-5897-y] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/30/2017] [Accepted: 09/16/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Laparoscopic liver resections for lesions in the postero-superior segments are technically demanding due their deep location and relation with the vena cava. However, previous reports have demonstrated the feasibility and safety of these resections in centres with advanced experience in laparoscopic liver surgery. In this case series, we present our results and experience of laparoscopic parenchymal sparing liver resections of lesions in segment 8. METHODS All patients undergoing laparoscopic liver resections of segment 8 lesions, alone or combined with other liver resections, between August 2003 and July 2016 were included. Analysis of baseline characteristics and perioperative results was performed for the whole cohort. A separate subgroup analysis was performed for isolated segment 8 resections. Long-term results were analyzed in patients with colorectal liver metastases. A video is attached for thorough explanation of surgical technique. RESULTS A total of 30 patients were included. Among them, 13 patients had isolated segment 8 resections. Operative time for the whole cohort and isolated segment 8 resections were 210 min (range 180-247 min) and 200 min (range 90-300 min), respectively. The conversion rate was 3.4% for the entire cohort and 0 for isolated segment 8 resections. Major morbidity was 7 and 0%, respectively. R0 rates were 96% for the entire cohort and 92% for isolated segment 8 resections. Recurrence free survival in the colorectal liver metastasis subgroup was 82, 71 and 54% at 1, 3 and 5 years. Overall survival was 94, 82 and 65% at 1, 3 and 5 years. CONCLUSIONS Laparoscopic resection of lesions in segment 8 is feasible and offers the benefits of minimally invasive surgery with parenchyma sparing resections. However, advanced experience in LLR is essential to ensure safety and oncological results.
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Kong SH, Haouchine N, Soares R, Klymchenko A, Andreiuk B, Marques B, Shabat G, Piechaud T, Diana M, Cotin S, Marescaux J. Robust augmented reality registration method for localization of solid organs' tumors using CT-derived virtual biomechanical model and fluorescent fiducials. Surg Endosc 2017; 31:2863-2871. [PMID: 27796600 DOI: 10.1007/s00464-016-5297-8] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2016] [Accepted: 10/14/2016] [Indexed: 12/11/2022]
Abstract
BACKGROUND Augmented reality (AR) is the fusion of computer-generated and real-time images. AR can be used in surgery as a navigation tool, by creating a patient-specific virtual model through 3D software manipulation of DICOM imaging (e.g., CT scan). The virtual model can be superimposed to real-time images enabling transparency visualization of internal anatomy and accurate localization of tumors. However, the 3D model is rigid and does not take into account inner structures' deformations. We present a concept of automated AR registration, while the organs undergo deformation during surgical manipulation, based on finite element modeling (FEM) coupled with optical imaging of fluorescent surface fiducials. METHODS Two 10 × 1 mm wires (pseudo-tumors) and six 10 × 0.9 mm fluorescent fiducials were placed in ex vivo porcine kidneys (n = 10). Biomechanical FEM-based models were generated from CT scan. Kidneys were deformed and the shape changes were identified by tracking the fiducials, using a near-infrared optical system. The changes were registered automatically with the virtual model, which was deformed accordingly. Accuracy of prediction of pseudo-tumors' location was evaluated with a CT scan in the deformed status (ground truth). In vivo: fluorescent fiducials were inserted under ultrasound guidance in the kidney of one pig, followed by a CT scan. The FEM-based virtual model was superimposed on laparoscopic images by automatic registration of the fiducials. RESULTS Biomechanical models were successfully generated and accurately superimposed on optical images. The mean measured distance between the estimated tumor by biomechanical propagation and the scanned tumor (ground truth) was 0.84 ± 0.42 mm. All fiducials were successfully placed in in vivo kidney and well visualized in near-infrared mode enabling accurate automatic registration of the virtual model on the laparoscopic images. CONCLUSIONS Our preliminary experiments showed the potential of a biomechanical model with fluorescent fiducials to propagate the deformation of solid organs' surface to their inner structures including tumors with good accuracy and automatized robust tracking.
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Affiliation(s)
- Seong-Ho Kong
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Nazim Haouchine
- Institut national de recherche en informatique et en automatique (INRIA) Mimesis, Strasbourg, France
| | - Renato Soares
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
| | - Andrey Klymchenko
- Biophotonic and Pharmacology Lab, UMR 7213 CNRS, Pharmacological Faculty, University of Strasbourg, Strasbourg, France
| | - Bohdan Andreiuk
- Biophotonic and Pharmacology Lab, UMR 7213 CNRS, Pharmacological Faculty, University of Strasbourg, Strasbourg, France
| | - Bruno Marques
- Institut national de recherche en informatique et en automatique (INRIA) Mimesis, Strasbourg, France
| | - Galyna Shabat
- IRCAD, Research Institute against Cancer of the Digestive System, 1, Place de l'Hôpital, 67091, Strasbourg, France
| | | | - Michele Diana
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France.
- IRCAD, Research Institute against Cancer of the Digestive System, 1, Place de l'Hôpital, 67091, Strasbourg, France.
| | - Stéphane Cotin
- Institut national de recherche en informatique et en automatique (INRIA) Mimesis, Strasbourg, France
| | - Jacques Marescaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, Strasbourg, France
- IRCAD, Research Institute against Cancer of the Digestive System, 1, Place de l'Hôpital, 67091, Strasbourg, France
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14
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Tarantino G, Magistri P, Serra V, Berardi G, Assirati G, Ballarin R, Di Benedetto F. Laparoscopic Liver Resection of Right Posterior Segments for Hepatocellular Carcinoma on Cirrhosis. J Laparoendosc Adv Surg Tech A 2017; 27:559-563. [PMID: 28245150 DOI: 10.1089/lap.2016.0506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Laparoscopic liver resection (LLR) is now widely adopted for the treatment of liver malignancies. Liver resection with laparoscopic approach was first adopted for tumors located in the peripheral portion of the anterolateral segments of the liver, but recent experiences in literature modified the attitude toward that approach. We herein report our technique and outcomes of LLR for hepatocellular carcinoma (HCC) located in the right-posterior segments of the liver (VI and VII). MATERIALS AND METHODS We retrospectively reviewed our prospectively maintained database, comparing peri- and postoperative outcomes of patients who underwent laparoscopic (13 patients) or open (51 patients) resections for HCC localized in the right-posterior segments between 2000 and 2014. RESULTS The two populations were homogeneous, showing no statistically significant differences in terms of gender, age, body mass index, and cirrhosis prevalence. Alpha-fetoprotein levels were higher in the open group (P = .04) and etiology of cirrhosis varied in a statistically significant manner (P = .01). The laparoscopic group showed an improved perioperative outcome with statistically significant less postoperative morbidity (P = .01) and less in-hospital stay (P = .0001). No differences were found in terms of blood loss or operative time, but any Pringle maneuver was needed (P = .04). CONCLUSIONS Patients affected by HCC localized in the right-posterior segments of the liver can be safely treated with laparoscopic approach. However, this kind of procedure can be challenging and should be performed in tertiary referral hospitals to provide the patient the best care, with the integration of different specialties.
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Affiliation(s)
- Giuseppe Tarantino
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Paolo Magistri
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
- 2 Department of Medical and Surgical Sciences and Translational Medicine, Sapienza-University of Rome , Rome, Italy
| | - Valentina Serra
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Giammauro Berardi
- 2 Department of Medical and Surgical Sciences and Translational Medicine, Sapienza-University of Rome , Rome, Italy
| | - Giacomo Assirati
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Roberto Ballarin
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Fabrizio Di Benedetto
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
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15
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Han DH, Choi SH, Park EJ, Kang DR, Choi GH, Choi JS. Surgical outcomes after laparoscopic or robotic liver resection in hepatocellular carcinoma: a propensity-score matched analysis with conventional open liver resection. Int J Med Robot 2015; 12:735-742. [PMID: 26537176 DOI: 10.1002/rcs.1714] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/10/2015] [Revised: 07/08/2015] [Accepted: 10/05/2015] [Indexed: 12/19/2022]
Abstract
BACKGROUND This study was designed to compare perioperative and oncologic outcomes between minimally invasive liver resection (MILR) and conventional open liver resection (COLR) for hepatocellular carcinoma (HCC) using a propensity-score matched analysis. METHODS Ninety-nine patients who received MILR were matched with 198 patients treated with COLR out of 928 patients with HCC who received curative liver resection from 2002 to 2012. A multivariable logistic model based on factors related to the patient, tumor, and surgical procedure was used to estimate a propensity score. RESULTS The MILR group experienced significantly less intraoperative blood loss (mean: 389.55 vs 580.66 mL; P = 0.008), lower complication rates (13.1% vs 24.7%; P = 0.020), and a shorter length of hospital stay (mean: 8.40 vs 13.39 days; P < 0.001). The two groups did not differ significantly in disease-free (P = 0.701) or overall survival (P = 0.086). CONCLUSIONS MILR produced better perioperative and comparable oncologic outcomes than COLR for HCC. Copyright © 2015 John Wiley & Sons, Ltd.
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Affiliation(s)
- Dai Hoon Han
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Sung Hoon Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Eun Jung Park
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea
| | - Dae Ryong Kang
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Gi Hong Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
| | - Jin Sub Choi
- Department of Surgery, Yonsei University College of Medicine, Seoul, Korea.,Robot & MIS Center, Severance Hospital, Yonsei University College of Medicine, Seoul, Korea
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16
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Wakabayashi G, Ikeda T, Otsuka Y, Nitta H, Cho A, Kaneko H. General Gastroenterological Surgery 3: Liver. Asian J Endosc Surg 2015; 8:365-73. [PMID: 26708579 DOI: 10.1111/ases.12225] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/21/2015] [Revised: 08/21/2015] [Accepted: 08/21/2015] [Indexed: 12/16/2022]
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17
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Affiliation(s)
- P V Usiakiĭ
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - V A Kubyshkin
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - Iu A Kovalenko
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
| | - D V Kalinin
- A.V. Vishnevsky Institute of Surgery, Ministry of Health of Russian Federation, Moscow
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18
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Langella S, Russolillo N, D'Eletto M, Forchino F, Lo Tesoriere R, Ferrero A. Oncological safety of ultrasound-guided laparoscopic liver resection for colorectal metastases: a case-control study. Updates Surg 2015. [PMID: 26220046 DOI: 10.1007/s13304-015-0325-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022]
Abstract
Laparoscopic liver surgery has gained widespread acceptance and nowadays it is suggested even for malignant disease. Although the benefits on short-term outcomes have been proven, data on oncological safety are still lacking. The aim of this study is to assess oncologic results after ultrasound-guided laparoscopic liver resection (LLR) or open liver resection (OLR) for colorectal metastases. 37 consecutive patients undergoing LLR between 01/2004 and 03/2014 were matched at a ratio of 1:1 with 37 OLR. Matching criteria were male sex, number and diameter of liver metastases, segment location, synchronous presentation, site and stage of primary tumor, positive lymph nodes of the primary, and concomitant extrahepatic disease. Demographic characteristics were similar among groups. Parenchymal transection time was longer in the LLR group (68 ± 38.2 SD vs 40 ± 33.7 SD, p = 0.01). Mortality was nil in LLR and OLR. Overall morbidity was significantly lower in LLR (13.5 vs 37.8%, p = 0.02), although severe complications were similar among the two groups. Patients undergoing LLR were discharged earlier (5 ± 2.3 SD vs 8 ± 6.6 SD days, p < 0.001). The median margin width was 5 (0-40) mm in LLR vs 8 (0-25) mm in OLR, p = 0.897. R1 resection was recorded in four LLR and three OLR (p = 1). Overall recurrences were similar among groups. Eight patients with hepatic or extrahepatic recurrence among LLR underwent surgery vs four of OLR (p = 0.03). After a median follow-up of 35.7 months in LLR and 47.9 months in OLR, 3-year overall survival was 91.8% LLR and 74.8% OLR (p = 0.14). 3-year disease-free survival was 69.1% LLR and 65.9% OLR (p = 0.53). Multivariate analysis showed that postoperative complications [HR 3.42 (95% CI 1.32-8.89)] and multiple metastases [HR 3.84 (95% CI 1.34-10.83)] were independent predictors of worse survival (p = 0.01). Ultrasound-LLR for colorectal hepatic metastases is safe, ensuring oncologic outcomes comparable to OLR.
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Affiliation(s)
- Serena Langella
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Largo Turati, 62, 10128, Turin, Italy
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19
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Coles SR, Besselink MG, Serin KR, Alsaati H, Di Gioia P, Samim M, Pearce NW, Abu Hilal M. Total laparoscopic management of lesions involving liver segment 7. Surg Endosc 2015; 29:3190-5. [DOI: 10.1007/s00464-014-4052-2] [Citation(s) in RCA: 32] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2014] [Accepted: 12/16/2014] [Indexed: 02/07/2023]
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20
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Cherian PT, Mishra AK, Kumar P, Sachan VK, Bharathan A, Srikanth G, Senadhipan B, Rela MS. Laparoscopic liver resection: Wedge resections to living donor hepatectomy, are we heading in the right direction? World J Gastroenterol 2014; 20:13369-13381. [PMID: 25309070 PMCID: PMC4188891 DOI: 10.3748/wjg.v20.i37.13369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/03/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection (OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have divided this review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection (LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy (LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.
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21
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Buchs NC, Oldani G, Orci LA, Majno PE, Mentha G, Morel P, Toso C. Current status of robotic liver resection: a systematic review. Expert Rev Anticancer Ther 2013; 14:237-46. [PMID: 24313681 DOI: 10.1586/14737140.2014.863155] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/01/2023]
Abstract
Robotic surgery is an emerging technique for the management of patients with liver disease, and only a limited number of reports are available. A systematic search of electronic databases (PubMed, Embase and Cochrane), including only case series with more than five patients, identified nine series (with one from our institution), which totaled to 232 patients. Overall, the peri-operative outcomes of the reported patients are similar to those utilizing the laparoscopic and open approaches. Robotic surgery appears to be a valid option for selected hepatic resections in experienced hands. It could represent a bridge toward minimally invasive approaches for confirmed liver surgeons. By contrast, the long-term oncological outcomes remain uncertain and need further studies.
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Affiliation(s)
- Nicolas C Buchs
- Department of Surgery, Clinic for Visceral and Transplantation Surgery, University Hospital of Geneva, Switzerland
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22
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Costa-Pinho A, Melo RB, Graca L, Lopes JM, Costa-Maia J. Multiple hepatic inflammatory pseudotumours diagnosed after laparoscopic excisional biopsy. J Clin Diagn Res 2013; 7:1730-1. [PMID: 24086894 DOI: 10.7860/jcdr/2013/6102.3304] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2013] [Accepted: 05/24/2013] [Indexed: 11/24/2022]
Abstract
Inflammatory pseudotumours (IPTs) may occur in almost every organ of the human body, the liver being the second most frequent organ which is affected. Inflammatory pseudotumours of the liver are rare benign lesions of unknown aetiology, which usually present as solitary liver masses of variable sizes. The differential diagnoses of malignant liver tumours are challenging and they usually require biopsies and histologic examinations. We are presenting the case of a patient with multiple hepatic lesions which mimicked liver metastases. Two percutaneous biopsies were inconclusive. The definitive diagnosis of multiple hepatic inflammatory pseudotumours was made after a laparoscopic exploration with an excisional biopsy of liver lesions and their pathologic evaluation. All lesions disappeared after several months, without any further treatments.
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Affiliation(s)
- Andre Costa-Pinho
- HBP Unit, Department of General Surgery, S. Joao Medical Center, Faculty of Medicine of Porto University , Portugal
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23
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Santambrogio R, Salceda J, Costa M, Kluger MD, Barabino M, Laurent A, Opocher E, Azoulay D, Cherqui D. External validation of a simplified BCLC staging system for early hepatocellular carcinoma. Eur J Surg Oncol 2013; 39:850-7. [PMID: 23726257 DOI: 10.1016/j.ejso.2013.05.001] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/14/2012] [Revised: 04/07/2013] [Accepted: 05/02/2013] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND AND AIMS The aim was to externally validate the capability of a simplified Barcelona Clinic Liver Cancer (s-BCLC) staging system in allocating patients to hepatic resection (HR) and the effect on survival: S-BCLC was defined by only 2 groups: AA included BCLC A1 + A2 classes with alpha-fetoprotein (AFP) ≤ 20 ng/ml and AB included A1 + A2 with AFP > 20 ng/ml plus A3 + A4 subgroups. METHODS This study compared a training group (TG) with hepatocellular carcinoma (HCC) submitted to hepatic resection (HR) in Milan with another group of patients, the validation group (VG) in Creteil. All patients underwent ultrasound-guided anatomical resection (<3 segments). RESULTS Overall survival got worse from A1 to A4 (p = 0.0271) in TG (n = 132), as well as in VG (n = 100) (p = 0.0044) with a more important overlapping of each curves. According s-BCLC classification, the survival curves of TG (p = 0.0001) and VG (p = 0.0250) showed a definitive separation in two different staging groups. The s-BCLC provided the best predictive accuracy and it also presented the highest separability index and C-statistics in both TG and VG. On the other hand, in the evaluation of discriminatory ability for death, measured by ROC curve areas, the s-BCLC system gave better results than the others. CONCLUSION This experience stressed the high value of BCLC system in staging of HCC, but the s-BCLC system seems to be more useful for therapeutic decision making.
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Affiliation(s)
- R Santambrogio
- Chirurgia 2 - Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di Milano, Italy.
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24
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Buchs NC, Volonte F, Pugin F, Toso C, Fusaglia M, Gavaghan K, Majno PE, Peterhans M, Weber S, Morel P. Augmented environments for the targeting of hepatic lesions during image-guided robotic liver surgery. J Surg Res 2013; 184:825-31. [PMID: 23684617 DOI: 10.1016/j.jss.2013.04.032] [Citation(s) in RCA: 55] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2013] [Revised: 04/08/2013] [Accepted: 04/17/2013] [Indexed: 12/19/2022]
Abstract
BACKGROUND Stereotactic navigation technology can enhance guidance during surgery and enable the precise reproduction of planned surgical strategies. Currently, specific systems (such as the CAS-One system) are available for instrument guidance in open liver surgery. This study aims to evaluate the implementation of such a system for the targeting of hepatic tumors during robotic liver surgery. MATERIAL AND METHODS Optical tracking references were attached to one of the robotic instruments and to the robotic endoscopic camera. After instrument and video calibration and patient-to-image registration, a virtual model of the tracked instrument and the available three-dimensional images of the liver were displayed directly within the robotic console, superimposed onto the endoscopic video image. An additional superimposed targeting viewer allowed for the visualization of the target tumor, relative to the tip of the instrument, for an assessment of the distance between the tumor and the tool for the realization of safe resection margins. RESULTS Two cirrhotic patients underwent robotic navigated atypical hepatic resections for hepatocellular carcinoma. The augmented endoscopic view allowed for the definition of an accurate resection margin around the tumor. The overlay of reconstructed three-dimensional models was also used during parenchymal transection for the identification of vascular and biliary structures. Operative times were 240 min in the first case and 300 min in the second. There were no intraoperative complications. CONCLUSIONS The da Vinci Surgical System provided an excellent platform for image-guided liver surgery with a stable optic and instrumentation. Robotic image guidance might improve the surgeon's orientation during the operation and increase accuracy in tumor resection. Further developments of this technological combination are needed to deal with organ deformation during surgery.
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Affiliation(s)
- Nicolas C Buchs
- Clinic for Visceral and Transplantation Surgery, Department of Surgery, University Hospital of Geneva, Geneva, Switzerland.
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Jiang P, Mu PY, Zhou NX, Bai YY. Clinical effects of laparoscopic ultrasound imaging in robot-assisted abdominal surgery. Shijie Huaren Xiaohua Zazhi 2013; 21:1046-1049. [DOI: 10.11569/wcjd.v21.i11.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
AIM: To explore the clinical effects of laparoscopic ultrasound imaging technique in robot-assisted abdominal surgery.
METHODS: Twenty-eight patients (including three with intrahepatic bile duct stones, three with calculous cholecystitis, eight with hepatic tumor, seven with hilar cholangiocarcinoma, four with pancreatic tumor, and three with hypersplenism) who underwent laparoscopic ultrasound-guided robot-assisted abdominal surgery in our hospital were included in our study. Laparoscopic ultrasound was used to determine the location of lesions and their relation with nearby tissue, choose the optimal surgical method, guide the pathway and evaluate the effects during surgery. The clinical effects were evaluated by ultrasound, contrast-enhanced CT, MRCP and biochemical assays after surgery.
RESULTS: All surgical procedures were performed successfully, and no serious intraoperative or postoperative complications occurred. Biochemical parameters returned or approached to normal levels. In RFA regions, color Doppler ultrasound imaging showed no color signal and contrast-enhanced CT showed no enhancement. Ultrasonography, CT or MRCP detected no abnormity in the bile duct. The volume of the entire spleen and damaged part of the spleen from RFA regions were measured by enhanced CT, and the percentages of damaged part of the spleen were 43%, 45% and 49%.
CONCLUSION: Laparoscopic ultrasound can not only determine the lesion and guide the operative route but also help surgeons to select the operative strategy. With the development of robot-assisted surgical system, laparoscopic ultrasound will become an indispensable part of this surgery.
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26
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Laparoscopic Ultrasound for Hepatocellular Carcinoma and Colorectal Liver Metastasis. Surg Laparosc Endosc Percutan Tech 2013; 23:135-44. [DOI: 10.1097/sle.0b013e31828a0b9a] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
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27
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Viganò L, Ferrero A, Amisano M, Russolillo N, Capussotti L. Comparison of laparoscopic and open intraoperative ultrasonography for staging liver tumours. Br J Surg 2013; 100:535-542. [PMID: 23339035 DOI: 10.1002/bjs.9025] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/30/2012] [Indexed: 12/13/2022]
Abstract
BACKGROUND Laparoscopic liver surgery must reproduce open surgical steps. Intraoperative ultrasonography (IOUS) is mandatory, but reliability of laparoscopic IOUS has been poorly evaluated. The aim of this study was to compare laparoscopic versus open IOUS in staging liver tumours. METHODS All patients scheduled for liver resection between September 2009 and March 2011 were considered. Inclusion criteria were primary and metastatic tumours. Exclusion criteria were: hilar/gallbladder cholangiocarcinoma, ten or more lesions, repeat resection, laparoscopic hepatectomy, adhesions and unresectability. Following percutaneous ultrasonography and thoracoabdominal computed tomography (CT), and on indication contrast-enhanced (CE) liver magnetic resonance imaging (MRI) and/or positron emission tomography (PET)-CT, patients were scheduled for laparoscopy, laparoscopic IOUS, then laparotomy, open IOUS and Partial hepatectomy. Data were collected prospectively. Reference standards were final pathology and 6-month follow-up results. RESULTS Sixty-five patients were included, who had a median of 3 preoperative imaging studies (ultrasonography/CT 100 per cent, CE-MRI 67 per cent, PET-CT 54 per cent). A total of 119 lesions were diagnosed. Laparoscopic IOUS detected 22 additional lesions (+18·5 per cent) in 14 patients. Open IOUS detected two additional lesions, but did not confirm four lesions; overall 20 additional lesions (+16·8 per cent) were detected in ten patients. Pathology confirmed 14 newly detected malignant nodules (+11·8 per cent) in eight patients. After 6 months ten new nodules were identified in six patients. The sensitivity of preoperative imaging, laparoscopic IOUS and open IOUS was 83·1, 92·3 and 93·0 per cent respectively; accuracy was 79, 82 and 88 per cent. In comparison with open IOUS, the sensitivity and accuracy of laparoscopic IOUS were 98·6 and 94 per cent. CONCLUSION Laparoscopic IOUS is a reliable tool for staging liver tumours with a performance similar to that of open IOUS in detecting new nodules.
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Affiliation(s)
- L Viganò
- Department of Hepatopancreatobiliary and Digestive Surgery, Ospedale Mauriziano Umberto I, Largo Turati 62, 10128 Torino, Italy.
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29
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Santambrogio R, Kluger MD, Costa M, Belli A, Barabino M, Laurent A, Opocher E, Azoulay D, Cherqui D. Hepatic resection for hepatocellular carcinoma in patients with Child-Pugh's A cirrhosis: is clinical evidence of portal hypertension a contraindication? HPB (Oxford) 2013; 15:78-84. [PMID: 23216782 PMCID: PMC3533715 DOI: 10.1111/j.1477-2574.2012.00594.x] [Citation(s) in RCA: 111] [Impact Index Per Article: 9.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 09/10/2012] [Indexed: 12/12/2022]
Abstract
BACKGROUND According to international guidelines [European Association for the Study of the Liver (EASL) and the American Association for the Study of Liver Diseases (AASLD)], portal hypertension (PHTN) is considered a contraindication for liver resection for hepatocellular carcinoma (HCC), and patients should be referred for other treatments. However, this statement remains controversial. The aim of this study was to elucidate surgical outcomes of minor hepatectomies in patients with PHTN (defined by the presence of esophageal varices or a platelet count of <100,000 in association with splenomegaly) and well-compensated liver disease. METHODS Between 1997 and 2012, a total of 223 cirrhotic patients [stage A according to the Barcelona Clinic Liver Cancer (BCLC) classification] were eligible for this analysis and were divided into two groups according to the presence (n = 63) or absence (n = 160) of PHTN. The demographic data were comparable in the two patient groups. RESULTS Operative mortality was not different (only one patient died in the PHTN group). However, patients with PHTN had higher liver-related morbidity (29% versus 14%; P = 0.009), without differences in hospital stay (8.8 versus 9.8 days, respectively). The PHTN group showed a worse survival rate only if biochemical signs of liver decompensation existed. Multivariate analysis identified albumin levels as an independent predictive factor for survival. CONCLUSIONS PHTN should not be considered an absolute contraindication to a hepatectomy in cirrhotic patients. Patients with PHTN have short- and long-term results similar to patients with normal portal pressure. A limited hepatic resection for early-stage tumours is an option for Child-Pugh class A5 patients with PHTN.
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Affiliation(s)
- Roberto Santambrogio
- Chirurgia 2, Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di MilanoItaly
| | - Michael D Kluger
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri MondorCréteil, France,Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, New York Presbyterian Hospital – Weill-Cornell Medical CenterNew York, USA
| | - Mara Costa
- Chirurgia 2, Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di MilanoItaly
| | - Andrea Belli
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri MondorCréteil, France
| | - Matteo Barabino
- Chirurgia 2, Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di MilanoItaly
| | - Alexis Laurent
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri MondorCréteil, France
| | - Enrico Opocher
- Chirurgia 2, Epato-bilio-pancreatica e Digestiva, Ospedale San Paolo, Università di MilanoItaly
| | - Daniel Azoulay
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri MondorCréteil, France
| | - Daniel Cherqui
- Department of Digestive and Hepatobiliary Surgery and Liver Transplantation, Hôpital Henri MondorCréteil, France,Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, New York Presbyterian Hospital – Weill-Cornell Medical CenterNew York, USA
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Yoon YS, Han HS, Cho JY, Kim JH, Kwon Y. Laparoscopic liver resection for centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava. Surgery 2012; 153:502-9. [PMID: 23257080 DOI: 10.1016/j.surg.2012.10.004] [Citation(s) in RCA: 76] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2012] [Accepted: 10/22/2012] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the accumulation of favorable results from laparoscopic liver resection (LLR), centrally located tumors close to the hilum, major hepatic veins, or inferior vena cava (IVC) are still considered contraindications for LLR. We evaluated the feasibility and safety of LLR for centrally located tumors. METHODS Of the 182 patients who underwent LLR for benign or malignant tumors between September 2003 and June 2010, the clinical outcomes of 13 patients with tumors within 1 cm or less of the major vascular structures, including the hilum, major hepatic veins, and IVC, were retrospectively analyzed. The perioperative outcomes of the patients were compared with those of the 23 patients who underwent open liver resection for tumors with similar criteria in terms of location and size during the same period. RESULTS Anatomic liver resection, including left and right hepatectomy, central bisectionectomy, right anterior and posterior sectionectomy, and extended S4 segementectomy, was performed in 10 patients. The remaining 3 patients underwent subsegmentectomy for tumors located in the Spiegel lobe of the caudate. There was no open conversion or postoperative mortality. Compared with the open group, the laparoscopic group showed similar rates of intraoperative transfusion, postoperative complications, and operative time. However, the laparoscopic group spent less time in the hospital postoperatively and had shorter resection margins. After a median follow-up of 34.3 months, there were no statistically significant differences between the 2 groups in reference to the overall survival rates and the disease-free survival rates. CONCLUSION This study shows that LLR can be safely performed in selected patients with centrally located tumors close to the liver hilum, the major hepatic veins, or the IVC that were previously considered to be contraindications for LLR. Recent technical developments in the performance of laparoscopic major liver resection may have contributed to the successful application of LLR for centrally located tumors.
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Affiliation(s)
- Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea
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Xiong JJ, Altaf K, Javed MA, Huang W, Mukherjee R, Mai G, Sutton R, Liu XB, Hu WM. Meta-analysis of laparoscopic vs open liver resection for hepatocellular carcinoma. World J Gastroenterol 2012; 18:6657-68. [PMID: 23236242 PMCID: PMC3516221 DOI: 10.3748/wjg.v18.i45.6657] [Citation(s) in RCA: 129] [Impact Index Per Article: 9.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/25/2012] [Revised: 09/17/2012] [Accepted: 09/22/2012] [Indexed: 02/06/2023] Open
Abstract
AIM: To conduct a meta-analysis to determine the safety and efficacy of laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC).
METHODS: PubMed (Medline), EMBASE and Science Citation Index Expanded and Cochrane Central Register of Controlled Trials in the Cochrane Library were searched systematically to identify relevant comparative studies reporting outcomes for both LLR and OLR for HCC between January 1992 and February 2012. Two authors independently assessed the trials for inclusion and extracted the data. Meta-analysis was performed using Review Manager Version 5.0 software (The Cochrane Collaboration, Oxford, United Kingdom). Pooled odds ratios (OR) or weighted mean differences (WMD) with 95%CI were calculated using either fixed effects (Mantel-Haenszel method) or random effects models (DerSimonian and Laird method). Evaluated endpoints were operative outcomes (operation time, intraoperative blood loss, blood transfusion requirement), postoperative outcomes (liver failure, cirrhotic decompensation/ascites, bile leakage, postoperative bleeding, pulmonary complications, intraabdominal abscess, mortality, hospital stay and oncologic outcomes (positive resection margins and tumor recurrence).
RESULTS: Fifteen eligible non-randomized studies were identified, out of which, 9 high-quality studies involving 550 patients were included, with 234 patients in the LLR group and 316 patients in the OLR group. LLR was associated with significantly lower intraoperative blood loss, based on six studies with 333 patients [WMD: -129.48 mL; 95%CI: -224.76-(-34.21) mL; P = 0.008]. Seven studies involving 416 patients were included to assess blood transfusion requirement between the two groups. The LLR group had lower blood transfusion requirement (OR: 0.49; 95%CI: 0.26-0.91; P = 0.02). While analyzing hospital stay, six studies with 333 patients were included. Patients in the LLR group were found to have shorter hospital stay [WMD: -3.19 d; 95%CI: -4.09-(-2.28) d; P < 0.00001] than their OLR counterpart. Seven studies including 416 patients were pooled together to estimate the odds of developing postoperative ascites in the patient groups. The LLR group appeared to have a lower incidence of postoperative ascites (OR: 0.32; 95%CI: 0.16-0.61; P = 0.0006) as compared with OLR patients. Similarly, fewer patients had liver failure in the LLR group than in the OLR group (OR: 0.15; 95%CI: 0.02-0.95; P = 0.04). However, no significant differences were found between the two approaches with regards to operation time [WMD: 4.69 min; 95%CI: -22.62-32 min; P = 0.74], bile leakage (OR: 0.55; 95%CI: 0.10-3.12; P = 0.50), postoperative bleeding (OR: 0.54; 95%CI: 0.20-1.45; P = 0.22), pulmonary complications (OR: 0.43; 95%CI: 0.18-1.04; P = 0.06), intra-abdominal abscesses (OR: 0.21; 95%CI: 0.01-4.53; P = 0.32), mortality (OR: 0.46; 95%CI: 0.14-1.51; P = 0.20), presence of positive resection margins (OR: 0.59; 95%CI: 0.21-1.62; P = 0.31) and tumor recurrence (OR: 0.95; 95%CI: 0.62-1.46; P = 0.81).
CONCLUSION: LLR appears to be a safe and feasible option for resection of HCC in selected patients based on current evidence. However, further appropriately designed randomized controlled trials should be undertaken to ascertain these findings.
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Toro A, Gagner M, Di Carlo I. Has laparoscopy increased surgical indications for benign tumors of the liver? Langenbecks Arch Surg 2012; 398:195-210. [PMID: 23053460 DOI: 10.1007/s00423-012-1012-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/25/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND We aimed to analyze the risk of an increased surgical indication rate in patients with benign tumors of the liver since the development of laparoscopy. Previous articles have reported increased numbers of laparoscopic procedures in different surgical fields. METHODS A literature search of MEDLINE (PubMed), Google Scholar, and The Cochrane Library was carried out. All articles that analyzed benign liver tumors (hemangiomas, focal nodular hyperplasia, and adenoma) were divided in two groups: group I included all manuscripts with open procedures between 1971 at 1990, and group II included all manuscripts with open or laparoscopic procedures between 1991 and 2010. Group II articles were divided into two subgroups. Subgroup IIA patients were treated by open or laparoscopic procedures between 1991 and 2000, and subgroup IIB patients were treated by open or laparoscopic procedures between 2001 and 2010. RESULTS Specific analysis of each kind of tumor observed in the two groups showed fewer surgically treated patients for hepatic hemangioma and hepatic adenoma in group II compared with group I and a greater number of patients for focal nodular hyperplasia. Fewer patients were treated with laparoscopic procedures in subgroup IIA than in subgroup IIB. A chi-square test with Yates' correction gave a P value of <0.001. CONCLUSION Laparoscopy has increased the rate of hepatic resection for benign tumors with doubtful indications.
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Affiliation(s)
- Adriana Toro
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, Cannizzaro Hospital, University of Catania, Via Messina 829, Catania, Italy
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Li N, Wu YR, Wu B, Lu MQ. Surgical and oncologic outcomes following laparoscopic versus open liver resection for hepatocellular carcinoma: A meta-analysis. Hepatol Res 2012; 42:51-9. [PMID: 21988222 DOI: 10.1111/j.1872-034x.2011.00890.x] [Citation(s) in RCA: 66] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
Abstract
AIM Laparoscopic hepatectomy has become a common method for treatment of hepatocellular carcinoma (HCC) nowadays, but the oncologic risks of laparoscopic liver resection for HCC are still under investigation. We performed a meta-analysis to quantitatively compare surgical and oncologic outcomes of patients with HCC undergoing laparoscopic versus open hepatectomy. METHODS Systematic review and meta-analysis of studies comparing laparoscopic with open liver resection for HCC. Two authors independently assessed study quality and extracted data. All data were analyzed using RevMan 5. RESULTS Ten studies comprising 627 patients were eligible for inclusion. The overall rate of conversion to open surgery was 6.6%. The laparoscopic group had significantly less blood loss by 223.17 mL (95% confidence interval [CI]: -331.81, -114.54; P < 0.0001), fewer need for transfusions (odds ratio [OR]: 0.42, 95% CI: 0.22, .079; P = 0.007), shorter hospital stay by 5.05 days (95% CI: -7.84, -2.25; P = 0.0004) and fewer postoperative complications (OR: 0.50; 95% CI: 0.32, 0.77; P = 0.002). No significant differences were found concerning surgery margin (weighted mean differences [WMD], 0.55; 95% CI: -0.71, 1.80; P = 0.39), resection margin positive rate (OR, 0.63; 95% CI: 0.25, 1.54; P = 0.31) and tumor recurrence (OR, 0.79; 95% CI: 0.49, 1.27; P = 0.33). In the 244 patients that underwent laparoscopic hepatectomy of all 10 studies included, no patients developed tumor recurrence at the site of resection margin, peritoneal dissemination or trocar-site metastases. CONCLUSIONS On currently available evidence, laparoscopic resection appears not to affect oncologic outcomes and increase tumor recurrence. It also offers less blood loss, decreased rate of intraoperative transfusion and shorter lengths of hospital stay. Laparoscopic resection is a safe and feasible choice for selected patients with HCC.
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Affiliation(s)
- Ning Li
- Liver Transplant Center, Third Affiliated Hospital of Sun Yat-sen University, Transplantation Research Institute of Sun Yat-sen University, Guangzhou, China
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Panaro F, Piardi T, Cag M, Cinqualbre J, Wolf P, Audet M. Robotic liver resection as a bridge to liver transplantation. JSLS 2011; 15:86-9. [PMID: 21902950 PMCID: PMC3134704 DOI: 10.4293/108680811x13022985131417] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022] Open
Abstract
BACKGROUND The surgical robotic system is superior to traditional laparoscopy in regards to 3-dimensional images and better instrumentation. Robotic surgery for hepatic resection has not yet been extensively reported. The aim of this article is to report the first known case of liver resection with the use of a robot in France. METHODS A 61-year-old male with hepatitis C liver cirrhosis and hepatocellular carcinoma was referred for surgical treatment. Preoperative clinical evaluation and laboratory data disclosed a Child-Pugh class A5 patient. Magnetic resonance imaging showed a 3.4-cm tumor in segment III. Liver size was normal, and there were not signs of portal hypertension. Five trocars were used. RESULTS Liver transection was achieved with Harmonic scalpel and bipolar forceps without pedicle clamping. Hemostasis of raw surface areas was accomplished with interrupted stitches. Operative time was 180 minutes. Blood loss was minimal, and the patient did not receive transfusion. The recovery was uneventful, and the patient was discharged on the fifth postoperative day without ascites formation. CONCLUSION The robotic approach may enable liver resection in patients with cirrhosis. The da Vinci robotic system allowed for technical refinements of laparoscopic liver resection due to 3-dimensional visualization of the operative field and instruments with wrist-type end-effectors.
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Affiliation(s)
- Fabrizio Panaro
- Centre de Chirurgie Viscérale et de Transplantation, Hôpital de Hautepierre, Hopitaux Universitaires de Strasbourg, Strasbourg, France.
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Kazaryan AM, Røsok BI, Marangos IP, Rosseland AR, Edwin B. Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments. Surg Endosc 2011; 25:3881-9. [PMID: 21735326 PMCID: PMC3213339 DOI: 10.1007/s00464-011-1815-x] [Citation(s) in RCA: 75] [Impact Index Per Article: 5.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2010] [Accepted: 06/09/2011] [Indexed: 02/06/2023]
Abstract
Background Totally laparoscopic liver resection of lesions located in the posterosuperior segments is reported to be technically challenging. This study aimed to define whether these technical difficulties affect the surgical outcome. Methods A total of 220 patients underwent laparoscopic liver resection during 244 procedures from August 1998 to December 2010. The patients who underwent primary minor single liver resection for malignant tumors affecting either posterosuperior segments 1, 7, 8, and, 4a (group 1) or anterolateral segments 2, 3, 5, 6, and 4b (group 2) were included in the study. Seventy-five procedures found to be eligible for the study, including 28 patients in group 1 and 47 patients in group 2. Intraoperative unfavorable incidents were graded on the basis of the Satava approach and postoperative complications were graded in agreement with the Accordion classification. Results The operative time (median, 127 min) and blood loss (median, 200 ml) were equivalent in the two groups. The rates for blood transfusions and intraoperative accidents did not differ statistically between the groups. A tumor-free margin resection was achieved in 94.7% of the procedures, equivalently in both groups. The postoperative course was similar in the two groups. Postoperative complications developed in 2 cases (7.1%) in group 1 and 2 cases (4.3%) in group 2 (p = 0.626). The median hospital stay was 2 days in both groups. Conclusions Laparoscopic liver resection for lesions located in posterosuperior segments represents certain technical challenges. However, appropriate adjustment of surgical techniques and optimal patient positioning enables the laparoscopic technique to provide safe and effective parenchyma-sparing resections for lesions located in both posterosuperior and anterolateral segments.
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Affiliation(s)
- Airazat M Kazaryan
- Interventional Centre, Rikshospitalet, Oslo University Hospital Health Trust, 0027 Oslo, Norway.
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Santambrogio R, Opocher E, Costa M, Barabino M, Zuin M, Bertolini E, De Filippi F, Bruno S. Hepatic resection for "BCLC stage A" hepatocellular carcinoma. The prognostic role of alpha-fetoprotein. Ann Surg Oncol 2011; 19:426-34. [PMID: 21732145 DOI: 10.1245/s10434-011-1845-6] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/22/2010] [Indexed: 12/14/2022]
Abstract
BACKGROUND Our aim was to assess the capability of Barcelona Clinic Liver Cancer (BCLC) staging system in allocating stage A patients to hepatic resection (HR) and the effect on survival. METHODS We enrolled 132 patients with hepatocellular carcinoma (HCC) amenable to HR. All patients underwent ultrasound (US)-guided anatomical resection (≤2 segments) and then postoperative results were evaluated. RESULTS Results showed 95% of patients were Child A, 49% in BCLC A1, 21% in A2, 6% in A3, and 24% in A4. No 30-day mortality occurred. Overall survival got worse from A1 to A4 (P = 0.0271), while no differences were found in Childs A patients with or without portal hypertension (P = 0.1674). Multivariate analysis (Cox model) shows that only AFP (<20 ng/ml) was an independent predictor of survival: If the AFP is incorporated in BCLC staging system (all A1 and A2 patients with abnormal AFP levels were included in A3 subgroup), 5-year survival rate including normal AFP for A1 was 57% and for A2 was 65%, whereas the survival rates impaired in the worst candidates (5-year survival rate including AFP abnormal for A3 and A4 was 36%; P = 0.002). So, introducing AFP in BCLC classification it is possible to simplify the algorithm in only 2 classes, well-separated in survival curves (class 1 [AFP-]: 60%; class 2 [AFP+]: 37%; P = 0.0001). CONCLUSION Our experience stressed the high value of BCLC system in staging of patients with HCC, but underlined that in selected patients (normal AFP) even A2 group may benefit from HR with a good survival.
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Affiliation(s)
- Roberto Santambrogio
- UOC di Chirurgia 2 (Chirurgia Epato-bilio-pancreatica e Digestiva), A.O. San Paolo, Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Milano, Milan, Italy.
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Abstract
OBJECTIVE To assess the feasibility and safety of robotic-assisted laparoscopic anatomic hepatectomy. BACKGROUND The development of minimally invasive surgery has led to an increase in the use of laparoscopic hepatectomy. However, laparoscopic hepatectomy remains technically challenging and is not widely developed. Robotic surgery represents a recent evolution in minimally invasive surgery that is being used increasingly for complex minimally invasive surgical procedures. Herein, we report our initial experience with robotic-assisted laparoscopic anatomic hepatectomy in 13 consecutive patients. PATIENTS AND METHODS Between April and July 2009, 13 consecutive patients underwent robotic-assisted laparoscopic anatomic hepatectomies for benign and malignant hepatic diseases. Major hepatectomies were performed in 9 patients, left lateral sectionectomies in 4 patients. Eight major hepatectomies were for malignant diseases and 5 hepatectomies (1 left hepatectomy and 4 left lateral sectionectomies) were for benign diseases. All the robotic-assisted hepatectomy procedures were performed anatomically with hilum dissection. Prior to starting the parenchymal transaction, vascular control of the portal vessels was carried out whenever possible. These robotic-assisted laparoscopic anatomic hepatectomies were compared with 20 traditional laparoscopic hepatectomies and 32 open resections that were contemporaneous and cohort-matched. RESULTS All 13 robotic-assisted laparoscopic anatomic hepatectomies were performed successfully in the manner of pure laparoscopic resection. No conversion to laparotomy or hand-assisted laparoscopic resection occurred. Despite its longer operative time (338 minutes) and higher hospital cost ($12,046), robotic liver surgery compared favorably with traditional laparoscopic hepatectomy and open resection in blood loss (280 vs. 350, 470 mL), transfusion requirement (0 vs. 3 of 20, 4 of 32), use of the Pringle maneuver (0 vs. 3 of 20, 6 of 32) and overall operative complications (7.8% vs. 10%,12.5%). Neither ascites nor transient hepatic decompensation occurred in the robotic group. The surgical margins in all 8 patients with malignant lesions were negative and as yet, no intrahepatic recurrences or metastases have been observed in the robotic group. The mean postoperative stay was shorter with the traditional laparoscopic procedure (5.2 days) than with robotic (6.7 days)or open surgery (9.6 days). Conversions from traditional laparoscopic to open and hand-assisted laparoscopic resection occurred in 2 patients (10.0%) who underwent right hemihepatectomy and left hepatectomy, respectively. CONCLUSIONS These preliminary results show that robotic-assisted laparoscopic anatomic hepatectomy is safe and feasible with a much lower complication and conversion rate than traditional laparoscopic hepatectomy or open resection. The robotic surgical system may broaden the indications for laparoscopic hepatactomy, and it enabled the surgeon to perform precise laparoscopic liver resection which required hylum dissection, hepatocaval dissection, endoscopic suturing, and microanastamosis. However, more long-term, evidence-based outcomes will be necessary to prove its efficacy, and further research on its cost-effectiveness is still required.
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Abstract
Laparoscopic liver resection (LHR) has shown classical advantages of minimally invasive surgery over open counterpart. In spite of introduction in early 1990's only few centres worldwide adapted LHR to routine practice. It was due to considerable technical challenges and uncertainty about oncologic outcomes. Surgical instrumentation and accumulation of surgical experience has largely enabled to solve many technical considerations. Intraoperative navigation options have also been improved. Consequently indications have been drastically expanded nearly reaching criteria equal to open liver resection in expert centres. Recent studies have verified oncologic integrity of LHR. However, mastering of LHR is still a quite demanding task limiting expansion of this patient friendly technique. This emphasizes the necessity of systematic training for laparoscopic liver surgery. This article reviews the state of the art of laparoscopic liver surgery lightening burning issues of research and clinical practice.
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Affiliation(s)
- B Edwin
- Intervention Centre, Oslo University Hospital, Rikshospitalet, Oslo, Norway.
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Santambrogio R, Costa M, Strada D, Bertolini E, Zuin M, Barabino M, Opocher E. Intraoperative ultrasound score to predict recurrent hepatocellular carcinoma after radical treatments. ULTRASOUND IN MEDICINE & BIOLOGY 2011; 37:7-15. [PMID: 21084155 DOI: 10.1016/j.ultrasmedbio.2010.10.007] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/11/2010] [Revised: 10/03/2010] [Accepted: 10/07/2010] [Indexed: 05/30/2023]
Abstract
Despite the high complete necrosis rate of radio-frequency ablation (RFA) or the complete removal following curative hepatic resection (HR), recurrent hepatocellular carcinoma (HCC) remains a significant problem. The aim of the study is to identify some intraoperative ultrasound (IOUS) patterns, predicting intrahepatic recurrences. From January 1997 to July 2009, 410 patients with HCC were treated (162 HR and 248 RFA through a surgical access). All patients were submitted to IOUS examination: 148 IOUS were performed during the laparotomic access while 262 IOUS were performed during the laparoscopic access. Primary HCC was classified according to diameter, HCC pattern (nodular or infiltrative), echogenicity (hyper- or hypo-echoic), echotexture (homogeneous or inhomogeneous), capsular invasion, mosaic pattern, nodule in nodule aspect and infiltration of portal vessels. Number of HCC nodules was also considered. Multivariate analysis (Cox model) was performed to determine features associated with recurrent HCC using IOUS patterns that independently predicted recurrent HCC, a IOUS score was developed. The patients were followed for 3-127 months, (median follow-up: 21.5 months). In 220 patients (54%), intrahepatic recurrences occurred. In 155 patients (38%), distant intrahepatic recurrences arose in different segments at the primary tumor site. In 65 HCC cases (16%), local recurrences were found. At multivariate analysis, multiple nodules, HCC diameter (>20 mm), HCC pattern (infiltrative), hyperechoic nodule and portal infiltration were statistically significant for risk factor of intrahepatic recurrences. Therefore, a IOUS scoring system was calculated on the basis of multivariate analysis and identified three risk categories of patients: in group 1 recurrences occurred in 37%, group 2 in 46% and group 3 in 66% (p = 0.0001). IOUS is an accurate staging tool during "surgical" procedures. This study showed an added value of IOUS: it permitted to identify ultrasound patterns, which can predict the risk of HCC recurrences. The calculated IOUS score permits to intraoperatively evaluate the actual surgical choice and to program the best treatment strategies during the follow-up period.
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Affiliation(s)
- Roberto Santambrogio
- UO Chirurgia 2, Azienda Ospedaliera San Paolo - Dipartimento di Medicina, Chirurgia ed Odontoiatria, Università degli Studi di Milano.
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Ker CG, Chen JS, Kuo KK, Chuang SC, Wang SJ, Chang WC, Lee KT, Chen HY, Juan CC. Liver Surgery for Hepatocellular Carcinoma: Laparoscopic versus Open Approach. Int J Hepatol 2011; 2011:596792. [PMID: 21994865 PMCID: PMC3170836 DOI: 10.4061/2011/596792] [Citation(s) in RCA: 49] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2010] [Revised: 02/11/2011] [Accepted: 03/10/2011] [Indexed: 12/19/2022] Open
Abstract
In this study, we try to compare the benefit of laparoscopic versus open operative procedures. Patients and Methods. One hundred and sixteen patients underwent laparoscopic liver resection (LR) and another 208 patients went for open liver resection (OR) for hepatocellular carcinoma (HCC). Patients' selection for open or laparoscopic approach was not randomized. Results. The CLIP score for LR and OR was 0.59 ± 0.75 and 0.86 ± 1.04, respectively, (P = .016). The operation time was 156.3 ± 308.2 and 190.9 ± 79.2 min for LR and OR groups, respectively. The necessity for blood transfusion was found in 8 patients (6.9%) and 106 patients (50.9%) for LR and OR groups. Patients resumed full diet on the 2nd and 3rd postoperative day, and the average length of hospital stay was 6 days and 12 days for LR and OR groups. The complication rate and mortality rate were 0% and 6.0%, 2.9% and 30.2% for LR and OR groups, respectively. The 1-yr, 3-yr, and 5-yr survival rate was 87.0%, 70.4%, 62.2% and 83.2%, 76.0%, 71.8% for LR and OR group, respectively, of non-significant difference. From these results, HCC patients accepted laparoscopic or open approach were of no significant differences between their survival rates.
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Affiliation(s)
- C. G. Ker
- Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - J. S. Chen
- Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan,*J. S. Chen:
| | - K. K. Kuo
- Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - S. C. Chuang
- Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - S. J. Wang
- Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - W. C. Chang
- Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - K. T. Lee
- Division of HBP Surgery, Chung-Ho Memorial Hospital, Institute of Medicine, Kaohsiung Medical University, Kaohsiung 80756, Taiwan
| | - H. Y. Chen
- Department of Surgery, Yuan's General Hospital, No. 162, Cheng-Kong 1st Road, Kaohsiung 80249, Taiwan
| | - C. C. Juan
- Department of Surgery, Yuan's General Hospital, No. 162, Cheng-Kong 1st Road, Kaohsiung 80249, Taiwan
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Santambrogio R, Costa M, Strada D, Barabino M, Conti M, Bertolini E, Zuin M, Opocher E. Intraoperative ultrasound patterns predict recurrences after surgical treatments for hepatocellular carcinoma(). J Ultrasound 2010; 13:150-7. [PMID: 23396628 DOI: 10.1016/j.jus.2010.10.003] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Hepatocellular carcinoma (HCC) is associated with a high incidence of postoperative recurrence, despite high rates of complete necrosis with radiofrequency ablation (RFA) and curative hepatic resections (HR). The aim of this study was to identify intraoperative ultrasound patterns observed during HR or RFA that predicting intrahepatic HCC recurrence. MATERIALS AND METHODS From January 1997 through August 2008, we treated 377 patients with HCC (158 with HR and 219 with surgical RFA). All patients underwent intraoperative ultrasound (IOUS) examination. Primary HCCs was classified according to diameter, HCC pattern (nodular or infiltrative), echogenicity (hyper- or hypo-), echotexture (homogeneous or inhomogeneous), capsular invasion, mosaic pattern, nodule-in-nodule appearance, and infiltration of portal vessels. Number of HCC nodules was also considered. Comparisons between the groups of possible factors for intrahepatic recurrence of treated tumors were performed using the Kaplan-Meier method and compared using the log-rank test. RESULTS Patients were followed for 9-127 months (median: 18.6 months), and intrahepatic recurrence was observed in 198 (52.5%). In 138 patients (36.5%), recurrences were located in different segments with respect to the primary tumor. In 60 HCC tumors (16%), local recurrences were found in the same segment as the primary tumor. At univariate analysis, primary HCC echogenicity and mosaic pattern were the only factors not significant associated with intrahepatic recurrences. CONCLUSION IOUS is an accurate staging tool for use during "surgical" resection or RFA. This study shows that IOUS patterns can also be used to estimate the risk of post-treatment HCC recurrence. In patients at high risk for this outcome, closer follow-up and use of adjuvant therapies could be useful.
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Giannotti GD, Ailabouni LD, Salti GI. Ultrasound-guided excision of nonpalpable malignant soft tissue tumors of the abdomen. Future Oncol 2010; 6:1513-5. [DOI: 10.2217/fon.10.98] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/21/2022] Open
Abstract
The use of intraoperative ultrasound to guide the excision of sonographically visible but nonpalpable lesions is a newer modality. Its use in intraoperative localization of recurrent malignant soft tissue tumors has not been reported. This report describes a technique of intraoperative localization by ultrasound to guide the excision of recurrent nonpalpable malignant soft tissue tumors of the abdominal wall in two patients. Tumors of both patients were successfully localized intraoperatively by ultrasonography and excised with adequate margins. This technique leads to reduced patient discomfort and anxiety, the avoidance of organizational requirements on the day of surgery, and allows for adequate margins of resection
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Affiliation(s)
- Giovanni D Giannotti
- Department of Surgical Oncology, University of Illinois at Chicago, 840 S Wood St (M/C 820), Chicago, IL 60612, USA
| | - Luay D Ailabouni
- Department of Surgical Oncology, University of Illinois at Chicago, 840 S Wood St (M/C 820), Chicago, IL 60612, USA
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Piccolboni D, Ciccone F, Settembre A, Corcione F. Laparoscopic intra-operative ultrasound in liver and pancreas resection: Analysis of 93 cases. J Ultrasound 2010; 13:3-8. [PMID: 23396978 DOI: 10.1016/j.jus.2010.06.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023] Open
Abstract
INTRODUCTION Laparoscopic inspection before pancreatic and liver surgery is a widely accepted approach and has changed the surgical strategy in a growing number of patients for the last 10 years. The addition of intra-operative ultrasound to laparoscopy has further refined surgical judgments. The aim of this study was to evaluate the impact of open (IOUS) or laparoscopic (LIOUS) ultrasound in patients undergoing hepatic or pancreatic resection for benign or malignant lesions. MATERIALS AND METHODS In the years 2005-2008, 45 patients (aged 42-75 years) were selected for liver resection, and 48 others (aged 14-72 years) were selected for partial pancreatic resection. Intra-operative ultrasound was performed for surgical staging. An Aloka SSD-5500 scanner (Aloka, Tokyo, Japan) was used with a flexible laparoscopic multifrequency linear and an electronic T-shaped linear probe. RESULTS LIOUS prevented useless laparotomies in six patients (13.3%) with liver tumors and, coupled with IOUS, revealed previously undetected tumors that required a change in the surgical strategy in 5 others (11.1%). In patients with pancreatic disease, LIOUS excluded the possibility of radical surgery in 7 patients (14.4%) due to the presence of mesenteric vein infiltration, involvement of the celiac or para-aortic nodes, or the presence of liver or peritoneal micro-metastases. In 11 patients with benign lesions, it defined the lesions' relation to the Wirsung duct and splenic vessels, and in 6 others it provided guidance for aspiration of fluid for chemical and cytologic analysis. CONCLUSIONS LIUOS and IOUS can play fundamental roles in selecting patients for resective surgery and in planning the surgical approach. They provided information that affected surgical strategies in 11 patients with liver disease (24.4%) and 13 with pancreas disease (27%).
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Affiliation(s)
- D Piccolboni
- General and Laparoscopic Surgery Department - Monaldi Hospital - Naples, Italy
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Chopra SS, Schmidt SC, Eisele R, Teichgräber U, Van der Voort I, Seebauer C, Streitparth F, Schumacher G. Initial results of MR-guided liver resection in a high-field open MRI. Surg Endosc 2010; 24:2506-12. [PMID: 20229210 DOI: 10.1007/s00464-010-0994-1] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/10/2009] [Accepted: 02/25/2010] [Indexed: 12/23/2022]
Abstract
BACKGROUND The goal of this study was to evaluate high-field open magnetic resonance imaging (MRI) for intraoperative real-time imaging during hand-assisted laparoscopic liver resection. MR guidance has several advantages compared to ultrasound and may represent a future technique for abdominal surgery. Various MRI-safe and -compatible instruments were developed, tested, and applied to realize minimally invasive liver surgery under MR guidance. As proof of the concept, liver resection was performed in a porcine model. METHODS All procedures were conducted in a 1.0-T open MRI unit. Imaging quality and surgical results were documented during three cadaveric and two live animal procedures. A nonferromagnetic hand port was used for manual access and the liver tissue was dissected using a Nd:YAG laser. RESULTS The intervention time ranged from 126 to 145 min, with a dissection time from 11 to 15 min. Both live animals survived the intervention with a blood loss of 250 and 170 ml and a specimen weight of 138 and 177 g. A dynamic T2W fast spin-echo sequence allowed real-time imaging (1.5 s/image) with good delineation of major and small hepatic vessels. The newly developed MR-compatible instruments and camera system caused only minor interferences and artifacts of the MR image. CONCLUSION MR-guided liver resection is feasible and provides additional image information to the surgeon. We conclude that MR-guided laparoscopic liver resection improves the anatomical orientation and may increase the safety of future minimally invasive liver surgery.
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Affiliation(s)
- Sascha Santosh Chopra
- Department of General-, Visceral- and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
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Yoon YS, Han HS, Cho JY, Ahn KS. Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver. Surg Endosc 2009; 24:1630-7. [PMID: 20035349 DOI: 10.1007/s00464-009-0823-6] [Citation(s) in RCA: 121] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2009] [Accepted: 07/01/2009] [Indexed: 12/11/2022]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) is still not a well-established treatment modality for hepatocellular carcinoma (HCC). Moreover, most reported cases have been limited to tumors in the anterolateral (AL) segments (segments 2, 3, 4b, 5, and 6). We evaluated clinical and oncologic outcomes after LLR for HCC located in all segments, including lesions located in the posterosuperior (PS) segments (segments 1, 4a, 7, and 8). METHODS This retrospective study included 69 patients who had undergone LLR for HCC between September 2003 and November 2008. The patients were divided into two groups (group AL and group PS) according to tumor location. The clinical data of the two groups were retrospectively analyzed. RESULT There was no postoperative mortality. Fifteen patients (21.7%) experienced 19 postoperative complications. During a median follow-up period of 21.3 months, recurrence was detected in 21 (30.4%) patients. The 3-year overall survival rate and disease-free survival rate were 90.4 and 60.4%, respectively. There was no difference in clinicopathologic characteristics between the two groups except for a male predominance in group PS (p = 0.021) and that there were more patients with thrombocytopenia in group AL (p = 0.001). Although group PS patients had longer operative time (p = 0.001) and longer postoperative hospital stay (p = 0.039), along with a tendency toward a higher rate of open conversion (p = 0.054) and greater blood loss (p = 0.068), there was no significant difference in rates of postoperative complications (p = 0.375), recurrence (p = 0.740), 3-year overall survival (p = 0.237) or disease-free survival (p = 0.411) between the two groups. CONCLUSIONS Our experience shows that LLR can be safely performed in selected patients with HCC located in all segments of the liver, including the posterosuperior segments, with acceptable postoperative morbidity and oncologic results.
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Affiliation(s)
- Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam, Gyeonggi, 463-707, Korea
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Herman P, Coelho FF, Lupinacci RM, Perini MV, Machado MAC, D´Albuquerque LAC, Cecconello I. Ressecões hepáticas por videolaparoscopia. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2009. [DOI: 10.1590/s0102-67202009000400009] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
INTRODUÇÃO: As ressecções hepáticas representam umas das últimas fronteiras vencidas pela cirurgia videolaparoscópica. Apesar da complexidade do procedimento, da demanda de grande incorporação de tecnologia e necessidade de experiência em cirurgia hepática e laparoscópica, a indicação do método tem crescido de forma expressiva nos últimos anos. OBJETIVO: Realizar análise crítica do método, baseada nos trabalhos existentes na literatura, ressaltando o estado atual de suas indicações, exequibilidade, segurança, resultados e aspectos técnicos primordiais. MÉTODO: Foram identificados e analisados os trabalhos pertinentes nas bases de dados LILACS e PUBMED até dezembro de 2009, utilizando-se os descritores "liver resection", "laparoscopic" e "liver surgery". Não foram encontrados trabalhos prospectivos e randomizados sobre o tema, sendo os dados disponíveis provenientes de série de casos, estudos caso-controle e alguns estudos multicêntricos e metanálises. CONCLUSÃO: A hepatectomia por videolaparoscopia é hoje operação segura e factível, mesmo para as ressecções hepáticas maiores, com baixo índice de morbimortalidade. O método pode ser utilizado para lesões malignas sem prejuízo dos princípios oncológicos e com vantagens nos pacientes com cirrose ou disfunção hepática. A melhor indicação recai sobre as lesões benignas, em especial o adenoma hepatocelular. Em mãos experientes e casos selecionados, como as lesões benignas localizadas nos segmentos anterolaterais hepáticos, principalmente no segmento lateral esquerdo, a ressecção videolaparoscópica pode ser considerada hoje como tratamento padrão.
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Abstract
Segmental hepatectomy is appealing for several reasons including preservation of liver parenchyma, reduction of intraoperative blood loss, and blood replacement by dividing tissues along the anatomic planes. A simple technique guided by intraoperative ultrasound is described here using radio-frequency energy to create coagulative desiccation of segmental or subsegmental arterial and portal vessels. Thirty patients underwent a segmental resection using this technique without mortality and with minor morbidity. This technique has a major advantage of being easy and safe to apply. We believe it has a potentially important role in both open and laparoscopic liver surgery.
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Laparoscopic liver resection: a systematic review. ACTA ACUST UNITED AC 2009; 16:410-21. [PMID: 19495556 DOI: 10.1007/s00534-009-0120-8] [Citation(s) in RCA: 120] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2009] [Accepted: 03/31/2009] [Indexed: 12/16/2022]
Abstract
BACKGROUND Outcomes of laparoscopic liver resection (LLR) are not clarified. The objective of this article is to depict the state of the art of LLR by means of a systematic review of the literature. METHODS Studies about LLR published before September 2008 were identified and their results summarized. RESULTS Indications for laparoscopic hepatectomy do not differ from those for open surgery. Technical feasibility is the only limiting factor. Bleeding is the major intraoperative concern, but, if managed by an expert surgeon, do not worsen outcomes. Hand assistance can be useful in selected cases to avoid conversion. Patient selection must take both tumor location and size into consideration. Potentially good candidates are patients with peripheral lesions requiring limited hepatectomy or left lateral sectionectomy; their outcomes, including reduced blood loss, morbidity, and hospital stay, are better than those of their laparotomic counterparts. The same advantages have been observed in cirrhotics. Laparoscopic major hepatectomies and resections of postero-superior segments need further evaluation. The results of LLR in cancer patients seem to be similar to those obtained with the laparotomic approach, especially in cases of hepatocellular carcinoma, but further analysis is required. CONCLUSIONS Laparoscopic liver resection is safe and feasible. The laparoscopic approach can be recommended for peripheral lesions requiring limited hepatectomy or left lateral sectionectomy. Preliminary oncological results suggest non-inferiority of laparoscopic to laparotomic procedures.
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Imaging sequences for intraoperative MR-guided laparoscopic liver resection in 1.0-T high field open MRI. Eur Radiol 2009; 19:2191-6. [DOI: 10.1007/s00330-009-1393-7] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/28/2008] [Revised: 02/18/2009] [Accepted: 03/01/2009] [Indexed: 10/20/2022]
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Chopra SS, Wiltberger G, Teichgraeber U, Papanikolaou I, Schwabe M, Schmidt S, Fikatas P, Streitparth F, Philipp C, Wichlas F, Seebauer C, Schumacher G. Evaluation of Laparoscopic Liver Resection with Two Different Nd:YAG Lasers for Future Use in a High-Field Open MRI. Photomed Laser Surg 2009; 27:281-6. [DOI: 10.1089/pho.2008.2305] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/07/2023] Open
Affiliation(s)
- Sascha Santosh Chopra
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Georg Wiltberger
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Ulf Teichgraeber
- Department of Radiology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Ioannis Papanikolaou
- Department of Gastroenterology, Charité Campus Virchow-Clinic, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Michael Schwabe
- Department of Pathology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Sven Schmidt
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Panagiotis Fikatas
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Florian Streitparth
- Department of Radiology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Carsten Philipp
- Department of Laser Medicine, Elisabeth Hospital, Berlin, Germany
| | - Florian Wichlas
- Department of Trauma Surgery, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Christian Seebauer
- Department of Trauma Surgery, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Guido Schumacher
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
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