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Kong X, Niu Z, Wang H, Liu M, Ma C, Lu J, Zhou X, Zhu H. Left-lateral decubitus jackknife position for laparoscopic resection of right posterior liver tumors: A safe and effective approach. Langenbecks Arch Surg 2025; 410:25. [PMID: 39755910 DOI: 10.1007/s00423-024-03595-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2024] [Accepted: 12/22/2024] [Indexed: 01/06/2025]
Abstract
PURPOSE To compare outcomes of LLR in VI/VII of the liver in Left-lateral Decubitus Jackknife Position (LDJP) and traditional Supine Position (SP). We used propensity score matching (PSM) to analyze clinical outcomes. PATIENTS & METHODS This study retrospectively analyzed patients undergoing LLR for liver tumors in segments VI and/or VII at Shandong Provincial Hospital from 2018 to 2023. A total of 218 cases were included (LDJP, n = 94; SP, n = 124). Matched 1:1 PSM groups were created and clinical indicators compared between groups. RESULTS 218 LLR patients, 94 LDJP and 124 supine. After 1:1 PSM, each group had 62 patients. No significant differences in clinical or laboratory parameters. All surgeries were successful, 1 LDJP conversion to open resection and 4 SP conversions (P = 0.375). LDJP average surgery duration: 220.6 ± 29.9 min, supine position: 262.6 ± 35.6 min (P < 0.001). LDJP perioperative blood loss: 169.0 ± 74.4 mL, supine position: 231.6 ± 84.6 mL (P < 0.001). Four LDJP patients required intraoperative blood transfusion compared to 16 supine position patients (P = 0.012). All cases had negative margins postoperatively. No significant differences in postoperative complications (8 LDJP vs 9 supine, P = 0.675) or length of hospital stay (25 LDJP vs 26 supine, ≥ 7 days) (P = 1.000). CONCLUSION Laparoscopic partial hepatectomy in LDJP for hepatic VI/VII tumor safe and feasible. Reduces operative time, blood loss, transfusion requirement, improving outcomes.
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Affiliation(s)
- Xiaohan Kong
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, 250021, China
| | - Zheyu Niu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, 250021, China
- Department of Clinical Research, Qilu Synva Pharmaceutical Co. Ltd, Dezhou, China
- Department of Physiology and Pathophysiology, School of Basic Medical Sciences, Cheeloo College of Medicine, Shandong University, Jinan, Shandong, China
| | - Heng Wang
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Meng Liu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, 250021, China
| | - Chaoqun Ma
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, 250021, China
| | - Jun Lu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, 250021, China
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Xu Zhou
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, 250021, China
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China
| | - Huaqiang Zhu
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong First Medical University, 324 Jingwuweiqi Road, Jinan, 250021, China.
- Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Shandong University, Jinan, 250021, China.
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Romito R, Masserano R, Nicolosi FM, Portigliotti L. Full-robotic liver resection of segment V-Vi using the harmonic ace curved shears and the hanging technique: an easy way to do it. Updates Surg 2025; 77:29-31. [PMID: 39719542 DOI: 10.1007/s13304-024-02042-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2024] [Accepted: 11/17/2024] [Indexed: 12/26/2024]
Affiliation(s)
- R Romito
- Chirurgia Generale II, AOU Maggiore Della Carità Hospital, Corso Mazzini 18, Novara, Italy
| | - R Masserano
- Chirurgia Generale, San Paolo Hospital, Via Antonio di Rudinì 8, 20142, Milan, Italy
| | - F M Nicolosi
- Chirurgia Generale II, AOU Maggiore Della Carità Hospital, Corso Mazzini 18, Novara, Italy
| | - L Portigliotti
- Chirurgia Generale II, AOU Maggiore Della Carità Hospital, Corso Mazzini 18, Novara, Italy.
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Muacevic A, Adler JR, Ueda T. Two Cases of Perihepatitis With the Liver Capsule Irritation Sign: A New Physical Examination Technique. Cureus 2023; 15:e34327. [PMID: 36865974 PMCID: PMC9972719 DOI: 10.7759/cureus.34327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/29/2023] [Indexed: 01/30/2023] Open
Abstract
Perihepatitis, including Fitz-Hugh-Curtis syndrome, is an uncommon, chronic manifestation of pelvic inflammatory disease usually affecting premenopausal women. It causes right upper quadrant pain due to inflammation of the liver capsule and adhesion of the peritoneum. Since delayed diagnosis of Fitz-Hugh-Curtis syndrome can lead to infertility and other complications, physical examination findings need to be investigated to predict perihepatitis in the early stages of the disease. Here, we hypothesized that perihepatitis is characterized by increased tenderness and spontaneous pain in the right upper abdomen when the patient is placed in the left lateral recumbent position (we termed this indication the "liver capsule irritation sign"). We examined the patients physically for the presence of this liver capsule irritation sign for an early diagnosis of perihepatitis. We report the first two cases of perihepatitis due to Fitz-Hugh-Curtis syndrome in which the liver capsule irritation sign observed during the physical examination was used for diagnosis. The liver capsule irritation sign is caused by two mechanisms: first, the liver falls gravitationally into the left lateral recumbent position, which makes the liver easier to palpate; and second, the peritoneum is stretched and thus stimulated. The second mechanism is that the transverse colon running around the right upper abdomen slumps gravitationally when the patient is in the left lateral recumbent position, allowing for direct palpation of the liver. The liver capsule irritation sign can be a useful physical finding, suggestive of perihepatitis due to Fitz-Hugh-Curtis syndrome. It may also be suitable in cases of perihepatitis caused by factors other than Fitz-Hugh-Curtis syndrome.
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Tabath M, Lim C, Goumard C, Scatton O. Surgical Glove Technique for Laparoscopic Liver Resection. J Gastrointest Surg 2020; 24:1912-1919. [PMID: 32270365 DOI: 10.1007/s11605-020-04577-8] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/10/2019] [Accepted: 03/16/2020] [Indexed: 01/31/2023]
Abstract
BACKGROUND Liver tumors located in segments 7 and 8 pose a technical challenge to standard laparoscopic liver resection. Intraoperative placement of a surgical glove behind the right liver after the right triangular ligament and coronary ligament are divided facilitates liver exposure during parenchymal transection and control of the bleeding at the deeper part of the parenchymal plane. The aim of this study was to describe our standardized technique in detail and to assess the feasibility of this technique in patients with different clinical backgrounds and clarify the limits of this technique. METHODS Medical records of 20 consecutive patients considered for laparoscopic liver resection using the surgical glove technique were reviewed. RESULTS All patients had malignant disease and the vast majority of patients had colorectal metastatic tumors. Overall, 65% of patients had tumors located in segment 8. Placing the surgical water glove could be achieved without complication in all 20 patients. One surgical glove was used in this series (usually size 6.5 to 7.5 is an adequate size). Time for preparing the surgical green water glove was estimated to be less than 1 min. The mean duration of operation ranged from 136 to 332 min (median, 240 min). Intermittent Pringle's maneuver was applied in all patients with a median time of 33 min. No additional intercostal trocars were required. There was no intraoperative blood transfusion or conversion to open surgery. The median maximum size of the tumor was 23 mm. There was no operative mortality. Overall morbidity was 30%. Surgical margins were negative in 80% of patients. CONCLUSIONS The surgical glove technique is easy, reproducible, effective, and safe and can be applied to both laparoscopic and robotic liver resection.
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Affiliation(s)
- Martin Tabath
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Paris, France
| | - Chetana Lim
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Paris, France
| | - Claire Goumard
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Paris, France.,Sorbonne Université, Paris, France.,Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Olivier Scatton
- Department of Digestive, Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtriere, Paris, France. .,Sorbonne Université, Paris, France. .,Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France.
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Inoue Y, Hayashi M, Tanaka R, Komeda K, Hirokawa F, Uchiyama K. Short-term Results of Laparoscopic versus Open Liver Resection for Liver Metastasis from Colorectal Cancer: A Comparative Study. Am Surg 2020. [DOI: 10.1177/000313481307900525] [Citation(s) in RCA: 36] [Impact Index Per Article: 7.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/27/2023]
Abstract
Laparoscopic liver resection is currently performed in an increasing number of institutions as a minimally invasive treatment. However, no randomized controlled trials have compared laparoscopic and open liver resections. Twenty-three laparoscopic and 24 open liver resections for colorectal cancer liver metastases (CRCLM) were performed, and these data for both were retrospectively compared in the short-term results. The estimated blood loss was 99 ± 207 mL in the laparoscopic group and 397 ± 381 mL in the open group ( P = 0.0018); blood loss was significantly higher in the open group. There were no differences in the surgical procedure, blood loss, transfusion rate, pathological margins, postoperative complications, 30-day mortality, duration of intravenous drip, or hospital stay. On postoperative courses, the values of total bilirubin, white blood cell count, and C-reactive protein were significantly lower in the laparoscopic group. The data of the present series suggest the lesser invasiveness and safety of laparoscopic liver resection even for patients with CRCLM, and they showed that postoperative laboratory tests were better after laparoscopy than after the traditional open approach with better short-term results. Tumor diameter less than 5 cm appears to be the appropriate indication for laparoscopic liver resection for CRCLM.
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Affiliation(s)
- Yoshihiro Inoue
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Michihiro Hayashi
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Ryo Tanaka
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Koji Komeda
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Fumitoshi Hirokawa
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
| | - Kazuhisa Uchiyama
- Departments of General and Gastroenterological Surgery, Osaka Medical College Hospital, Osaka, Japan
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Laparoscopic Management of Hepatocellular Carcinoma: A Critical Reappraisal. Surg Laparosc Endosc Percutan Tech 2017; 27:203-205. [DOI: 10.1097/sle.0000000000000415] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
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The liver hanging maneuver in laparoscopic liver resection: a systematic review. Surg Today 2017; 48:18-24. [PMID: 28365891 DOI: 10.1007/s00595-017-1520-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2016] [Accepted: 02/28/2017] [Indexed: 02/07/2023]
Abstract
PURPOSE Laparoscopic surgery has gained the acceptance of the hepatobiliary surgical community and expert teams are now advocating major laparoscopic liver resections (LLRs). In this setting, the liver hanging maneuver (LHM) has been described in numerous series. We conducted a systematic review to investigate the effectiveness of the LHM in LLR. METHODS We performed an electronic literature search using PubMed, EMBASE, and COCHRANE databases. The final search was carried out in December, 2015. RESULTS We found 11 articles describing a collective total of 104 surgical procedures that were eligible for this study. Laparoscopic LHM was used in LLR for both benign and malignant conditions, and also in living donor liver transplantation (LDLT). The LHM was used mainly in right hepatectomy and only two authors reproduced the original LHM. We investigated the intraoperative parameters, preservation of postoperative liver function, and oncological outcomes. The clear benefit of using the LHM in LLR is for better identification of the parenchymal transection plane with less blood loss. The other benefits of LHM could not be corroborated by solid data on its positive value. CONCLUSIONS In view of the data published in the literature, our findings are not strong enough to support the systematic use of LHM in LLR.
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Fusaglia M, Tinguely P, Banz V, Weber S, Lu H. A Novel Ultrasound-Based Registration for Image-Guided Laparoscopic Liver Ablation. Surg Innov 2016; 23:397-406. [PMID: 26969718 DOI: 10.1177/1553350616637691] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/11/2023]
Abstract
Background Patient-to-image registration is a core process of image-guided surgery (IGS) systems. We present a novel registration approach for application in laparoscopic liver surgery, which reconstructs in real time an intraoperative volume of the underlying intrahepatic vessels through an ultrasound (US) sweep process. Methods An existing IGS system for an open liver procedure was adapted, with suitable instrument tracking for laparoscopic equipment. Registration accuracy was evaluated on a realistic phantom by computing the target registration error (TRE) for 5 intrahepatic tumors. The registration work flow was evaluated by computing the time required for performing the registration. Additionally, a scheme for intraoperative accuracy assessment by visual overlay of the US image with preoperative image data was evaluated. Results The proposed registration method achieved an average TRE of 7.2 mm in the left lobe and 9.7 mm in the right lobe. The average time required for performing the registration was 12 minutes. A positive correlation was found between the intraoperative accuracy assessment and the obtained TREs. Conclusions The registration accuracy of the proposed method is adequate for laparoscopic intrahepatic tumor targeting. The presented approach is feasible and fast and may, therefore, not be disruptive to the current surgical work flow.
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Belli A, Fantini C, Cioffi L, D’Agostino A, Belli G. Mils for HCC: the state of art. Updates Surg 2015; 67:105-9. [DOI: 10.1007/s13304-015-0316-1] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/11/2015] [Accepted: 06/26/2015] [Indexed: 02/06/2023]
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Limongelli P, Vitiello C, Belli A, Pai M, Tolone S, del Genio G, Brusciano L, Docimo G, Habib N, Belli G, Jiao LR, Docimo L. Costs of laparoscopic and open liver and pancreatic resection: A systematic review. World J Gastroenterol 2014; 20:17595-17602. [PMID: 25516675 PMCID: PMC4265622 DOI: 10.3748/wjg.v20.i46.17595] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2014] [Revised: 04/20/2014] [Accepted: 05/26/2014] [Indexed: 02/06/2023] Open
Abstract
AIM: To study costs of laparoscopic and open liver and pancreatic resections, all the compiled data from available observational studies were systematically reviewed.
METHODS: A systematic review of the literature was performed using the Medline, Embase, PubMed, and Cochrane databases to identify all studies published up to 2013 that compared laparoscopic and open liver [laparoscopic hepatic resection (LLR) vs open liver resection (OLR)] and pancreatic [laparoscopic pancreatic resection (LPR) vs open pancreatic resection] resection. The last search was conducted on October 30, 2013.
RESULTS: Four studies reported that LLR was associated with lower ward stay cost than OLR (2972 USD vs 5291 USD). The costs related to equipment (3345 USD vs 2207 USD) and theatre (14538 vs 11406) were reported higher for LLR. The total cost was lower in patients managed by LLR (19269 USD) compared to OLR (23419 USD). Four studies reported that LPR was associated with lower ward stay cost than OLR (6755 vs 9826 USD). The costs related to equipment (2496 USD vs 1630 USD) and theatre (5563 vs 4444) were reported higher for LPR. The total cost was lower in the LPR (8825 USD) compared to OLR (13380 USD).
CONCLUSION: This systematic review support the economic advantage of laparoscopic over open approach to liver and pancreatic resection.
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Dua MM, Worhunsky DJ, Hwa K, Poultsides GA, Norton JA, Visser BC. Extracorporeal Pringle for laparoscopic liver resection. Surg Endosc 2014; 29:1348-55. [DOI: 10.1007/s00464-014-3801-6] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2014] [Accepted: 08/05/2014] [Indexed: 01/26/2023]
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Tolone S, Docimo G, Del Genio G, Brusciano L, Verde I, Gili S, Vitiello C, D'Alessandro A, Casalino G, Lucido F, Leone N, Pirozzi R, Ruggiero R, Docimo L. Long term quality of life after laparoscopic antireflux surgery for the elderly. BMC Surg 2014. [PMID: 24267446 DOI: 10.1186/1471-2482-13-s2-s10\r1471-2482-13-s2-s10[pii]] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/07/2023] Open
Abstract
BACKGROUND Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. METHODS Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. RESULTS Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). CONCLUSIONS In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.
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Tolone S, Docimo G, Del Genio G, Brusciano L, Verde I, Gili S, Vitiello C, D'Alessandro A, Casalino G, Lucido F, Leone N, Pirozzi R, Ruggiero R, Docimo L. Long term quality of life after laparoscopic antireflux surgery for the elderly. BMC Surg 2013; 13 Suppl 2:S10. [PMID: 24267446 PMCID: PMC3851040 DOI: 10.1186/1471-2482-13-s2-s10] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Abstract
Background Studies have previously shown laparoscopic antireflux surgery is a safe and effective treatment for GERD even in elderly patients. The aim of the current study was to evaluate patients receiving laparoscopic antireflux surgery before and after 65 years of age and to assess their surgical outcomes and improvements in long term quality of life. Methods Patients were given a standardized symptoms questionnaire and the Short-Form 36 Health Survey for quality-of-life evaluation before and after laparoscopic total fundoplication. Results Forty-nine patients older than 65 years of age were defined as the elderly group (EG) whereas the remaining 262 younger than 65 years of age were defined as the young group (YG). There were 114 (36.6%) patients who filled out the SF36 questionnaire (98 in the younger group, rate: 37.4%; 16 in the elderly group, rate: 32.6%) pre- and post-operatively. There was no significant difference between the two age groups regarding preoperative PCS ( 45.6 ± 7.8 in YG vs. 44.2 ± 8.2 in EG; P = 0.51) and MCS ( 48.1 ± 10.7 in YG vs. 46.9 ± 9.2 in EG; P = 0.67). There was no significant difference between the two age groups regarding postoperative PCS (49.8 ± 11.9 in YG and 48.2 ± 9.5 in EG ; P = 0.61 and MCS (48.4 ± 10.7 in YG vs. 50.1 ± 6.9 in EG; P = 0.54). Conclusions In conclusion, laparoscopic total fundoplication is a safe and effective surgical treatment for gastroesophageal reflux disease generally warranting low morbidity and mortality rates and a significant improvement of symptoms comparable. An improved long-term quality of life is warranted even in the elderly.
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Docimo G, Limongelli P, Conzo G, Gili S, Bosco A, Rizzuto A, Amoroso V, Marsico S, Leone N, Esposito A, Vitiello C, Fei L, Parmeggiani D, Docimo L. Axillary lymphadenectomy for breast cancer in elderly patients and fibrin glue. BMC Surg 2013; 13 Suppl 2:S8. [PMID: 24266959 PMCID: PMC3851152 DOI: 10.1186/1471-2482-13-s2-s8] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Axillary lymphadenectomy or sentinel biopsy is integral part of breast cancer treatment, yet seroma formation occurs in 15-85% of cases. Among methods employed to reduce seroma magnitude and duration, fibrin glue has been proposed in numerous studies with controversial results. METHODS Thirty patients over 60 years underwent quadrantectomy or mastectomy with level I/II axillary lymphadenectomy; a suction drain was fitted in all patients. Fibrin glue spray were applied to the axillary fossa in 15 patients; the other 15 patients were treated with harmonic scalpel. RESULTS Suction drainage was removed between post-operative Days 3 and 4. Seroma magnitude and duration were not significant in patients receiving fibrin glue compared with the harmonic scalpel group. CONCLUSIONS Use of fibrin glue does not always prevent seroma formation, but can reduce seroma magnitude, duration and necessary evacuative punctures.
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Belli G, Gayet B, Han HS, Wakabayashi G, Kim KH, Cannon R, Kaneko H, Gamblin T, Koffron A, Dagher I, Buell JF. Laparoscopic left hemihepatectomy a consideration for acceptance as standard of care. Surg Endosc 2013; 27:2721-6. [DOI: 10.1007/s00464-013-2840-8] [Citation(s) in RCA: 53] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/03/2012] [Accepted: 01/21/2013] [Indexed: 12/16/2022]
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Segment 6: Laparoscopic Approach. Updates Surg 2013. [DOI: 10.1007/978-88-470-2664-3_32] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Scuderi V, Ceriello A, Aragiusto G, Giuliani A, Calise F. Encircling the Pedicle for the Pringle Maneuver. Updates Surg 2013. [DOI: 10.1007/978-88-470-2664-3_15] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
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Casaccia M, Andorno E, Di Domenico S, Santori G, Fazio F, Gelli M, Valente U. Laparoscopic right posterior sectionectomy for hepatocellular carcinoma using a modified liver-hanging maneuver. J Laparoendosc Adv Surg Tech A 2012; 22:488-91. [PMID: 22462648 DOI: 10.1089/lap.2011.0491] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
BACKGROUND Posterosuperior liver segments are the most difficult locations for laparoscopy to access. This location is considered by most surgeons to be a poor indication for a laparoscopic liver resection due to the limited visualization and the difficulty of controlling bleeding. The liver-hanging maneuver (LHM) is a technique taking aim at reducing intraoperative blood loss through an open approach. METHODS We report our early experience on adopting a modified liver-hanging technique to perform a totally laparoscopic right posterior sectionectomy to remove a 5-cm hepatocellular carcinoma located in Couinaud's segments 6 and 7. RESULTS The procedure was completed laparoscopically with acceptable time of surgery and blood loss. A 3.5-cm tumor-free resection margin was achieved. The patient was discharged on postoperative Day 10 without complications. No evidence of recurrence was seen at the 12-month follow-up. CONCLUSIONS Total laparoscopic posterior sectionectomy using a modified LHM is a possible operative procedure greatly facilitating surgical manipulation. This maneuver was successfully used to mobilize the liver, to guide the hepatic transection, and to prevent bleeding. The potential advantages of this procedure should be evaluated in a comparative study on a large number of patients.
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Affiliation(s)
- Marco Casaccia
- Advanced Laparoscopy Unit, General and Transplant Surgery Department, St Martino Hospital, University of Genoa, Genoa, Italy.
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Rotellar F, Pardo F, Bueno A, Martí-Cruchaga P, Zozaya G. Extracorporeal tourniquet method for intermittent hepatic pedicle clamping during laparoscopic liver surgery: an easy, cheap, and effective technique. Langenbecks Arch Surg 2011; 397:481-5. [PMID: 22183106 DOI: 10.1007/s00423-011-0887-3] [Citation(s) in RCA: 36] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/15/2011] [Accepted: 11/29/2011] [Indexed: 12/27/2022]
Abstract
PURPOSE This paper aims to describe an extracorporeal tourniquet (ET) method for laparoscopic Pringle maneuver (PM). PATIENTS AND TECHNIQUE From January 2007 to June 2011, we have performed 44 laparoscopic hepatic resections: one hand-assisted and 43 totally laparoscopic procedures. In 39 of these patients, an ET was prepared. In 20 cases (lesions posteriorly located), the patient was placed in the left lateral position, and in 19 cases (lesions anteriorly located), in the supine position. The ET is prepared according to the following steps: from the right flank and through the foramen of Winslow, a grasper is passed behind the hepatoduodenal ligament to place a 75-cm cotton tape around it. The tape is externalized through a 5-mm incision and then passed through a 22CH Tiemann catheter whose ends are cut. The internal end of the catheter is left close to the pedicle, while the other part, with the ends of the tape, is kept outside. The PM is performed from outside the abdomen. RESULTS In every patient, the ET was uneventfully prepared. No unsuccessful attempts were made. Intermittent clamping was applied. Median (interquartile range) occlusion time was 47.5 min (26.7-64.2). No lesions of any structures related to the placement and use of the tourniquet were observed. CONCLUSIONS This ET for laparoscopic liver resection is easy to prepare and its use simple, fast, and safe.
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Affiliation(s)
- Fernando Rotellar
- Department of General and Abdominal Surgery, University Clinic of Navarre, University of Navarre, Avda. Pio XII no. 36, Pamplona, Spain.
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Belli G, D'Agostino A, Fantini C, Belli A, Cioffi L, Limongelli P, Russo G. Laparoscopic hand-assisted right hemihepatectomy by ultrasound-directed intrahepatic approach. ACTA ACUST UNITED AC 2010; 16:781-5. [PMID: 19779667 DOI: 10.1007/s00534-009-0156-9] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/09/2009] [Accepted: 07/02/2009] [Indexed: 01/25/2023]
Abstract
BACKGROUND/PURPOSE Laparoscopic hepatectomy is a promising option for patients affected by a liver mass, and the procedure is gaining popularity. Minor laparoscopic resections have been widely reported. In contrast, major laparoscopic hepatectomy has been performed in only a limited number of cases. Hand-assisted laparoscopic liver surgery has been advocated in order to improve liver exposure and vascular control and increase the safety of the procedure. Transparenchymal en-bloc transection of the right portal triad has been reported to be safe and useful in open surgery. METHODS We describe a personal technique for hand-assisted right hemihepatectomy. With ultrasound guidance, the right hepatic pedicle is isolated intrahepatically and transected en bloc with a single firing of an endostapler. Parenchymal transection is carried out with ultrasonically activated or vessel-sealing devices together with endostaplers. RESULTS The procedure was successfully accomplished in three patients. The Pringle maneuver was never performed. No intraoperative or postoperative complications occurred. CONCLUSION This study is the first to report a technique of right hemihepatectomy that combines hand-assisted laparoscopy and an ultrasound-guided intrahepatic approach. This technique may be a useful option to simplify the operation, reduce operative time, and increase the safety of the procedure.
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Affiliation(s)
- Giulio Belli
- Department of General and Hepato-Pancreato-Biliary Surgery, S.M. Loreto Nuovo Hospital, Naples, Italy.
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Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc 2009; 24:246. [PMID: 19688384 DOI: 10.1007/s00464-009-0667-0] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2009] [Accepted: 07/18/2009] [Indexed: 10/20/2022]
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Belli G, Limongelli P, Fantini C, D'Agostino A, Cioffi L, Belli A, Russo G. Laparoscopic and open treatment of hepatocellular carcinoma in patients with cirrhosis. Br J Surg 2009; 96:1041-8. [DOI: 10.1002/bjs.6680] [Citation(s) in RCA: 166] [Impact Index Per Article: 10.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Abstract
Background
Few studies have compared survival and recurrence rates between laparoscopic and open liver resection for hepatocellular carcinoma in patients with cirrhosis.
Methods
A retrospective analysis of a prospectively maintained database of 179 liver resections performed for HCC in cirrhotic liver between 2000 and 2007 was performed.
Results
Fifty-four patients underwent a laparoscopic resection and 125 patients had open surgery. Histopathological features were largely comparable in the two groups. Tumours operated laparoscopically were smaller than those removed at open operation and laparoscopic liver resection was less extensive. Laparoscopic surgery had a lower morbidity rate than open surgery (19 versus 36·0 per cent; P = 0·020), whereas 30-day mortality was similar (2 versus 4·0 per cent; P = 0·615). After a median follow-up of 24 months, 1- and 3-year survival rates were 94 and 67 per cent in the laparoscopic group. Recurrence rates were similar after laparoscopic and open procedures (45 versus 52·5 per cent; P = 0·381), as was disease-free survival (P = 0·864).
Conclusion
Laparoscopic resection of HCC in cirrhotic liver is feasible and safe in selected patients. Adequate long-term survival and recurrence is achieved compared with open surgery, when stratified for tumour characteristics known to be related to survival outcome.
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Affiliation(s)
- G Belli
- Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy
| | - P Limongelli
- Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy
| | - C Fantini
- Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy
| | - A D'Agostino
- Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy
| | - L Cioffi
- Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy
| | - A Belli
- Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy
| | - G Russo
- Department of General and Hepato-Pancreato-Biliary Surgery, S. M. Loreto Nuovo Hospital Via A. Vespucci, 80142 Naples, Italy
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Belli G, Fantini C, D'Agostino A, Cioffi L, Limongelli P, Russo G, Belli A. Re: Safe and feasible inflow occlusion in laparoscopic liver resection. Surg Endosc 2009; 23:1686. [PMID: 19466487 DOI: 10.1007/s00464-009-0519-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2009] [Accepted: 04/01/2009] [Indexed: 11/29/2022]
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Sekimoto M, Nishikawa A, Taniguchi K, Takiguchi S, Miyazaki F, Doki Y, Mori M. Development of a compact laparoscope manipulator (P-arm). Surg Endosc 2009; 23:2596-604. [PMID: 19357921 DOI: 10.1007/s00464-009-0460-0] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Revised: 03/08/2009] [Accepted: 03/14/2009] [Indexed: 10/20/2022]
Abstract
BACKGROUND Laparoscope manipulating robots are useful for maintaining a stable view during a laparoscopic operation and as a substitute for the surgeon who controls the laparoscope. However, there are several problems to be solved. A large apparatus sometimes interferes with the surgeon. The setting and repositioning is awkward. Furthermore, the initial and maintenance costs are expensive. This study was designed to develop a new laparoscope manipulating robot to overcome those problems. METHODS We developed a compact robot applicable for various types of laparoscopic surgery with less expensive materials. The robot was evaluated by performing an in vitro laparoscopic cholecystectomy using extracted swine organs. Then, the availability of the robot to various operations was validated by performing a laparoscopic cholecystectomy, anterior resection of the rectum, and distal gastrectomy using a living swine. The reliability of the system was tested by long-time continuous running. RESULTS A compact and lightweight laparoscope manipulating robot by the name of P-arm was developed. The surgical time of an in vitro laparoscopic cholecystectomy with and without the P-arm was not different. The three types of operations were accomplished successfully. During the entire procedure, the P-arm worked without trouble and did not interfere with the surgeons. Continuous 8-h operating tests were performed three times and neither discontinuance nor trouble occurred with the system. CONCLUSIONS The P-arm worked steadily for various swine operations, without interfering with surgeon's work.
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Affiliation(s)
- Mitsugu Sekimoto
- Department of Gastroenterological Surgery, Osaka University Graduate School of Medicine, 2-2 Yamadaoka Suita, Osaka, 565-0871, Japan.
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