|
1
|
Wu J, Liu F, Sun W, Liu Z, Hou H, Jiang R, Hu H, Ren P, Zhang R, Zhang X. Boundary-aware convolutional attention network for liver segmentation in ultrasound images. Sci Rep 2024; 14:21529. [PMID: 39278955 PMCID: PMC11403006 DOI: 10.1038/s41598-024-70527-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/15/2024] [Accepted: 08/19/2024] [Indexed: 09/18/2024] Open
Abstract
Liver ultrasound is widely used in clinical practice due to its advantages of non-invasiveness, non-radiation, and real-time imaging. Accurate segmentation of the liver region in ultrasound images is essential for accelerating the auxiliary diagnosis of liver-related diseases. This paper proposes BACANet, a deep learning algorithm designed for real-time liver ultrasound segmentation. Our approach utilizes a lightweight network backbone for liver feature extraction and incorporates a convolutional attention mechanism to enhance the network's ability to capture global contextual information. To improve early localization of liver boundaries, we developed a selective large kernel convolution module for boundary feature extraction and introduced explicit liver boundary supervision. Additionally, we designed an enhanced attention gate to efficiently convey liver body and boundary features to the decoder to enhance the feature representation capability. Experimental results across multiple datasets demonstrate that BACANet effectively completes the task of liver ultrasound segmentation, achieving a balance between inference speed and segmentation accuracy. On a public dataset, BACANet achieved a DSC of 0.921 and an IOU of 0.854. On a private test dataset, BACANet achieved a DSC of 0.950 and an IOU of 0.907, with an inference time of approximately 0.32 s per image on a CPU processor.
Collapse
Affiliation(s)
- Jiawei Wu
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Fulong Liu
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Weiqin Sun
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Zhipeng Liu
- Department of Information, Taizhou People's Hospital Affiliated to Nanjing Medical University, Taizhou, 225300, China
| | - Hui Hou
- Department of Imaging, The Fourth People's Hospital of Taizhou in Jiangsu Province, Taizhou, 225300, China
| | - Rui Jiang
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Haowei Hu
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Peng Ren
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Ran Zhang
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China
| | - Xiao Zhang
- School of Medical Informatics and Engineering, Xuzhou Medical University, Xuzhou, 221000, China.
- Yantai Longch Technologies Co., Ltd, Yantai, 264000, China.
| |
Collapse
|
|
2
|
Fontana AP, Russolillo N, Di Menno Stavron J, Langella S, Tesoriere RL, Ricotti A, Ferrero A. Inverse probability of treatment weighting analysis of laparoscopic versus open Sg4b-5 bi-segmentectomy in patients with gallbladder cancer. Updates Surg 2023; 75:1471-1480. [PMID: 37495871 DOI: 10.1007/s13304-023-01599-0] [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: 04/10/2023] [Accepted: 07/15/2023] [Indexed: 07/28/2023]
Abstract
Sg4b-5 anatomical bi-segmentectomy with regional lymphadenectomy (Sg4b5) is a surgical option for gallbladder cancer (GBC) treatment. The laparoscopic approach to this challenging operation is still controversial. Aim of this study was to compare short- and long-term outcomes of laparoscopic versus open Sg4b5 in a single institution series of patients. All consecutive patients who underwent Sg4b5 for GBC from January 2000 to September 2021 were retrospectively reviewed. Inverse probability of treatment weighting (IPTW) analysis was performed. 75 patients were analyzed, 18 in the laparoscopic and 57 in the open group. After IPTW, laparoscopic approach was associated with a significantly decreased median intraoperative blood loss (100 vs 237.09 ml, p = 0.001), shorter median length of hospital stay (4 vs 8 days, p = < 0.001) and a higher median number of harvested nodes (9 vs 7, p = 0.026). Operation time was shorter in the open group (355 vs 259 min, p < 0.001). No significant differences were found regarding clear resection margins, overall and major (Clavien-Dindo ≥ 3) morbidity, bile leakage rate, 90 days post-operative mortality, overall and disease-free survival. Laparoscopic Sg4b-5 anatomical bi-segmentectomy and regional lymphadenectomy is feasible and safe with long term outcome comparable to open approach at least in early stages. Laparoscopic approach confirms its well-known short-term benefits with less intraoperative bleeding and shorter length of stay. Moreover, it might allow a better lymphadenectomy.
Collapse
Affiliation(s)
- Andrea P Fontana
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy.
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Juliana Di Menno Stavron
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| | - Andrea Ricotti
- Clinical Trial Unit, Medical Direction of Hospital, Mauriziano Hospital, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Largo Turati 62, 10128, Turin, Italy
| |
Collapse
|
|
3
|
Liu R, Abu Hilal M, Wakabayashi G, Han HS, Palanivelu C, Boggi U, Hackert T, Kim HJ, Wang XY, Hu MG, Choi GH, Panaro F, He J, Efanov M, Yin XY, Croner RS, Fong YM, Zhu JY, Wu Z, Sun CD, Lee JH, Marino MV, Ganpati IS, Zhu P, Wang ZZ, Yang KH, Fan J, Chen XP, Lau WY. International experts consensus guidelines on robotic liver resection in 2023. World J Gastroenterol 2023; 29:4815-4830. [PMID: 37701136 PMCID: PMC10494765 DOI: 10.3748/wjg.v29.i32.4815] [Citation(s) in RCA: 26] [Impact Index Per Article: 13.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/05/2023] [Revised: 07/22/2023] [Accepted: 08/09/2023] [Indexed: 08/25/2023] Open
Abstract
The robotic liver resection (RLR) has been increasingly applied in recent years and its benefits shown in some aspects owing to the technical advancement of robotic surgical system, however, controversies still exist. Based on the foundation of the previous consensus statement, this new consensus document aimed to update clinical recommendations and provide guidance to improve the outcomes of RLR clinical practice. The guideline steering group and guideline expert group were formed by 29 international experts of liver surgery and evidence-based medicine (EBM). Relevant literature was reviewed and analyzed by the evidence evaluation group. According to the WHO Handbook for Guideline Development, the Guidance Principles of Development and Amendment of the Guidelines for Clinical Diagnosis and Treatment in China 2022, a total of 14 recommendations were generated. Among them were 8 recommendations formulated by the GRADE method, and the remaining 6 recommendations were formulated based on literature review and experts' opinion due to insufficient EBM results. This international experts consensus guideline offered guidance for the safe and effective clinical practice and the research direction of RLR in future.
Collapse
Affiliation(s)
- Rong Liu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Mohammed Abu Hilal
- Hepatobiliary Pancreatic, Robotic & Laparoscopic Surgery, Poliambulanza Foundation Hospital, Brescia 25100, Italy
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Saitama 362-0075, Japan
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul 03080, South Korea
| | - Chinnusamy Palanivelu
- GEM Hospital & Research Centre, GEM Hospital & Research Centre, Coimbatore 641045, India
| | - Ugo Boggi
- Division of General and Transplant Surgery, University of Pisa, Pisa 56126, Italy
| | - Thilo Hackert
- Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg 20251, Germany
| | - Hong-Jin Kim
- Department of Surgery, Yeungnam University Hospital, Daegu 42415, South Korea
| | - Xiao-Ying Wang
- Department of Liver Surgery and Transplantation, Liver Cancer Institute, Zhongshan Hospital, Fudan University, Shanghai 200032, China
| | - Ming-Gen Hu
- Faculty of Hepato-Pancreato-Biliary Surgery, The First Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Gi Hong Choi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Severance Hospital, Yonsei University, College of Medicine, Seoul 03722, South Korea
| | - Fabrizio Panaro
- Department of Surgery/Division of Robotic and HBP Surgery, Montpellier University Hospital-School of Medicine, Montpellier 34090, France
| | - Jin He
- Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD 21218, United States
| | - Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, Moscow 111123, Russia
| | - Xiao-Yu Yin
- Department of Pancreatobiliary Surgery, The First Affiliated Hospital, Sun Yat-Sen University, Guangzhou 510080, Guangdong Province, China
| | - Roland S Croner
- Department of General, Visceral, Vascular and Transplant Surgery, University Hospital Magdeburg, Magdeburg 39120, Germany
| | - Yu-Man Fong
- Department of Surgery, City of Hope Medical Center, Duarte, CA 91010, United States
| | - Ji-Ye Zhu
- Department of Hepatobiliary Surgery, Peking University People’s Hospital, Beijing 100000, China
| | - Zheng Wu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Xi’an Jiaotong University, Xi’an 710061, Shaanxi Province, China
| | - Chuan-Dong Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Affiliated Hospital of Qingdao University, Qingdao 266000, Shandong Province, China
| | - Jae Hoon Lee
- Division of Hepatobiliary & Pancreatic surgery, Asan Medical Center, University of Ulsan College of Medicine, Ulsan 682, South Korea
| | - Marco V Marino
- General Surgery Department, F. Tappeiner Hospital, Merano 39012, Italy
| | - Iyer Shridhar Ganpati
- Hepatobiliary and Pancreatic Surgery, National University Hospital, Singapore 189969, Singapore
| | - Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Zi-Zheng Wang
- Department of Hepatobiliary Surgery, Senior Department of Hepatology, The Fifth Medical Center of Chinese PLA General Hospital, Beijing 100000, China
| | - Ke-Hu Yang
- Evidence-Based Medicine Center, Lanzhou University, Lanzhou 730000, Gansu Province, China
| | - Jia Fan
- Zhongshan Hospital, Fudan University, Shanghai 200000, China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430000, Hubei Province, China
| | - Wan Yee Lau
- Faculty of Medicine, The Chinese University of Hong Kong, Hong Kong 999077, China
| |
Collapse
|
|
4
|
Lv X, Zhang L, Yu X, Yu H. The difficulty grade of laparoscopic hepatectomy for hepatocellular carcinoma correlates with long-term outcomes. Updates Surg 2023:10.1007/s13304-023-01452-4. [PMID: 36773170 DOI: 10.1007/s13304-023-01452-4] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2022] [Accepted: 02/03/2023] [Indexed: 02/12/2023]
Abstract
The tremendous development of laparoscopic hepatectomy helps to relieve the difficulties encountered during open hepatectomy. Therefore, a difficulty scoring system was produced to assess the difficulty grade of laparoscopic hepatectomy. The aim of this study was to explore whether the IWATE-DSS is comparable to the long-term outcomes of LH for hepatocellular carcinoma. Clinical data from all consecutive patients who underwent laparoscopic hepatectomy for hepatocellular carcinoma at the Sir Run Run Shaw Hospital, Hangzhou, were prospectively collected and reviewed. The difficulty level of the operations was graded using the IWATE-DSS. The perioperative and postoperative outcomes of laparoscopic hepatectomy were compared at each difficulty level. A total of 300 patients underwent laparoscopic hepatectomy for HCC during the study period. The perioperative and postoperative outcomes were significantly different between the groups according to the IWATE-DSS. There were significant differences in both the intraoperative (bleeding control p = 0.000; surgical time p = 0.000; estimated blood loss p = 0.033) and postoperative variables (postoperative hospital stay p = 0.005) among these four groups. The 5-year disease-free survival decreased significantly along with the LH difficulty score (p = 0.000). The 5-year overall survival also decreased significantly along with the LH difficulty score (p = 0.000). IWATE-DSS was significantly correlated with short- and long-term outcomes in patients who underwent laparoscopic hepatectomy for HCC.
Collapse
Affiliation(s)
- Xiaocui Lv
- Department of Anesthesia, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Hangzhou, Zhejiang, China
| | - Lina Zhang
- Department of Anesthesia, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Hangzhou, Zhejiang, China
| | - Xin Yu
- Department of Anesthesia, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Hangzhou, Zhejiang, China.
| | - Hong Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, No. 3 Qingchun East Road, Hangzhou, Zhejiang, China.
| |
Collapse
|
|
5
|
Zhang X, Huang Z, Lu H, Yang X, Cao L, Wen Z, Zheng Q, Peng H, Xue P, Jiang X. Identification of resection plane for anatomical liver resection using ultrasonography-guided needle insertion. Front Surg 2023; 9:1035315. [PMID: 36756661 PMCID: PMC9899840 DOI: 10.3389/fsurg.2022.1035315] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/02/2022] [Accepted: 11/29/2022] [Indexed: 01/24/2023] Open
Abstract
Purposes To set up an easy-handled and precise delineation of resection plane for hepatic anatomical resection (AR). Methods Cases of AR using ultrasonography-guided needle insertion to trace the target hepatic vein for delineation of resection planes [new technique (NT) group, n = 22] were retrospectively compared with those without implementation of this surgical technique [traditional technique (TT) group, n = 29] in terms of perioperative courses and surgical outcomes. Results The target hepatic vein was successfully exposed in all patients of the NT group, compared with a success rate of 79.3% in the TT group (P < 0.05). The average operation time and intraoperative blood loss were 280 ± 32 min and 550 ± 65 ml, respectively, in the NT group. No blood transfusion was required in either group. The postoperative morbidities (bile leakage and peritoneal effusion) were similar between groups. No mortality within 90 days was observed. Conclusions Ultrasonography-guided needle insertion is a convenient, safe and efficient surgical approach to define a resection plane for conducting AR.
Collapse
|
|
6
|
Nassar A, Tzedakis S, Dhote A, Strigalev M, Coriat R, Karoui M, Dohan A, Gaillard M, Marchese U, Fuks D. Multiple Laparoscopic Liver Resection for Colorectal Liver Metastases. Cancers (Basel) 2023; 15:cancers15020435. [PMID: 36672384 PMCID: PMC9856366 DOI: 10.3390/cancers15020435] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 12/29/2022] [Accepted: 01/07/2023] [Indexed: 01/12/2023] Open
Abstract
Over the past decades, liver cancer's minimally invasive approach has primarily become as a new standard of oncological care. Colorectal liver metastases (CRLM) are one of the most developed indications of laparoscopic liver resection (LLR). CRLM resection is still the best treatment known in terms of survival. As multiple CRLM are found in up to 80% of cases at diagnosis (Manfredi S. and al, Annals of Surgery 2006), a lot of possible technical management approaches are described. With the development of the parenchymal-sparing strategy, multiple concomitant laparoscopic liver resections (LLR) are gaining acceptance. However, no recommendation is available regarding its indications and feasibility. Also, laparoscopic two-stage hepatectomy is developing for bilobar CRLM, and this also does not have established recommendation. The purpose of this paper was to highlight novelty and updates in the field of multiple minimally invasive liver resections. A review of the international literature was performed. The feasibility of laparoscopic concomitant multiple LLR and two-stage hepatectomy for CRLM as well as their outcomes were discussed. These clarifications could further guide the implementation of minimal resection in multiple colorectal liver metastases therapies.
Collapse
Affiliation(s)
- Alexandra Nassar
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
- Correspondence: ; Tel.: +33-1-58-41-17-24
| | - Stylianos Tzedakis
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| | - Alix Dhote
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| | - Marie Strigalev
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| | - Romain Coriat
- Department of Gastroenterology and Digestive Oncology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| | - Mehdi Karoui
- Department of General Digestive Surgery and Cancerology, Hopital Européen Georges Pompidou, Université Paris Cité, 75015 Paris, France
| | - Anthony Dohan
- Department of Radiology, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| | - Martin Gaillard
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| | - Ugo Marchese
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| | - David Fuks
- Department of Hepato-Pancreatic-Biliary and Endocrine Surgery, Cochin Hospital, Assistance Publique-Hôpitaux de Paris Centre, Université Paris Cité, 75014 Paris, France
| |
Collapse
|
|
7
|
Lo Tesoriere R, Forchino F, Fracasso M, Russolillo N, Langella S, Ferrero A. Color Doppler Intraoperative Ultrasonography Evaluation of Hepatic Hemodynamics for Laparoscopic Parenchyma-Sparing Liver Resections. J Gastrointest Surg 2022; 26:2111-2118. [PMID: 35915379 DOI: 10.1007/s11605-022-05430-w] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/18/2022] [Accepted: 07/23/2022] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tumors involving the hepatic veins at the hepatocaval confluence often require major or extended hepatectomies. Color Doppler intraoperative ultrasonography (CD-IOUS) evaluation of liver hemodynamics to assess congestion in the veno-occlusive parenchyma provides real-time information helpful in parenchyma-sparing surgery (PSS). This study evaluated the feasibility of CD-IOUS in patients undergoing laparoscopic liver resections for such tumors and its capacity to allow PSS. METHODS Consecutive patients undergoing laparoscopic liver resection for tumors at the hepatocaval confluence requiring resection of at least one hepatic vein between January 2010 and August 2020 were included. Patients were divided in 3 groups: (A) patients not assessed with CD-IOUS because it would not change the scheduled operation; patients assessed with CD-IOUS and treated with (B) PSS and (C) no-PSS. Portal blood flow in the veno-occlusive parenchyma was assessed using CD-IOUS at baseline and after clamping the concerned hepatic vein. RESULTS The study included 43 out of 47 patients with tumors at the hepatocaval confluence. There were 19 patients in group A. Among patients assessed with CD-IOUS, the resection of 26 hepatic veins was planned: 25 were resected, and 1 was spared. Group B included 22 patients treated with PSS, whereas group C included 2 patients with resection of all veno-occlusive parenchyma. No postoperative mortality or major morbidity was observed. The median length of hospital stay was 5 days. CONCLUSIONS Selected patients with tumors involving the hepatocaval confluence can be safely approached using laparoscopy. CD-IOUS evaluation of the veno-occlusive area can increase the success rate of PSS.
Collapse
Affiliation(s)
- Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy.
| | - Fabio Forchino
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Mariasole Fracasso
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| |
Collapse
|
|
8
|
Tanaka R, Sonomura T, Ueno M, Koike M, Makitani A, Sato H, Fukuda K, Higashino N, Ikoma A, Murata SI, Minamiguchi H. Usefulness of ethiodized oil and gelatin sponge particles for delaying the washout of indocyanine green from the liver in swine. Jpn J Radiol 2022; 40:1300-1306. [PMID: 35841454 DOI: 10.1007/s11604-022-01315-9] [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: 05/10/2022] [Accepted: 06/30/2022] [Indexed: 11/24/2022]
Abstract
PURPOSE To assess the effect of ethiodized oil (EO) and gelatin sponge particles (GS) on delaying the washout of indocyanine green (ICG) from the liver in swine. METHODS Fifteen swine were divided into 3 groups: injection of a mixture of ICG and water-soluble contrast medium (CM) followed by embolization with GS (group A), injection of a mixture of ICG and EO (group B) and injection of a mixture of ICG and EO followed by embolization with GS (group C). The liver surface was observed using an infrared camera system during and at 1, 2, 3, and 6 h after the procedure to measure ICG contrast. Livers were removed at 6 h for histopathological examination. RESULTS The contrast ratio between injected and non-injected regions at 6 h was 1.45 ± 0.44 in group A, 1.89 ± 0.37 in group B, and 3.62 ± 0.76 in group C. The contrast ratio in group C was significantly greater than that in groups A and B (P = 0.032 and 0.033, respectively). CONCLUSIONS EO and GS delayed the washout of ICG from the liver in swine and may extend intraoperative navigation in clinical use. Indocyanine green (ICG) mixed with ethiodized oil (EO) was injected into the left hepatic artery in swine, and the artery was embolized with gelatin sponge particles (GS). We confirmed that ICG remained in the liver parenchyma up to 6 h after the procedure. EO and GS delayed the washout of ICG from the liver in swine.
Collapse
Affiliation(s)
- Ryota Tanaka
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan.
| | - Tetsuo Sonomura
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Masaki Ueno
- Second Department of Surgery, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Masataka Koike
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Ayano Makitani
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Hirotatsu Sato
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Kodai Fukuda
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Nobuyuki Higashino
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Akira Ikoma
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Shin-Ichi Murata
- Department of Human Pathology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| | - Hiroki Minamiguchi
- Department of Radiology, Wakayama Medical University, 811-1 Kimiidera, Wakayama-shi, Wakayama, 641-8509, Japan
| |
Collapse
|
|
9
|
Russolillo N, Casella M, Langella S, Lo Tesoriere R, Ossola P, Ferrero A. Correlation between anthropometric data and preparatory maneuvers difficulties during laparoscopic right liver resections: a single center prospective study. Surg Endosc 2022; 36:7343-7351. [PMID: 35211801 DOI: 10.1007/s00464-022-09130-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2021] [Accepted: 02/09/2022] [Indexed: 11/29/2022]
Abstract
PURPOSE The difficulty of laparoscopic right liver resections (LRLR) is mainly associated with their poor accessibility. Anthropometric data rather than BMI was reported to predict transection time and blood loss. Aim of the study was to evaluate the correlation between anthropometric data and preparatory manoeuvres difficulties during LRLR. METHODS All patients who underwent LRLR requiring full right liver mobilization from November 2019 to March 2021 were prospectively included in the study. Data on surgeons' difficulty perceptions on liver mobilization (LM), isolation of right hepatic vein (RHVI), liver manageability and visibility were rated with a 5-point scale. Data on cranio-caudal liver diameters (CCliv), CHALLENGE Index (CCliv/latero-lateral abdomen diameter), times needed to LM and RHVI were collected. RESULTS Sixty-five patients (29 wedge and 36 anatomical resections) with a median BMI of 25.5 were analysed. One patient required open conversion due to oncological reason. No correlations between BMI and CCliv or CHALLENGE Index were found. Larger CCliv diameter correlated with longer time for both RHVI (r = 0.589, p = 0.002) and LM (r = 0.222, p = 0.049). Higher CHALLENGE index correlated with longer time for RHVI (r = 0.589, p = 0.002). The CHALLENGE index showed a linear correlation with difficulty to the isolation of RHV (r = 0.327, p = 0.045), whilst the liver manipulation difficulty increased with latero-lateral liver diameter (r = 0.244, p = 0.033). BMI had no correlation with the duration of preparatory maneuvers neither with surgeons' difficulties. CONCLUSIONS Anthropometric data can help to anticipate the difficulty of preparatory maneuvers during laparoscopic right liver resections.
Collapse
Affiliation(s)
- Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy. .,Department of General and Oncological Surgery, Umberto I Mauriziano Hospital Largo Turati, 62-10128, Turin, Italy.
| | - Michele Casella
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Paolo Ossola
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| |
Collapse
|
|
10
|
Felli E, Ishizawa T, Cherkaoui Z, Diana M, Tripon S, Baumert TF, Schuster C, Pessaux P. Laparoscopic anatomical liver resection for malignancies using positive or negative staining technique with intraoperative indocyanine green-fluorescence imaging. HPB (Oxford) 2021; 23:1647-1655. [PMID: 34289953 DOI: 10.1016/j.hpb.2021.05.006] [Citation(s) in RCA: 30] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/18/2021] [Revised: 05/18/2021] [Accepted: 05/24/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND Indications for a minimally invasive resections are increasing worldwide, but respecting anatomical planes during intraparenchymal transection is demanding. Intraoperative ICG fluorescence staining of liver parenchyma has been introduced as a tool for real-time intraoperative guidance. The aim of this study is to make a systematic review of the current relevant literature on indications, techniques, and results of laparoscopic anatomical liver resection (LALR) using intraoperative indocyanine green (ICG) fluorescence for positive and negative staining of liver segments in patients affected by liver malignancies. METHODS Electronic bibliographical databases (MEDLINE and PubMed) were searched according to the PRISMA criteria. English language articles meeting the selection criteria and published until June 2020 were retrieved and reviewed. RESULTS a total of 86 articles were initially found and 11 articles were finally included in the analysis with a total of 83 patients treated. Sixty-two patients (74.6%) underwent mono-segmentectomies. Thirty-five patients (42.1%) underwent the positive staining technique, and forty-eight patients (57.8%) the negative staining technique. CONCLUSIONS The positive or negative indocyanine green staining technique with real-time fluorescence guidance is an emerging and promising approach. However, the technique has to be standardized and advantages in terms of oncologic results still need validation in further studies.
Collapse
Affiliation(s)
- Emanuele Felli
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France
| | - Takeaki Ishizawa
- Department of Gastroenterological Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Ariake, Japan; Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Zineb Cherkaoui
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France
| | - Michele Diana
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France
| | - Simona Tripon
- Hepatology and Gastroenterology Department, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France
| | - Thomas F Baumert
- Hepatology and Gastroenterology Department, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France
| | | | - Patrick Pessaux
- Digestive and Endocrine Surgery, Nouvel Hôpital Civil, University of Strasbourg, Strasbourg, France; IHU Strasbourg, Institute for Image-Guided Surgery, Strasbourg, France; IRCAD, Research Institute Against Digestive Cancer, Strasbourg, France; Institute of Viral and Liver Disease, INSERM U1110, Strasbourg, France.
| |
Collapse
|
|
11
|
Langella S, Menonna F, Casella M, Russolillo N, Lo Tesoriere R, Alessandro F. Vascular Resection During Hepatectomy for Liver Malignancies. Results from a Tertiary Center using Autologous Peritoneal Patch for Venous Reconstruction. World J Surg 2021; 44:3100-3107. [PMID: 32418027 DOI: 10.1007/s00268-020-05564-5] [Citation(s) in RCA: 13] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
BACKGROUND To evaluate early outcomes of venous reconstruction with peritoneal patch (PP) during resection for hepatic malignancies. METHODS Since May 2015, PP was considered as the first option for venous reconstruction in the case of lateral resection. Between May 2015 and June 2019, 579 consecutive hepatectomies for malignancies were performed at our institution. Among 27 patients requiring venous resection, PP was used in 22, who were included in the present study. Data from a prospectively collected database were analysed. RESULTS Tumour types were ten colorectal metastases (CRLM), six intrahepatic cholangiocarcinomas, four hilar cholangiocarcinomas, one hepatocellular carcinoma and one gallbladder carcinoma. Hepatectomies were major in 50% of cases. Eleven patients had hepatic vein resections, eight portal vein and three inferior vena cava. Venous reconstruction enabled resection in 12 (54.5%) patients, otherwise non-resectable. Among CRLM, the venous reconstruction allowed avoidance of major resection in eight (80%) cases. Median operative time was 456 min (range 270-960). Blood loss was a median 300 cc (range 40-1500), and blood transfusions were required in three patients (13.6%). At pathological examination, venous infiltration was confirmed in 14 (63.6%) patients. No vascular complications related to the patch were recorded. Post-operative major (Dindo III/IV) complications were observed in two (9%) patients. One patient died because of liver failure without vascular thrombosis and one due to biliary fistula complicated by arterial bleeding. Overall, post-operative mortality was 9% (2/22). CONCLUSIONS Venous reconstruction with peritoneal patch during hepatectomy for malignancies can feasibly allow resection in otherwise unresectable patients and decrease the rate of major resection in colorectal liver metastases.
Collapse
Affiliation(s)
- Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy.
| | - Francesca Menonna
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Michele Casella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| | - Ferrero Alessandro
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I" Hospital, Largo Turati, 62, 10128, Turin, Italy
| |
Collapse
|
|
12
|
Laparoscopic hepatic lobectomy for symptomatic polycystic liver disease. HPB (Oxford) 2021; 23:56-62. [PMID: 32451237 DOI: 10.1016/j.hpb.2020.04.010] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/27/2020] [Revised: 04/15/2020] [Accepted: 04/20/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopic fenestration has largely replaced open fenestration of liver cysts. However, most hepatectomies for polycystic liver disease (PCLD) are performed open. Outcomes data on laparoscopic hepatectomy for PCLD are lacking. METHODS Patients who underwent surgery for PCLD at a single institution between 2010 and 2019 were reviewed and grouped by operative approach. Pre- and post-operative volumes were calculated for patients who underwent resection. Primary outcomes were: volume reduction, re-admission and postoperative complications. RESULTS Twenty-six patients were treated for PCLD: 13 laparoscopic fenestration, nine laparoscopic hepatectomy, three open hepatectomy and one liver transplantation. Median length of stay for patients after laparoscopic resection was 3 days (IQR 2-3). The only complication was post-operative atrial fibrillation in one patient. There were no readmissions. Overall volume reduction was 51% (range 22-69) for all resections, 32% (range 22-46) after open resection and 56% (range 39-69) after laparoscopic resection. CONCLUSION Volume reduction achieved through laparoscopic approach exceeded open volume reduction at this institution and is comparable to volume reduction in previously published open resection series. Adequate volume reduction can be accomplished by laparoscopic means with acceptable postoperative morbidity.
Collapse
|
|
13
|
Russolillo N, Maina C, Fleres F, Langella S, Lo Tesoriere R, Ferrero A. Comparison and validation of three difficulty scoring systems in laparoscopic liver surgery: a retrospective analysis on 300 cases. Surg Endosc 2020; 34:5484-5494. [PMID: 31950272 DOI: 10.1007/s00464-019-07345-1] [Citation(s) in RCA: 22] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Accepted: 12/24/2019] [Indexed: 02/07/2023]
Abstract
BACKGROUND Difficulty scores (DSs) have been proposed to rate laparoscopic liver resection (LLR) technical difficulty increasing surgical safety. The aim of the study was to validate three DSs (Hasegawa, Halls and Kawaguchi) and compare their ability to predict technical difficulty and postoperative outcomes. MATERIALS AND METHODS All patients who underwent LLR from January 2006 to January 2019 were analyzed. Exclusion criteria were cyst fenestrations, thermal ablation, missing data for the computation of the DS and a follow-up < 90 days. RESULTS The population comprised 300 patients. The DS distribution in the study population was: Halls low 55 (18.3%), moderate 82 (27.3%), high 111 (37%) and extremely high 52 (17.3%); Hasegawa low 130 (43.3%), medium 105 (35%) and high 65 (21.7%); Kawaguchi Grade I 194 (64.7%), Grade II 47 (15.7%) and Grade III 59 (19.7%). Hasegawa and Kawaguchi showed the strongest correlation (r = 0.798, p < 0.001). Technical complexity, evaluated using the Pringle maneuver, Pringle time, blood loss and operative time, increased significantly with Hasegawa and Kawaguchi score classes (p < 0.001 for all comparisons). None of the scores properly stratified postoperative complications. The highest Kawaguchi (23.7% grade III vs. 13.7% grades I and II, p = 0.057) and Hasegawa (24.6% high vs. 13.2% low/medium, p = 0.025) classes had a higher overall morbidity rate than medium-low ones. CONCLUSIONS Kawaguchi and Hasegawa scores predicted LLR's technical difficulty. None of the scores discriminated the postoperative complication risk of low classes compared with medium ones.
Collapse
Affiliation(s)
- Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy.
- Umberto I Mauriziano Hospital, Largo Turati, 62, 10128, Turin, Italy.
| | - Cecilia Maina
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Francesco Fleres
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital, Turin, Italy
| |
Collapse
|
|
14
|
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]
|
|
15
|
Russolillo N, Maina C, Langella S, Lo Tesoriere R, Casella M, Ferrero A. Impact of anthropometric data on technical difficulty of laparoscopic liver of resections of segments 7 and 8: the CHALLENGE index. Surg Endosc 2020; 35:5088-5095. [PMID: 32968919 DOI: 10.1007/s00464-020-07993-8] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/08/2020] [Accepted: 09/14/2020] [Indexed: 12/16/2022]
Abstract
BACKGROUND The high technical difficulty of using a laparoscopic approach to reach the posterosuperior liver segments is mainly associated with their poor accessibility. This study was performed to analyze correlations between anthropometric data and intraoperative outcomes. STUDY DESIGN All patients who underwent segmentectomy or wedge laparoscopic liver resection (LLR) of segments seven and/or eight from June 2012 to November 2019 were retrospectively analyzed. The exclusion criteria were intrahepatic cholangiocarcinoma, associated resection, multiple concomitant LLR, redo resection, and lack of preoperative imaging. Anthropometric data were correlated with intraoperative outcomes. RESULTS Forty-one patients (wedge resection, n = 32; segmentectomy, n = 9) were analyzed. A strong correlation was found between the craniocaudal liver diameter (CCliv) and liver volume (r = 0.655, p < 0.001). The anteroposterior liver diameter was moderately correlated with both the laterolateral abdominal diameter (LLabd) (r = 0.372, p = 0.008) and anteroposterior abdominal diameter (r = 0.371, p = 0.008). The body mass index (BMI) was not correlated with liver diameters. Women had a longer CCliv (p = 0.002) and shorter LLabd (p < 0.001) than men. The liver and abdominal measurements were combined to reduce this sex-related disparity. The CCliv/LLabd ratio (CHALLENGE index) was significantly correlated with the time of transection (r = 0.382, p = 0.037) and blood loss (r = 0.352, p = 0.029). The association between the CHALLENGE index and intraoperative blood loss was even stronger when considering only anatomical resection (r = 0.577, p = 0.048). A CHALLENGE index of > 0.4 (area under the curve, 0.757; p = 0.046) indicated a higher bleeding risk. The BMI predicted no intraoperative outcomes. CONCLUSION Anthropometric data rather than the BMI can help anticipate the difficulty of LLR of segments seven and eight.
Collapse
Affiliation(s)
- Nadia Russolillo
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, 62-10128, Turin, Italy.
| | - Cecilia Maina
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, 62-10128, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, 62-10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, 62-10128, Turin, Italy
| | - Michele Casella
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, 62-10128, Turin, Italy
| | - Alessandro Ferrero
- Department of General and Oncological Surgery, Umberto I Mauriziano Hospital, Largo Turati, 62-10128, Turin, Italy
| |
Collapse
|
|
16
|
Ferrero A, Lo Tesoriere R, Giovanardi F, Langella S, Forchino F, Russolillo N. Laparoscopic right posterior anatomic liver resections with Glissonean pedicle-first and venous craniocaudal approach. Surg Endosc 2020; 35:449-455. [PMID: 32833101 DOI: 10.1007/s00464-020-07916-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2020] [Accepted: 08/17/2020] [Indexed: 12/22/2022]
Abstract
BACKGROUND Laparoscopic segment 7 segmentectomy and segment 6-7 bisegmentectomy are challenging resections because of the posterior position and the lack of landmarks. The anatomy of the right posterior Glissonean pedicle and the caudal view of laparoscopy make such resections suitable for the Glissonean pedicle-first approach. METHODS The study population included all consecutive patients treated with laparoscopic liver resection from August 2019 to February 2020. The approach is based on the ultrasonographic identification of the right posterior or segmental pedicle from the dorsal side of the liver after complete mobilization. The pedicle of interest is isolated through mini-hepatotomy and clamped. The segment anatomy is defined by ischemia. The transection starts from the ventral side, close to the right hepatic vein that is exposed and followed craniocaudally. RESULTS Ten patients underwent anatomical laparoscopic resection of right posterolateral segments. There were 7 colorectal liver metastases, 2 hepatocellular carcinoma, and 1 biliary cysto-adenoma. Five patients underwent Sg7 resection, one patient underwent a Sg7 subsegmentectomy, and 4 underwent Sg6-7 bisegmentectomy. The Glissonean pedicle-first approach was feasible in eight patients. The craniocaudal approach to the RHV was feasible in six patients, not indicated in three cases and was abandoned in one patient for technical difficulty. There was no operative morbidity or mortality. Median post-operative hospital stay was 5 days. CONCLUSIONS The Glissonean pedicle-first approach is safe and effective for laparoscopic anatomic resections of the right posterior sector. The craniocaudal approach to right hepatic vein from the ventral side is a convenient procedure to follow the segmental anatomy deep in the parenchyma.
Collapse
Affiliation(s)
- Alessandro Ferrero
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy.
| | - Francesco Giovanardi
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Serena Langella
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Fabio Forchino
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Ospedale Mauriziano "Umberto I", Largo Turati 62, 10128, Turin, Italy
| |
Collapse
|
|
17
|
Kazaryan AM, Aghayan DL, Fretland ÅA, Semikov VI, Shulutko AM, Edwin B. Laparoscopic liver resection with simultaneous diaphragm resection. ANNALS OF TRANSLATIONAL MEDICINE 2020; 8:214. [PMID: 32309361 PMCID: PMC7154494 DOI: 10.21037/atm.2020.01.62] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
Background Liver resection or ablation remains the only curative treatment for patients with colorectal metastases. Simultaneous resection of tumors in the liver with invasion to the diaphragm is challenging and controversial. Therefore, we wanted to assess the safety of simultaneous laparoscopic liver and diaphragm resection (SLLDR) in a large single center. Methods Patients who underwent primary laparoscopic liver resection (LLR) for colorectal liver metastases at Oslo University Hospital between 2008 and 2019 were included in this study. Patients who underwent SLLDR (group 1) were compared to patients who underwent LLR only (group 2). Perioperative and oncologic outcomes were analyzed. Results A total of 467 patients were identified, of whom 12 patients needed a simultaneous diaphragm resection (group 1) while 455 underwent laparoscopic liver surgery alone (group 2). The conversion rate was 16.7% in group 1 and 2.4% in group 2 (P=0.040). In 10 of 12 (83.3%) cases the diaphragm resection was performed en bloc with the liver tumor. There was no significant difference in operative time, blood loss, resection margins, hospital stay or postoperative complications. One patient died within 30 postoperative days (0.2%) in group 2 and none in group 1. Overall survival was not statistically different between the groups. Conclusions In selected patients, SLLDR can be performed safely with good surgical and oncological outcomes.
Collapse
Affiliation(s)
- Airazat M Kazaryan
- Department of Surgery, Øsfold Hospital Trust, Grålum, Norway.,Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia
| | - Davit L Aghayan
- Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Department of Surgery N1, Yerevan State Medical University after M. Heratsi, Yerevan, Armenia.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Åsmund A Fretland
- Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Hepatopancreatobiliary Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| | - Vasiliy I Semikov
- Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Alexander M Shulutko
- Department of Faculty Surgery N2, I.M.Sechenov First Moscow State Medical University, Moscow, Russia
| | - Bjørn Edwin
- Intervention Centre, Oslo University Hospital-Rikshospitalet, Oslo, Norway.,Institute of Clinical Medicine, University of Oslo, Oslo, Norway.,Department of Hepatopancreatobiliary Surgery, Oslo University Hospital-Rikshospitalet, Oslo, Norway
| |
Collapse
|
|
18
|
Guadagni S, Furbetta N, Franco GD, Palmeri M, Gianardi D, Bianchini M, Guadagnucci M, Pollina L, Masi G, Cremolini C, Falcone A, Mosca F, Di Candio G, Morelli L. Robotic-assisted surgery for colorectal liver metastasis: A single-centre experience. J Minim Access Surg 2020; 16:160-165. [PMID: 30777992 PMCID: PMC7176011 DOI: 10.4103/jmas.jmas_265_18] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2018] [Revised: 11/28/2018] [Accepted: 12/04/2018] [Indexed: 02/05/2023] Open
Abstract
BACKGROUND Although minimally invasive surgery (MIS) of the liver is increasingly widespread, its role in the treatment of colorectal liver metastasis (CRLM) remains uncertain. In this setting, the role of robotic-assisted surgery (RAS) has not been significantly evaluated yet. The aim of this study was to report our experience with RAS for treatment of CRLM. MATERIAL AND METHODS Prospectively collected surgical and oncologic data on all of the robotic-assisted liver resections for CRLM performed at our centre were retrieved from the institutional database and retrospectively analysed. Intra-operative ultrasound (US) was obtained with a dedicated robotic probe using the TilePro™ function. RESULTS Twenty patients underwent robotic-assisted resection of CRLM between May 2012 and April 2018. Six patients (30%) had multiple synchronous CRLM resections (median = 2; range 2-4). The tumour size averaged 3.0 ± 1.8 cm. All of the lesions were removed using a parenchymal-sparing approach, with R0 resection margins. Mean hospital stay was 4.7 ± 1.8 days. The mean follow-up was 22.5 ± 19.5 months. During the study period, there were no local recurrences, while 9 patients (45%) developed new systemic metastasis. All patients are still alive as of September 2018 with 1- and 3-year disease-free survival of 89.5% and 35.8%, respectively. CONCLUSIONS In our experience, RAS for CRLM surgical treatment was feasible and played a positive role even in patients with multiple metastases and previous or synchronous surgery. RAS seemed to be oncologically effective in this setting, as no patients experienced local relapse in the treated area.
Collapse
Affiliation(s)
- Simone Guadagni
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Niccolò Furbetta
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Gregorio Di Franco
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Matteo Palmeri
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Desirée Gianardi
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Matteo Bianchini
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Martina Guadagnucci
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Luca Pollina
- Department of Surgical, Medical, Molecular Pathology and Critical Area, Division of Surgical Pathology, University of Pisa, Pisa, Italy
| | - Gianluca Masi
- Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Chiara Cremolini
- Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Alfredo Falcone
- Department of Oncology, University Hospital of Pisa, Pisa, Italy
| | - Franco Mosca
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| | - Giulio Di Candio
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
| | - Luca Morelli
- Department of Surgery, Translational and New Technologies in Medicine, General Surgery Unit, University of Pisa, Pisa, Italy
- EndoCAS (Center for Computer Assisted Surgery), University of Pisa, Pisa, Italy
| |
Collapse
|
|
19
|
Decision-making based on 3D printed models in laparoscopic liver resections with intraoperative ultrasound: a prospective observational study. Eur Radiol 2019; 30:1306-1312. [PMID: 31773294 PMCID: PMC7033053 DOI: 10.1007/s00330-019-06511-2] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/02/2019] [Revised: 08/28/2019] [Accepted: 10/11/2019] [Indexed: 02/06/2023]
Abstract
OBJECTIVES The aim of this study was to evaluate impact of 3D printed models on decision-making in context of laparoscopic liver resections (LLR) performed with intraoperative ultrasound (IOUS) guidance. METHODS Nineteen patients with liver malignances (74% were colorectal cancer metastases) were prospectively qualified for LLR or radiofrequency ablation in a single center from April 2017 to December 2018. Models were 3DP in all cases based on CT and facilitated optical visualization of tumors' relationships with portal and hepatic veins. Planned surgical extent and its changes were tracked after CT analysis and 3D model inspection, as well as intraoperatively using IOUS. RESULTS Nineteen patients were included in the analysis. Information from either 3DP or IOUS led to changes in the planned surgical approach in 13/19 (68%) patients. In 5/19 (26%) patients, the 3DP model altered the plan of the surgery preoperatively. In 4/19 (21%) patients, 3DP independently changed the approach. In one patient, IOUS modified the plan post-3DP. In 8/19 (42%) patients, 3DP model did not change the approach, whereas IOUS did. In total, IOUS altered surgical plans in 9 (47%) cases. Most of those changes (6/9; 67%) were caused by detection of additional lesions not visible on CT and 3DP. CONCLUSIONS 3DP can be helpful in planning complex and major LLRs and led to changes in surgical approach in 26.3% (5/19 patients) in our series. 3DP may serve as a useful adjunct to IOUS. KEY POINTS • 3D printing can help in decision-making before major and complex resections in patients with liver cancer. • In 5/19 patients, 3D printed model altered surgical plan preoperatively. • Most surgical plan changes based on intraoperative ultrasonography were caused by detection of additional lesions not visible on CT and 3D model.
Collapse
|
|
20
|
Ferrero A, Lo Tesoriere R, Russolillo N. Ultrasound Liver Map Technique for Laparoscopic Liver Resections. World J Surg 2019; 43:2607-2611. [PMID: 31161357 DOI: 10.1007/s00268-019-05046-3] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/08/2023]
Abstract
BACKGROUND Laparoscopic liver resection (LLR) is reported as a safe procedure with potential advantages over open surgery albeit with inherent limitations, such as loss of haptic perception and spatial orientation. Ultrasound is considered the best tool to identify anatomic landmarks and the transection plane during liver surgery. The aim of this study was to analyse the outcomes of LLR performed with a standardized US guidance technique. METHODS We have standardized a 4-step technique for ultrasound-guided LLR: (1) compose a 3-D mind map by studying relationships among lesions and surrounding anatomic structures, (2) sketch the map on the liver surface, (3) check, and (4) correct the transection plane in real time. RESULTS Between 01/2006 and 12/2016, 190 consecutive patients treated with US-guided LLR were analysed. The indications for LLR included malignant tumours in 148 patients (81.8%). The procedures were classified according to a difficulty scale. There were 18 major hepatectomies (9.9%), 80 anatomic bi- and monosegmentectomies (44.2%), and 101 non-anatomic resections (55.8%). Redo resection was performed in 17 patients (9.4%), and multiple liver resections were performed in 25 patients (24.7%). Median intraoperative blood loss was 100 ± 154 mL. Overall and major morbidity rates were 14.9% and 1.6%, respectively. Mortality was nil. CONCLUSIONS Ultrasound liver map technique enables planning and real-time guidance during laparoscopic liver resections.
Collapse
Affiliation(s)
- Alessandro Ferrero
- Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Largo Turati, 62, 10128, Turin, Italy.
| | - Roberto Lo Tesoriere
- Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Largo Turati, 62, 10128, Turin, Italy
| | - Nadia Russolillo
- Department of General and Oncological Surgery, Mauriziano Hospital "Umberto I", Largo Turati, 62, 10128, Turin, Italy
| |
Collapse
|
|
21
|
Zygomalas A, Kehagias I. Up-to-date intraoperative computer assisted solutions for liver surgery. World J Gastrointest Surg 2019; 11:1-10. [PMID: 30705734 PMCID: PMC6354070 DOI: 10.4240/wjgs.v11.i1.1] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2018] [Revised: 12/12/2018] [Accepted: 12/30/2018] [Indexed: 02/06/2023] Open
Abstract
Computer assisted surgical planning allowed for a better selection of patients, evaluation of operative strategy, appropriate volumetric measurements, identification of anatomical risks, definition of tumour resection margins and choice of surgical approach in liver oncologic resections and living donor liver transplantations. Although preoperative computer surgical analysis has been widely used in daily clinical practice, intraoperative computer assisted solutions for risk analysis and navigation in liver surgery are not widely available or still under clinical evaluation. Computer science technology can efficiently assist modern surgeons during complex liver operations, mainly by providing image guidance with individualized 2D images and 3D models of the various anatomical and pathological structures of interest. Intraoperative computer assisted liver surgery is particularly useful in complex parenchyma-sparing hepatectomies, for intraoperative risk analysis and for the effective treatment of colorectal metastases after neoadjuvant therapy or when they are multiple. In laparoscopic liver surgery, intraoperative computer aid is definitively more important as, apart from a restricted field of view, there is also loss of the fine haptic feedback. Intraoperative computer assisted developments face challenges that prevent their application in daily clinical practice. There is a vast variety of studies regarding intraoperative computer assisted liver surgery but there are no clear objective measurements in order to compare them and select the most effective solutions. An overview of up-to-date intraoperative computer assisted solutions for liver surgery will be discussed.
Collapse
Affiliation(s)
- Apollon Zygomalas
- Surgical Oncology, OLYMPION General Clinic of Patras, Patras 26442, Greece
| | - Ioannis Kehagias
- Department of Surgery, University Hospital of Patras, Patras 26500, Greece
| |
Collapse
|
|
22
|
|
|
23
|
Zhu P, Liao W, Ding ZY, Luo HC, Zhang BH, Zhang WG, Zhang W, Zhang ZG, Zhang BX, Chen XP. Intraoperative ultrasonography of robot-assisted laparoscopic hepatectomy: initial experiences from 110 consecutive cases. Surg Endosc 2018; 32:4071-4077. [PMID: 30151749 DOI: 10.1007/s00464-017-5854-9] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/13/2017] [Accepted: 08/22/2017] [Indexed: 01/29/2023]
Abstract
BACKGROUND To evaluate the safety and efficacy of IOUS in robotic liver surgery and propose a standard protocol of IOUS for safe robot-assisted hepatectomy. METHODS Between February 2015 and December 2016, liver resection was performed in 110 patients with robotic approach in Tongji Hospital. In these patients, IOUS was routinely performed. All data about demographic, surgical procedure, postoperative course were collected prospectively and analyzed. RESULTS A four steps IOUS protocol in robotic liver surgery was proposed, including exploration, verification, guidance, and confirmation. A total of 11 additional lesions in 11 patients were detected and 7 patients accepted strategic surgical modification. No patient suffered from any single or multiple organ dysfunctions, and there were no mortalities observed. CONCLUSION IOUS is indispensable to understand lesions and vessels in robotic liver surgery. A four-step standard protocol of IOUS is essential for safe robot-assisted hepatectomy.
Collapse
Affiliation(s)
- Peng Zhu
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Liao
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Ze-Yang Ding
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Hong-Chang Luo
- Medical Ultrasound Department, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bin-Hao Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wan-Guang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Wei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Zhan-Guo Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Bi-Xiang Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
|
24
|
Heiselman JS, Clements LW, Collins JA, Weis JA, Simpson AL, Geevarghese SK, Kingham TP, Jarnagin WR, Miga MI. Characterization and correction of intraoperative soft tissue deformation in image-guided laparoscopic liver surgery. J Med Imaging (Bellingham) 2017; 5:021203. [PMID: 29285519 DOI: 10.1117/1.jmi.5.2.021203] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2017] [Accepted: 11/21/2017] [Indexed: 12/12/2022] Open
Abstract
Laparoscopic liver surgery is challenging to perform due to a compromised ability of the surgeon to localize subsurface anatomy in the constrained environment. While image guidance has the potential to address this barrier, intraoperative factors, such as insufflation and variable degrees of organ mobilization from supporting ligaments, may generate substantial deformation. The severity of laparoscopic deformation in humans has not been characterized, and current laparoscopic correction methods do not account for the mechanics of how intraoperative deformation is applied to the liver. We first measure the degree of laparoscopic deformation at two insufflation pressures over the course of laparoscopic-to-open conversion in 25 patients. With this clinical data alongside a mock laparoscopic phantom setup, we report a biomechanical correction approach that leverages anatomically load-bearing support surfaces from ligament attachments to iteratively reconstruct and account for intraoperative deformations. Laparoscopic deformations were significantly larger than deformations associated with open surgery, and our correction approach yielded subsurface target error of [Formula: see text] and surface error of [Formula: see text] using only sparse surface data with realistic surgical extent. Laparoscopic surface data extents were examined and found to impact registration accuracy. Finally, we demonstrate viability of the correction method with clinical data.
Collapse
Affiliation(s)
- Jon S Heiselman
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States.,Vanderbilt University, Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, United States
| | - Logan W Clements
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States.,Vanderbilt University, Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, United States
| | - Jarrod A Collins
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States.,Vanderbilt University, Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, United States
| | - Jared A Weis
- Wake Forest School of Medicine, Department of Biomedical Engineering, Winston-Salem, North Carolina, United States
| | - Amber L Simpson
- Memorial Sloan-Kettering Cancer Center, Hepatopancreatobiliary Service, Department of Surgery, New York, New York, United States
| | - Sunil K Geevarghese
- Vanderbilt University Medical Center, Division of Hepatobiliary Surgery and Liver Transplantation, Nashville, Tennessee, United States
| | - T Peter Kingham
- Memorial Sloan-Kettering Cancer Center, Hepatopancreatobiliary Service, Department of Surgery, New York, New York, United States
| | - William R Jarnagin
- Memorial Sloan-Kettering Cancer Center, Hepatopancreatobiliary Service, Department of Surgery, New York, New York, United States
| | - Michael I Miga
- Vanderbilt University, Department of Biomedical Engineering, Nashville, Tennessee, United States.,Vanderbilt University, Vanderbilt Institute for Surgery and Engineering, Nashville, Tennessee, United States
| |
Collapse
|
|
25
|
Diffusion, outcomes and implementation of minimally invasive liver surgery: a snapshot from the I Go MILS (Italian Group of Minimally Invasive Liver Surgery) Registry. Updates Surg 2017; 69:271-283. [PMID: 28861759 DOI: 10.1007/s13304-017-0489-x] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/07/2017] [Accepted: 08/21/2017] [Indexed: 12/20/2022]
Abstract
The Italian Group of MILS (I Go MILS) prospective registry was established in 2014 with the goals to create a hub for data and projects on a national basis and to promote the diffusion and implementation of MILS programs on a national scale. The primary endpoint of the present study is to give a snapshot of the real diffusion and outcomes of MILS in Italy, while analyzing the role of the registry in the implementation of MILS programs nationwide. The I Go MILS Registry is a prospective and intention-to-treat registry opened to any Italian center performing MILS, without restriction criteria based on number of procedures. The Registry is developed through the eClinical, an electronic platform for the management of clinical trials and is based on 34 clinical variables, regarding indication, intra- and postoperative course. Clinical outcomes and data regarding implementation of MILS activity have been analyzed for the aim of the study. Between November 2014 and June 2017, data from 1678 MILS performed in 48 centers have been collected (mean number of procedures per center 35, range 1-302). 22% of procedures were performed for benign and 78% for malignant disease (HCC constituted the 49.1% and CRLM the 31.2% of malignant tumors). Major liver resections (>3 liver segments), including right and left hepatectomies, trisectionectomies and ALPPS procedures were 10% of the series. Mean blood loss was 200 ± 230 mL Morbidity rate was 20.5% and mortality was 0.3%. 10.4% of cases were converted to open approach. Median length of stay was 5 days. MILS/total resections ratio in 13 experienced centers increased from 14 to 30% after Registry establishment. MILS programs are well established in Italy, with progressive increase both in the number of cases and in the numerosity of centers. The I Go MILS Registry is playing a crucial role in monitoring the development of MILS in the real world on a national basis while giving a significant contribution to the implementation of MILS programs.
Collapse
|
|
26
|
Diana M, Liu YY, Pop R, Kong SH, Legnèr A, Beaujeux R, Pessaux P, Soler L, Mutter D, Dallemagne B, Marescaux J. Superselective intra-arterial hepatic injection of indocyanine green (ICG) for fluorescence image-guided segmental positive staining: experimental proof of the concept. Surg Endosc 2017; 31:1451-1460. [PMID: 27495341 DOI: 10.1007/s00464-016-5136-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/16/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intraoperative liver segmentation can be obtained by means of percutaneous intra-portal injection of a fluorophore and illumination with a near-infrared light source. However, the percutaneous approach is challenging in the minimally invasive setting. We aimed to evaluate the feasibility of fluorescence liver segmentation by superselective intra-hepatic arterial injection of indocyanine green (ICG). MATERIALS AND METHODS Eight pigs (mean weight: 26.01 ± 5.21 kg) were involved. Procedures were performed in a hybrid experimental operative suite equipped with the Artis Zeego®, multiaxis robotic angiography system. A pneumoperitoneum was established and four laparoscopic ports were introduced. The celiac trunk was catheterized, and a microcatheter was advanced into different segmental hepatic artery branches. A near-infrared laparoscope (D-Light P, Karl Storz) was used to detect the fluorescent signal. To assess the correspondence between arterial-based fluorescence demarcation and liver volume, metallic markers were placed along the fluorescent border, followed by a 3D CT-scanning, after injecting intra-arterial radiological contrast (n = 3). To assess the correspondence between arterial and portal supplies, percutaneous intra-portal angiography and intra-arterial angiography were performed simultaneously (n = 1). RESULTS Bright fluorescence signal enhancing the demarcation of target segments was obtained from 0.1 mg/mL, in matter of seconds. Correspondence between the volume of hepatic segments and arterial territories was confirmed by CT angiography. Higher background fluorescence noise was found after positive staining by intra-portal ICG injection, due to parenchymal accumulation and porto-systemic shunting. CONCLUSIONS Intra-hepatic arterial ICG injection, rapidly highlights hepatic target segment borders, with a better signal-to-background ratio as compared to portal vein injection, in the experimental setting.
Collapse
Affiliation(s)
- Michele Diana
- IRCAD, Research Institute Against Cancer of the Digestive System, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France.
| | - Yu-Yin Liu
- IRCAD, Research Institute Against Cancer of the Digestive System, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
- Department of General Surgery, Chang Gung Memorial Hospital, Chang Gung University, Linkou, Taiwan
| | - Raoul Pop
- Interventional Radiology Department, University Hospital of Strasbourg, Strasbourg Cedex, France
| | - Seong-Ho Kong
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
- Department of Surgery, Seoul National University Hospital, Seoul, Korea
| | - Andras Legnèr
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - Remy Beaujeux
- Interventional Radiology Department, University Hospital of Strasbourg, Strasbourg Cedex, France
| | - Patrick Pessaux
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
- Department of General and Digestive Surgery, University Hospital of Strasbourg, Strasbourg Cedex, France
| | - Luc Soler
- IRCAD, Research Institute Against Cancer of the Digestive System, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - Didier Mutter
- Department of General and Digestive Surgery, University Hospital of Strasbourg, Strasbourg Cedex, France
| | - Bernard Dallemagne
- IRCAD, Research Institute Against Cancer of the Digestive System, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
| | - Jacques Marescaux
- IRCAD, Research Institute Against Cancer of the Digestive System, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
- IHU-Strasbourg, Institute of Image-Guided Surgery, 1, place de l'Hôpital, 67091, Strasbourg Cedex, France
| |
Collapse
|
|
27
|
Alvarez FA, Sanchez Claria R, Oggero S, de Santibañes E. Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases. World J Gastrointest Surg 2016; 8:407-23. [PMID: 27358673 PMCID: PMC4919708 DOI: 10.4240/wjgs.v8.i6.407] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/31/2015] [Revised: 02/02/2016] [Accepted: 03/22/2016] [Indexed: 02/06/2023] Open
Abstract
Liver resection is the treatment of choice for patients with colorectal liver metastases (CLM). However, major resections are often required to achieve R0 resection, which are associated with substantial rates of morbidity and mortality. Maximizing the amount of residual liver gained increasing significance in modern liver surgery due to the high incidence of chemotherapy-associated parenchymal injury. This fact, along with the progressive expansion of resectability criteria, has led to the development of a surgical philosophy known as "parenchymal-sparing liver surgery" (PSLS). This philosophy includes a variety of resection strategies, either performed alone or in combination with ablative therapies. A profound knowledge of liver anatomy and expert intraoperative ultrasound skills are required to perform PSLS appropriately and safely. There is a clear trend toward PSLS in hepatobiliary centers worldwide as current evidence indicates that tumor biology is the most important predictor of intrahepatic recurrence and survival, rather than the extent of a negative resection margin. Tumor removal avoiding the unnecessary sacrifice of functional parenchyma has been associated with less surgical stress, fewer postoperative complications, uncompromised cancer-related outcomes and higher feasibility of future resections. The increasing evidence supporting PSLS prompts its consideration as the gold-standard surgical approach for CLM.
Collapse
|
|
28
|
Impact of obesity on postoperative outcome of hepatic resection for colorectal metastases. Surgery 2015; 158:1521-9. [DOI: 10.1016/j.surg.2015.07.024] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/20/2015] [Revised: 06/19/2015] [Accepted: 07/10/2015] [Indexed: 12/23/2022]
|
|
29
|
Ettorre GM, Levi Sandri GB, Santoro R, Vennarecci G, Lepiane P, Colasanti M, Felli E, de Werra E, Colace L, D’Offizi G, Montalbano M, Visco U, Maritti M, Antonini M, Santoro E. Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients: single center experience of 90 cases. Hepatobiliary Surg Nutr 2015; 4:320-324. [PMID: 26605279 PMCID: PMC4607835 DOI: 10.3978/j.issn.2304-3881.2015.06.13] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/22/2015] [Accepted: 06/25/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Hepatocellular carcinoma (HCC) with or without underlying liver disease can be treated by surgical resection. The aim of this study was to evaluate the feasibility, morbidity and mortality of a laparoscopic approach in cirrhotic patients with HCC. METHODS From 2004 to September 2014, 90 patients underwent a laparoscopic liver resection (LLR) for HCC. Data were collected in a prospectively maintained database since 2001. Preoperative patient evaluation was based on a multidisciplinary team meeting assessment. RESULTS Median age was 63 years; 67 (74.4%) patients were male. Median body mass index (BMI) was 26.7. Underlying liver disease was known in 68 patients: in 46 patients' hepatitis C virus (HCV)-related, in 15 patients to hepatitis B virus (HBV)-related, in 5 patients alcohol-related. Child-Pugh Score was of grade A in 85 patients and of grade B in 5 patients; 63 patients had a Model for End-stage Liver Disease (MELD) <10 and 27 patients MELD >10. A total of 18 left lateral sectionectomies, 1 left hepatectomy and 71 wedge resections or segmentectomies were performed. Conversion to laparotomy was necessary in 7 (7.7%) patients (five cases for bleeding and two cases for oncological reasons). In 90 patients, 98 HCC nodules were resected: 79 patients had one nodule, 8 patients had two nodules and 1 patient had three nodules. HCC nodules medium diameter was 29 mm (range, 4-100 mm) with median value of 25 mm. Tumor margins distance was 16 mm (range, 0-35 mm) with a median of 5 mm. Seventy nodules were located within the anterior sectors and 28 nodules within the posterior sectors. CONCLUSIONS LLR for HCC can be performed with acceptable morbidity in patients with underlying liver disease. The use of laparoscopic surgery in cirrhotic patients may be proposed as the first-line treatment for HCC or as bridge treatment before liver transplantation.
Collapse
|
|
30
|
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.
Collapse
Affiliation(s)
- Serena Langella
- Department of General and Oncological Surgery, "Umberto I" Mauriziano Hospital, Largo Turati, 62, 10128, Turin, Italy
| | | | | | | | | | | |
Collapse
|
|
31
|
Aoki T, Murakami M, Koizumi T, Kusano T, Fujimori A, Enami Y, Matsuda K, Goto S, Watanabe M, Otsuka K. Preoperative Tattooing for Precise and Expedient Localization of Landmark in Laparoscopic Liver Resection. J Am Coll Surg 2015; 221:e97-e101. [PMID: 26278038 DOI: 10.1016/j.jamcollsurg.2015.07.444] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/27/2015] [Revised: 07/06/2015] [Accepted: 07/16/2015] [Indexed: 12/01/2022]
Affiliation(s)
- Takeshi Aoki
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan.
| | - Masahiko Murakami
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tomotake Koizumi
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Tomokazu Kusano
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Akira Fujimori
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Yuta Enami
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Kazuhiro Matsuda
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Satoru Goto
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Makoto Watanabe
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| | - Koji Otsuka
- Department of Gastroenterological and General Surgery, School of Medicine, Showa University, Tokyo, Japan
| |
Collapse
|
|
32
|
Cipriani F, Rawashdeh M, Ahmed M, Armstrong T, Pearce NW, Abu Hilal M. Oncological outcomes of laparoscopic surgery of liver metastases: a single-centre experience. Updates Surg 2015; 67:185-91. [PMID: 26109140 DOI: 10.1007/s13304-015-0308-1] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2015] [Accepted: 05/28/2015] [Indexed: 02/06/2023]
Abstract
In the era of multimodal management of liver metastases, surgical resection remains the only curative option, with open approach still being referred to as the standard of care. Currently, the feasibility and benefits of the laparoscopic approach for liver resection have been largely demonstrated. However, its oncologic adequacy remains to be confirmed. The aim of this study is to report the oncological results of laparoscopic liver resection for metastatic disease in a single-centre experience. A single-centre database of 413 laparoscopic liver resections was reviewed and procedures for liver metastases were selected. The assessment of oncologic outcomes included analysis of minimal tumour-free margin, R1 resection rate and 3-year survival. The feasibility and safety of the procedures were also evaluated through analysis of perioperative outcomes. The study comprised 209 patients (294 procedures). Colorectal liver metastases were the commonest indication (67.9%). Fourteen patients had conversion (6.7%) and oncological concern was the commonest reason for conversion (42.8%). Median tumour-free margin was 10 mm and complete radical resections were achieved in 211 of 218 curative-intent procedures (96.7%). For patients affected by colorectal liver metastases, 1- and 3-year OS resulted 85.9 and 66.7%. For patients affected by neuroendocrine liver metastases, 1- and 3-year OS resulted 93 and 77.8%. Among the patients with metastases from other primaries, 1- and 3-year OS were 83.3 and 70.5%. The laparoscopic approach is a safe and valid option in the treatment of patients with metastatic liver disease undergoing curative resection. It does offer significant perioperative benefits without compromise of oncologic outcomes.
Collapse
Affiliation(s)
- Federica Cipriani
- University Hospital Southampton NHS Foundation Trust, E level, Tremona Road, Southampton, SO166YD, UK
| | | | | | | | | | | |
Collapse
|