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Arend J, Franz M, Rose A, March C, Rahimli M, Perrakis A, Lorenz E, Croner R. Robotic Complete ALPPS (rALPPS)-First German Experiences. Cancers (Basel) 2024; 16:1070. [PMID: 38473426 DOI: 10.3390/cancers16051070] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2024] [Revised: 03/02/2024] [Accepted: 03/04/2024] [Indexed: 03/14/2024] Open
Abstract
BACKGROUND ALPPS leads to fast and effective liver hypertrophy. This enables the resection of extended tumors. Conventional ALPPS is associated with high morbidity and mortality. MILS reduces morbidity and the robot adds technical features that make complex procedures safe. MATERIAL AND METHODS The MD-MILS was screened for patients who underwent rALPPS. Demographic and perioperative data were evaluated retrospectively. Ninety days postoperative morbidity was scored according to the CD classification. The findings were compared with the literature. RESULTS Since November 2021, five patients have been identified. The mean age and BMI of the patients were 50.0 years and 22.7 kg/m2. In four cases, patients suffered from colorectal liver metastases and, in one case, intrahepatic cholangiocarcinoma. Prior to the first operation, the mean liver volume of the residual left liver was 380.9 mL with a FLR-BWR of 0.677%. Prior to the second operation, the mean volume of the residual liver was 529.8 mL with a FLR-BWR of 0.947%. This was an increase of 41.9% of the residual liver volume. The first and second operations were carried out within 17.8 days. The mean time of the first and second operations was 341.2 min and 440.6 min. The mean hospital stay was 27.2 days. Histopathology showed the largest tumor size of 39 mm in diameter with a mean amount of 4.7 tumors. The mean tumor-free margin was 12.3 mm. One complication CD > 3a occurred. No patient died during the 90-day follow up. CONCLUSION In the first German series, we demonstrated that rALPPS can be carried out safely with reduced morbidity and mortality in selected patients.
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Affiliation(s)
- Jörg Arend
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Mareike Franz
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Alexander Rose
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Christine March
- Department of Radiology and Nuclear Medicine, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Mirhasan Rahimli
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Aristotelis Perrakis
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Eric Lorenz
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
| | - Roland Croner
- Department of General-, Visceral-, Vascular- and Transplant Surgery, University Hospital Magdeburg, 39120 Magdeburg, Germany
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Takase K, Sakamoto T, Takeda Y, Ohmura Y, Katsura Y, Shinke G, Kawai K, Murakami K, Kagawa Y, Masuzawa T, Takeno A, Hata T, Murata K. Safety and efficacy of laparoscopic repeat liver resection and re-operation for liver tumor. Sci Rep 2021; 11:11605. [PMID: 34078927 PMCID: PMC8172640 DOI: 10.1038/s41598-021-89864-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 04/30/2021] [Indexed: 01/22/2023] Open
Abstract
Laparoscopic liver resection (LLR) has been reported as a safe, minimally invasive, and effective surgery for the management of liver tumor. However, the efficacy and safety of laparoscopic repeat liver resection (LRLR) for recurrent liver tumor are unclear. Here, we analyzed the surgical results of LRLR. From June 2010 to May 2019, we performed 575 LLR surgeries in our department, and 454 of them underwent pure LLR for the single tumor. We classified the patients who received pure LLR for the single tumor into three groups: LRLR (n = 80), laparoscopic re-operation after previous abdominal surgery (LReOp; n = 136), and laparoscopic primary liver resection (LPLR; n = 238). We compared patient characteristics and surgical results between patients undergoing LRLR, LReOp and LPLR. We found no significant differences between LRLR and LPLR in the conversion rate to laparotomy (p = 0.8033), intraoperative bleeding (63.0 vs. 152.4 ml; p = 0.0911), or postoperative bile leakage rate (2.50 vs. 3.78%; p = 0.7367). We also found no significant difference in the surgical results between LReOp and LPLR. However, the number of patients undergoing the Pringle maneuver was lower in the LRLR group than the LPLR group (61.3 vs. 81.5%; p = 0.0004). This finding was more pronounced after open liver resection than laparoscopic liver resection (38.9 vs. 67.7%; p = 0.0270). The operative time was significantly longer in patients with proximity to previous cut surface than patients with no proximity to previous cut surface (307.4 vs. 235.7 min; p = 0.0201). LRLR can safely be performed with useful surgical results compared to LPLR.
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Affiliation(s)
- Koki Takase
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Takuya Sakamoto
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan.
| | - Yoshiaki Ohmura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yoshiteru Katsura
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Go Shinke
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kenji Kawai
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kohei Murakami
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Yoshinori Kagawa
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Toru Masuzawa
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Atsushi Takeno
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Taishi Hata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
| | - Kohei Murata
- Department of Surgery, Kansai Rosai Hospital, 3-1-69, Inabaso, Amagasaki, Hyogo, 660-8511, Japan
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Mahamid A, Sawaied M, Berger Y, Halim NA, Goldberg N, Abu-Zaydeh O, Bitterman A, Sadot E, Haddad R. Hand-assisted Laparoscopic Surgery for Colorectal Liver Metastasis: Analysis of Short-term and Long-term Results. Surg Laparosc Endosc Percutan Tech 2021; 31:543-549. [PMID: 33788821 DOI: 10.1097/sle.0000000000000931] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2020] [Accepted: 02/01/2021] [Indexed: 12/07/2022]
Abstract
BACKGROUND There is scant data regarding the outcomes of hand-assisted laparoscopic surgery (HALS) for colorectal liver metastasis (CRLM). The aim of this study is to report our experience and analyze the short-term and long-term results. MATERIALS AND METHODS Retrospective study of patients undergoing HALS for CRLM in 2 university affiliated medical centers. RESULTS Two hundred and thirty-eight liver procedures were performed on 145 patients including 205 parenchymal sparing resections and 33 anatomic resections. The median number of metastases was 1 (range: 1 to 8), 38 patients (26.2%) had 3 or more metastases, and 41 patients (28.3 had a bi-lobar disease. The tumor size was 20 (2 to 90) mm, and 52 patients (36.6%) had a tumor larger than 30 mm. Nighty-nine patients (67.8%) received neoadjuvant chemotherapy. In 8 patients (5.5%) the laparoscopic liver resection was combined with ablation, and 16 patients (11%) underwent a synchronous resection of colorectal cancer. The median operative time, blood loss during surgery, and postoperative hospital stay were 163 minutes, 300 mL, and 4 days, respectively. The median modified Iwate complexity score was 4 (0 to 10) and the conversion rate to open surgery was 5.5%. The overall and major complication rates were 23.8% and 3.6%, respectively. The mortality rate was 0.7%. R0 resections were achieved in 91% of patients. Median overall survival for all the cohort (intend to treat) was 59 months, and the 8- and 10-year overall survival rates were 47.3% and 24.9%, respectively. CONCLUSIONS This study shows that HALS is a safe and efficacious treatment for selected patients with CRLM.
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Affiliation(s)
- Ahmad Mahamid
- Departments of Surgery
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
| | | | - Yael Berger
- Department of Surgery, Rabin Medical Center, Petach-Tikva
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Nasser A Halim
- Department of Surgery, Rabin Medical Center, Petach-Tikva
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Natalia Goldberg
- Radiology, Carmel Medical Center
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
| | | | - Arie Bitterman
- Departments of Surgery
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
| | - Eran Sadot
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
- Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riad Haddad
- Departments of Surgery
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa
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Melandro F, Giovanardi F, Hassan R, Larghi Laureiro Z, Ferri F, Rossi M, Mennini G, Pawlik TM, Lai Q. Minimally Invasive Approach in the Setting of ALPPS Procedure: a Systematic Review of the Literature. J Gastrointest Surg 2019; 23:1917-1924. [PMID: 31197682 DOI: 10.1007/s11605-018-04092-x] [Citation(s) in RCA: 28] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/18/2018] [Accepted: 12/20/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Associating liver partition with portal vein ligation for staged hepatectomy (ALPPS) represents a new surgical technique for the resection of advanced hepatic malignancies with predicted insufficient future liver remnant. In some patients, ALPPS can be associated with an increased risk of poor outcomes. Minimally invasive surgery (MIS) has been proposed in combination with ALPPS with the intent to minimize this risk. We systematically evaluated the outcomes of MIS-ALPPS cases to compare the relative outcomes of open ALPPS versus MIS-ALPPS. METHODS A systematic review was done in accordance with the PRISMA guidelines. Search terms utilized included the following: ("ALPPS"[Title/Abstract] OR "associating liver partition and portal vein ligation for staged hepatectomy"[Title/Abstract] OR "in situ split"[Title/Abstract]) AND ("minimally invasive"[Title/Abstract] OR "laparoscopic"[Title/Abstract] OR "robotic"[Title/Abstract]). RESULTS Fifteen articles were identified, with a total of 27 patients reported. Colorectal metastatic disease was the most commonly observed indication for MIS-ALPPS (66.7%), followed by hepatocellular carcinoma (25.9%). Time passed from the first to the second stage ranged 7-30 days. MIS-ALPPS patients did not experience procedure failures between the first and second stages. Only four (15.4%) subjects had a grade IIIb complication. No perioperative mortality after the first or second stage was reported. Compared with open ALPPS, MIS-ALPPS demonstrated better results. Hospital stay duration ranged 8-33 days with a follow-up ranging 1-20 months. CONCLUSIONS MIS-ALPPS appears to be safe, with potentially lower morbidities and mortalities relative to open patients. The present results should be considered with caution. A limited number of articles exist on this topic. Furthermore, selection biases exist when comparing open versus MIS-ALPPS data. Registry studies are needed to better define the outcomes of patients undergoing MIS-ALPPS.
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Affiliation(s)
- Fabio Melandro
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Francesco Giovanardi
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Redan Hassan
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Zoe Larghi Laureiro
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Flaminia Ferri
- Division of Gastroenterology, Department of Clinical Medicine, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Massimo Rossi
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Gianluca Mennini
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy
| | - Timothy M Pawlik
- The Ohio State University Wexner Medical Center, Columbus, OH, USA
| | - Quirino Lai
- Hepato-bilio-pancreatic and Liver Transplant Unit, Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Rome, Italy. .,Department of General Surgery and Organ Transplantation, Umberto I Policlinic of Rome, Sapienza University of Rome, Viale del Policlinico 155, 00161, Rome, Italy.
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6
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Laparoscopy-assisted versus open and pure laparoscopic approach for liver resection and living donor hepatectomy: a systematic review and meta-analysis. HPB (Oxford) 2018; 20:687-694. [PMID: 29571616 DOI: 10.1016/j.hpb.2018.02.379] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2017] [Revised: 01/24/2018] [Accepted: 02/04/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND Laparoscopy-assisted (hybrid) liver surgery is considered a minimally invasive technique, however there are doubts regarding loss of the benefits of laparoscopy due to the use of an auxiliary incision. The aim of this study was to compare perioperative results of hybrid vs. open and hybrid vs. pure laparoscopic approach to liver resection for focal lesions and living donation. METHODS A systematic review was performed in Medline, EMBASE, Cochrane Library Central and LILACS databases. Perioperative outcomes were analyzed. RESULTS 21 studies were included. Hybrid vs. open: operative time was lower in open group (mean difference [MD] = 34 min; 95%CI: 22-47; P < 0.001; N = 669). Hybrid technique was associated with a reduction in operative blood loss [MD = -43 ml; 95%CI: -74-(-13); P = 0.005, N = 1738]; shorter hospital stay [MD = -1.9 days; 95%CI: -3.2-(-0.5); P = 0.008; N = 833] and lower morbidity [risk difference (RD) = -0.05; 95%CI: -0.10-(-0.01); P = 0.010; N = 1359]. Hybrid vs. pure laparoscopic: There was no difference regarding blood loss, transfusion rate, hospital stay and morbimortality. DISCUSSION Hybrid technique had perioperative outcomes that were more in keeping with pure laparoscopic outcomes than open surgery. Hybrid liver surgery should be considered a minimally invasive approach.
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7
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Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma in 157 patients: A case controlled study with propensity score matching at two Chinese centres. Int J Surg 2018; 56:203-207. [DOI: 10.1016/j.ijsu.2018.06.026] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/28/2018] [Revised: 05/17/2018] [Accepted: 06/10/2018] [Indexed: 12/20/2022]
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8
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Noda T, Eguchi H, Iwagami Y, Yamada D, Asaoka T, Gotoh K, Kawamoto K, Kobayashi S, Hashimoto Y, Takeda Y, Tanemura M, Umeshita K, Doki Y, Mori M. Minimally invasive liver resection for hepatocellular carcinoma of patients with liver damage B: A propensity score-based analysis. Hepatol Res 2018; 48:539-548. [PMID: 29316082 DOI: 10.1111/hepr.13057] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/14/2017] [Revised: 01/05/2018] [Accepted: 01/06/2018] [Indexed: 12/16/2022]
Abstract
AIM Minimally invasive liver resection (MILR) is considered a safe and feasible treatment for malignant liver tumors. However, few studies have investigated the surgical outcomes of MILR in patients with impaired liver function. Liver damage is used for consideration of hepatectomy. The aim of this study is to clarify the efficacy of MILR for patients with impaired liver function by using propensity score matching. METHODS Ninety-nine patients with liver damage B underwent hepatic resection were analyzed. The patients were divided into two groups, the MILR group (n = 24) and the open liver resection (OLR) group (n = 75). After matching of a propensity score, we compared clinicopathological features and surgical outcomes. RESULTS After matching, 36 patients (18 patients from each group) were selected and the patients' characteristics and tumor characteristics were not significantly different between the two groups. Blood loss (P = 0.0163) and complication rate (P = 0.0162) were significantly decreased in the MILR group. Complications were observed in eight patients, comprising one patient in the MILR group and seven patients in the OLR group. The postoperative hospital stay was significantly shortened in the MILR group (P = 0.0118). CONCLUSION Minimally invasive liver resection might be effective for patients with impaired liver function. It reduces surgical complications and consequently shortens hospitalization time.
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Affiliation(s)
- Takehiro Noda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Hidetoshi Eguchi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yoshifumi Iwagami
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Daisaku Yamada
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Tadafumi Asaoka
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Kunihito Gotoh
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Koichi Kawamoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Shogo Kobayashi
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yasuji Hashimoto
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Surgery, Yao Municipal Hospital, Osaka, Japan
| | - Yutaka Takeda
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Masahiro Tanemura
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Koji Umeshita
- Division of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Masaki Mori
- Department of Gastroenterological Surgery, Graduate School of Medicine, Osaka University, Osaka, Japan
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9
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Noda T, Eguchi H, Wada H, Iwagami Y, Yamada D, Asaoka T, Gotoh K, Kawamoto K, Takeda Y, Tanemura M, Umeshita K, Doki Y, Mori M. Short-term surgical outcomes of minimally invasive repeat hepatectomy for recurrent liver cancer. Surg Endosc 2017. [PMID: 28639044 DOI: 10.1007/s00464-017-5632-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022]
Abstract
BACKGROUND Repeat liver resection is an effective treatment, with long-term surgical outcomes for recurrent hepatocellular carcinoma and colorectal liver metastasis. However, the efficacy of a minimally invasive surgical approach for recurrent liver cancer is not yet confirmed. The purpose of this study is to examine the efficacy of minimally invasive repeat liver resection (MISRLR) compared with open repeat liver resection (ORLR) for primary and metastatic liver cancer. Here, we retrospectively analyzed the clinicopathological features and short-term surgical outcomes of patients undergoing MISRLR and ORLR. METHODS From 2005 to 2016, 97 patients with liver cancer underwent repeat hepatectomy. Of these patients, 68 patients receiving macroscopically curative resection and only hepatectomy, without other additional operations, were selected. Twenty patients underwent MISRLR and 48 patients underwent ORLR. We compared the clinicopathological and surgical parameters in the MISRLR group with those in the ORLR group. RESULTS There were no statistically significant differences in patients' gender, age, viral infection status, Child-Pugh classification, tumor size, tumor number, tumor location, or the presence of liver cirrhosis in the two groups. The operative times were similar, but blood loss was significantly lower in MISRLR group (159 vs. 502 ml, P = 0.0035). The length of the postoperative hospital stay was significantly shorter in the MISRLR group (14.2 vs. 19.2 days, P = 0.0275). Postoperative complications were observed only in the ORLR group, with a complication rate of 19%. CONCLUSIONS We demonstrate that MISRLR for primary and metastatic liver cancer reduces blood loss and postoperative complications compared with ORLR. MISRLR might be a feasible and effective procedure for the selected patients.
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Affiliation(s)
- Takehiro Noda
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Hidetoshi Eguchi
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan.
| | - Hiroshi Wada
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yoshifumi Iwagami
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Daisaku Yamada
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Tadafumi Asaoka
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Kunihito Gotoh
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Koichi Kawamoto
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Yutaka Takeda
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan.,Department of Surgery, Kansai Rosai Hospital, Hyogo, Japan
| | - Masahiro Tanemura
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan.,Department of Surgery, Osaka Police Hospital, Osaka, Japan
| | - Koji Umeshita
- Departments of Health Sciences, Graduate School of Medicine, Osaka University, Osaka, Japan
| | - Yuichiro Doki
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
| | - Masaki Mori
- Departments of Surgery, Graduate School of Medicine, Osaka University, 2-2 Yamadaoka, Suita, Osaka, Japan
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10
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Coelho FF, Kruger JAP, Jeismann VB, Fonseca GM, Makdissi FF, Ferreira LA, D'Albuquerque LAC, Cecconello I, Herman P. Are Hybrid Liver Resections Truly Minimally Invasive? A Propensity Score Matching Analysis. J Laparoendosc Adv Surg Tech A 2017; 27:1236-1244. [PMID: 28498007 DOI: 10.1089/lap.2017.0074] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Hybrid liver resection is considered a modality of minimally invasive surgery; however, there are doubts regarding loss of benefits of laparoscopy due to the use of an auxiliary incision. We compared perioperative results of patients undergoing hybrid × open and hybrid × pure laparoscopic resections. METHODS Consecutive patients undergoing liver resection between June 2008 and January 2016 were studied. Study groups were compared after propensity score matching (PSM). RESULTS Six hundred forty-four resections were included in the comparative analysis: 470 open, 120 pure laparoscopic, and 54 hybrids. After PSM, 54 patients were included in each group. Hybrid × open: hybrid technique had shorter operative time (319.5 ± 108.6 × 376.2 ± 155.8 minutes, P = .033), shorter hospital stay (6.0 ± 2.7 × 8.1 ± 5.6 days, P = .001), and lower morbidity (18.5% × 40.7%, P = .003). Hybrid × pure laparoscopic: hybrid group had lower conversion rate (0% × 13%, P = .013). There was no difference regarding estimated blood loss, transfusion rate, hospital stay, complications, or mortality. CONCLUSIONS Hybrid resection has better perioperative results than the open approach and is similar to pure laparoscopy. The hybrid technique should be considered a minimally invasive approach.
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Affiliation(s)
- Fabricio Ferreira Coelho
- 1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil
| | - Jaime Arthur Pirola Kruger
- 1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil .,2 Digestive Surgery Division, Department of Surgery, Cancer Institute of the State of São Paulo (ICESP) , São Paulo, Brazil
| | - Vagner Birk Jeismann
- 1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil .,2 Digestive Surgery Division, Department of Surgery, Cancer Institute of the State of São Paulo (ICESP) , São Paulo, Brazil
| | - Gilton Marques Fonseca
- 1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil
| | - Fábio Ferrari Makdissi
- 2 Digestive Surgery Division, Department of Surgery, Cancer Institute of the State of São Paulo (ICESP) , São Paulo, Brazil
| | - Leandro Augusto Ferreira
- 1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil
| | - Luiz Augusto Carneiro D'Albuquerque
- 3 Liver and Gastrointestinal Transplant Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil
| | - Ivan Cecconello
- 1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil
| | - Paulo Herman
- 1 Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School , São Paulo, Brazil
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Fuji H, Hatano E, Seo S, Arimoto A, Okabe M, Fujikawa T, Nishitai R, Ishii T, Kaihara S, Matsushita T, Oike F, Ichimiya M, Ohta S, Yamanaka K, Taura K, Yasuchika K, Uemoto S. Prospective registry for laparoscopic liver resection. Asian J Endosc Surg 2017; 10:173-178. [PMID: 27976516 DOI: 10.1111/ases.12351] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Revised: 10/24/2016] [Accepted: 11/06/2016] [Indexed: 01/22/2023]
Abstract
INTRODUCTION Laparoscopic liver resection (LLR) has been widely performed throughout the world. Although prospective registry studies to clarify the safety of LLR have been feasible, no prior multicenter prospective study has addressed this issue. We have conducted a multicenter prospective cohort study to reveal the current status of LLR in Japan. METHODS From April 2015 to March 2016, candidates for LLR were preoperatively enrolled at 12 institutions. The primary end-point was surgical safety, which was evaluated based on surgical factors and on short-term and midterm outcomes. RESULTS A total of 102 patients were enrolled. Planned laparoscopic procedures included 96 pure laparoscopies, 1 hand-assisted laparoscopy, and 5 hybrid techniques. Non-anatomical partial resection or left lateral sectionectomy were performed in almost all cases. The median duration of surgery was 221 min. The median blood loss was 80.5 mL. Conversion was required for four patients (3.9%). The 90-day postoperative morbidities with grades more severe than II in the Clavien-Dindo classification were observed in six patients (5.9%). The median postoperative hospital stay was 9.5 days. No cases involved reoperation or mortality. CONCLUSION Minor resection of LLR has been performed safely. To ensure the safe dissemination of LLR, including for major resection, a larger multicenter prospective study is required.
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Affiliation(s)
- Hiroaki Fuji
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,Department of Surgery, Hyogo College of Medicine, Nishinomiya, Japan
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Akira Arimoto
- Department of Surgery, Osaka Red Cross Hospital, Osaka, Japan
| | - Michio Okabe
- Department of Surgery, Kurashiki Central Hospital, Kurashiki, Japan
| | | | - Ryuta Nishitai
- Department of Surgery, Kyoto Katsura Hospital, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Nishi Kobe Medical Center, Kobe, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe City Medical Center General Hospital, Kobe, Japan
| | - Takakazu Matsushita
- Department of Surgery, National Hospital Organization Himeji Medical Center, Himeji, Japan
| | - Fumitaka Oike
- Department of Surgery, Mitsubishi Kyoto Hospital, Kyoto, Japan
| | - Masato Ichimiya
- Department of Surgery, Japan Red Cross Wakayama Medical Center, Wakayama, Japan
| | - Shuichi Ohta
- Department of Surgery, Osakafu Saiseikai Noe Hospital, Osaka, Japan
| | - Kenya Yamanaka
- Department of Surgery, Kishiwada City Hospital, Kishiwada, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kentaro Yasuchika
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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Laparoscopic Hepatectomy: Current State in Japan Based on the 4th Nationwide Questionnaire. Gastroenterol Res Pract 2017; 2017:6868745. [PMID: 28386272 PMCID: PMC5366230 DOI: 10.1155/2017/6868745] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/13/2016] [Revised: 01/07/2017] [Accepted: 01/23/2017] [Indexed: 12/17/2022] Open
Abstract
Purpose. Since laparoscopic hepatectomy (LH) became covered by national health insurance in April 2010 in Japan, the numbers of applied cases and institutions performing it have increased and the indication has expanded. We surveyed the current state and safety of LH in Japan. Methods. A questionnaire survey was performed in 41 institutions related to the Japanese Endoscopic Liver Surgery Study Group and 747 institutions certified by the Japanese Society of Gastroenterological Surgery, and responses concerning all 2962 cases of LH performed by August 2011 were obtained. Results. The surgical procedure employed was hemihepatectomy in 234 (8%), segmentectomy in 88 (3%), left lateral segmentectomy in 434 (15%), segmentectomy in 156 (5%), and partial resection in 1504 (51%) cases. The approach was pure laparoscopy in 1835 (63%), hand-assisted laparoscopic surgery in 201 (7%), and laparoscopy-assisted surgery in 926 (31%). Regarding perioperative complications, surgery was switched to laparotomy in 59 (2.0%), reoperation was performed in 4 (0.1%), and surgery-related death occurred in 2 (0.07%). Intraoperative accidents occurred in 68 (2.3%), and postoperative complications developed in 94 (3.2%). Conclusions. When the selection of cases is appropriate, LH for liver diseases can be safely performed.
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Monden K, Sadamori H, Hioki M, Nakano K, Asami S, Ohno S, Sasaki K, Ueki T, Yabushita K, Uka M, Hyodo T, Sakaguchi K, Takakura N. Usefulness of a CT-guided hookwire marking in laparoscopic partial hepatectomy for hepatocellular carcinoma invisible on ultrasonography. Asian J Endosc Surg 2017; 10:100-103. [PMID: 28045236 DOI: 10.1111/ases.12321] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/08/2016] [Revised: 07/14/2016] [Accepted: 07/18/2016] [Indexed: 11/28/2022]
Abstract
INTRODUCTION The intra-operative detection of hepatocellular carcinoma (HCC) by ultrasonography is indispensable for laparoscopic partial hepatectomy. However, it is occasionally difficult to localize an HCC on an ultrasound in chronic liver disease. Two cases of partial hepatectomy using hookwire marking under CT guidance are presented. MATERIALS AND SURGICAL TECHNIQUE The location of the HCC was identified by CT scan, and the puncture site was determined. A hookwire system, made of a stainless steel hook, was used to localize the HCC. The hookwire was placed percutaneously close to the HCC, and then the patient was taken to the operating room as soon as possible. After identification of the hookwire marker, the cutting line was determined on the liver surface to ensure a sufficient surgical margin in laparoscopic partial hepatectomy. DISCUSSION Two cases underwent these procedures with easy intra-operative marking of the resection area. This technique facilitates safe laparoscopic partial hepatectomy for an HCC that is invisible on ultrasound.
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Affiliation(s)
- Kazuteru Monden
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Hiroshi Sadamori
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Masayoshi Hioki
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Kanyu Nakano
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Shinya Asami
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Satoshi Ohno
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Japan
| | - Kyo Sasaki
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Toru Ueki
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Kazuhisa Yabushita
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Mayu Uka
- Department of Radiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Tsuyoshi Hyodo
- Department of Radiology, Fukuyama City Hospital, Fukuyama, Japan
| | - Kousaku Sakaguchi
- Department of Internal Medicine, Fukuyama City Hospital, Fukuyama, Japan
| | - Norihisa Takakura
- Department of Gastroenterological Surgery, Fukuyama City Hospital, Fukuyama, Japan
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Yamada S, Shimada M, Imura S, Morine Y, Ikemoto T, Saito Y, Takasu C, Yoshikawa M, Teraoku H, Yoshimoto T, Takata A. Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy. Surg Endosc 2016; 31:2623-2629. [DOI: 10.1007/s00464-016-5273-3] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2016] [Accepted: 09/27/2016] [Indexed: 01/22/2023]
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15
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Akyuz M, Yazici P, Yigitbas H, Dural C, Okoh A, Aliyev S, Aucejo F, Quintini C, Fung J, Berber E. Oncologic results of laparoscopic liver resection for malignant liver tumors. J Surg Oncol 2015; 113:127-9. [DOI: 10.1002/jso.24119] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/06/2015] [Accepted: 11/18/2015] [Indexed: 12/29/2022]
Affiliation(s)
- Muhammet Akyuz
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | - Pinar Yazici
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | - Hakan Yigitbas
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | - Cem Dural
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | - Alexis Okoh
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | - Shamil Aliyev
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | - Federico Aucejo
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | | | - John Fung
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
| | - Eren Berber
- Department of General Surgery; Cleveland Clinic; Cleveland Ohio
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Ogawa C, Minami Y, Noda T, Arasawa S, Izuta M, Kubo A, Matsunaka T, Tamaki H, Shibatoge M, Kudo M. Initial Experience Performing Percutaneous Ultrasound Examination with Real-Time Virtual Sonography with Color Display. Oncology 2015; 89 Suppl 2:11-8. [PMID: 26584031 DOI: 10.1159/000440626] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/19/2022]
Abstract
PURPOSE We report the efficacy of percutaneous ultrasound (US) examination using a novel real-time virtual sonography (RVS) method that collates multiple Digital Imaging and Communications in Medicine (DICOM) data sources and displays reference images in color. MATERIALS AND METHODS A total of 7 patients with 9 hepatocellular carcinomas were evaluated. Using the SYNAPSE VINCENT volume analyzer, DICOM data of the portal vein, hepatic vein, tumor, and hepatic segment were isolated from contrast-enhanced computed tomography DICOM data. Each portion of DICOM data was uploaded into an US scanner (HI VISION Ascendus, Hitachi Aloka Medical Ltd., Tokyo, Japan) and unified on a US platform to create a single reference image. Each uploaded portion of DICOM data was assigned a different color. Further, conventional RVS was performed using this information. RESULTS The maximal tumoral diameter ranged from 6.4 to 15 mm (mean ± SD, 11.0 ± 2.8). DICOM data could be isolated, enabling the display of color RVS in all patients. Color RVS facilitated superior visibility compared with conventional grayscale RVS and facilitated the comprehension of spatial positioning. CONCLUSION RVS with color display demonstrates utility in increasing operator comprehension of spatial and positional relationships during percutaneous US examination.
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Affiliation(s)
- Chikara Ogawa
- Department of Gastroenterology and Hepatology, Faculty of Medicine, Kinki University, Osaka-Sayama, Japan
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Kobayashi S, Takeda Y, Nakahira S, Tsujie M, Shimizu J, Miyamoto A, Eguchi H, Nagano H, Doki Y, Mori M. Fibrin Sealant with Polyglycolic Acid Felt vs Fibrinogen-Based Collagen Fleece at the Liver Cut Surface for Prevention of Postoperative Bile Leakage and Hemorrhage: A Prospective, Randomized, Controlled Study. J Am Coll Surg 2015; 222:59-64. [PMID: 26597705 DOI: 10.1016/j.jamcollsurg.2015.10.006] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/10/2015] [Accepted: 10/08/2015] [Indexed: 12/21/2022]
Abstract
BACKGROUND The incidence of postoperative biliary leakage and hemorrhage is low, but these factors remain important in liver surgery, and this study's objective was to explore the efficacy of fibrin sealant (FS) with polyglycolic acid (PGA) vs fibrinogen-based collagen fleece (CF) at the liver cut surface. Fibrinogen-based collagen fleece is generally used for hemostasis; PGA-FS has reduced biliary leakage in several retrospective studies. STUDY DESIGN We designed a multicenter, randomized, controlled trial. The primary outcome was the rate of biliary leakage and hemorrhage. Secondary outcomes included morbidities and effusion at the liver cut surface at 3 months post-surgery. Biliary leakage was diagnosed when the drain/serum bilirubin ratio was >5. Hemorrhage was diagnosed when relaparotomy or transfusion was needed. RESULTS Of 786 patients from 11 institutions enrolled from 2009 to 2014, a total of 391 were randomly assigned to PGA-FS and 395 to CF. Regarding primary outcomes, rates of biliary leakage were 4.1% with PGA-FS and 5.1% with CF, and rates of hemorrhage were 1.0% in each group; groups did not differ significantly. For secondary outcomes, morbidity rates were 18.7% in the PGA-FS group and 24.6% in the CF group (p = 0.0450). Effusion at the cut liver surface was less with PGA-FS (22.2%) than with CF (32.9%) (p = 0.0142). Regarding morbidity, infection around the liver, jaundice, and abdominal paracentesis were less in the PGA-FS group. CONCLUSIONS Compared with CF, PGA-FS did not reduce biliary leakage and hemorrhage. Surgical site infection around the liver, effusion at the liver cut surface, and abdominal paracentesis were less in the PGA-FS group.
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Affiliation(s)
- Shogo Kobayashi
- Department of Surgery, Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan; Department of Surgery, Osaka University Hospital, Osaka, Japan.
| | - Yutaka Takeda
- Department of Surgery, Kansai Rosai Hospital, Osaka, Japan
| | - Shin Nakahira
- Department of Surgery, Kansai Rosai Hospital, Osaka, Japan
| | - Masanori Tsujie
- Department of Surgery, Nara Hospital, Kinki University Faculty of Medicine, Osaka, Japan
| | - Junzo Shimizu
- Department of Surgery, Osaka Rosai Hospital, Osaka, Japan
| | - Atsushi Miyamoto
- Department of Hepatobiliary-Pancreatic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan
| | | | - Hiroaki Nagano
- Department of Surgery, Osaka University Hospital, Osaka, Japan
| | - Yuichiro Doki
- Department of Surgery, Osaka University Hospital, Osaka, Japan
| | - Masaki Mori
- Department of Surgery, Osaka University Hospital, Osaka, Japan
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Cai X, Duan L, Wang Y, Jiang W, Liang X, Yu H, Cai L. Laparoscopic hepatectomy by curettage and aspiration: a report of 855 cases. Surg Endosc 2015; 30:2904-13. [PMID: 26487222 DOI: 10.1007/s00464-015-4576-0] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2015] [Accepted: 09/19/2015] [Indexed: 12/13/2022]
Abstract
BACKGROUND In 1998, the technique of laparoscopic hepatectomy by curettage and aspiration was developed and a special instrument, laparoscopic multifunctional operative dissector (LPMOD), was designed for this procedure. In the past 17 years, this procedure was developed gradually and had become the routine procedure for laparoscopic hepatectomy in local area. This paper is to report results of 17-year practice of this procedure. METHODS Patients who underwent laparoscopic hepatectomy from August 1998 to March 2015 were reviewed. Hepatectomies were performed using the technique of laparoscopic hepatectomy by curettage and aspiration. By using the LPMOD, liver parenchyma was crashed and aspirated immediately and the intrahepatic ducts and small vessels were preserved and were safely dissected for ligation. Laparoscopic selective hepatic flow occlusion was performed routinely for hemi-hepatectomies to control intraoperative blood loss. RESULTS A total of 855 cases underwent laparoscopic hepatectomy by curettage and aspiration. No perioperative death, 105 patients were converted to open operation, and 84 of them were converted before liver transection without any emergency. Postoperative bleeding occurred in three patients (0.4 %), and bile leakage occurred in seven patients (0.8 %). CONCLUSION Laparoscopic hepatectomy by curettage and aspiration is a safe procedure for liver resection with acceptable morbidity and mortality.
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Affiliation(s)
- XiuJun Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310016, China.
| | - Lian Duan
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310016, China
| | - YiFan Wang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310016, China
| | - Wenbin Jiang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310016, China
| | - Xiao Liang
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310016, China
| | - Hong Yu
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310016, China
| | - LiuXin Cai
- Department of General Surgery, Sir Run Run Shaw Hospital, Zhejiang University School of Medicine, 3, East Qingchun Road, Hangzhou, 310016, China
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Hibi T, Cherqui D, Geller DA, Itano O, Kitagawa Y, Wakabayashi G. Expanding indications and regional diversity in laparoscopic liver resection unveiled by the International Survey on Technical Aspects of Laparoscopic Liver Resection (INSTALL) study. Surg Endosc 2015; 30:2975-83. [DOI: 10.1007/s00464-015-4586-y] [Citation(s) in RCA: 31] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2015] [Accepted: 09/19/2015] [Indexed: 02/07/2023]
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Coelho FF, Perini MV, Kruger JAP, Lupinacci RM, Makdissi FF, D'Albuquerque LAC, Cecconello I, Herman P. Video assisted resections. Increasing access to minimally invasive liver surgery? Rev Col Bras Cir 2015; 42:318-24. [DOI: 10.1590/0100-69912015005009] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/06/2014] [Accepted: 01/03/2015] [Indexed: 01/27/2023] Open
Abstract
Objective: To evaluate perioperative outcomes, safety and feasibility of video-assisted resection for primary and secondary liver lesions. Methods : From a prospective database, we analyzed the perioperative results (up to 90 days) of 25 consecutive patients undergoing video-assisted resections in the period between June 2007 and June 2013. Results : The mean age was 53.4 years (23-73) and 16 (64%) patients were female. Of the total, 84% were suffering from malignant diseases. We performed 33 resections (1 to 4 nodules per patient). The procedures performed were non-anatomical resections (n = 26), segmentectomy (n = 1), 2/3 bisegmentectomy (n = 1), 6/7 bisegmentectomy (n = 1), left hepatectomy (n = 2) and right hepatectomy (n = 2). The procedures contemplated postero-superior segments in 66.7%, requiring multiple or larger resections. The average operating time was 226 minutes (80-420), and anesthesia time, 360 minutes (200-630). The average size of resected nodes was 3.2 cm (0.8 to 10) and the surgical margins were free in all the analyzed specimens. Eight percent of patients needed blood transfusion and no case was converted to open surgery. The length of stay was 6.5 days (3-16). Postoperative complications occurred in 20% of patients, with no perioperative mortality. Conclusion : The video-assisted liver resection is feasible and safe and should be part of the liver surgeon armamentarium for resection of primary and secondary liver lesions.
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Reply to Letter: "Long-term Survival Analysis of Pure Laparoscopic Versus Open Hepatectomy for Hepatocellular Carcinoma in Patients With Cirrhosis: A Single-center Experience". Ann Surg 2015; 262:e20-1. [PMID: 24374548 DOI: 10.1097/sla.0000000000000444] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
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Takahara T, Wakabayashi G, Beppu T, Aihara A, Hasegawa K, Gotohda N, Hatano E, Tanahashi Y, Mizuguchi T, Kamiyama T, Ikeda T, Tanaka S, Taniai N, Baba H, Tanabe M, Kokudo N, Konishi M, Uemoto S, Sugioka A, Hirata K, Taketomi A, Maehara Y, Kubo S, Uchida E, Miyata H, Nakamura M, Kaneko H, Yamaue H, Miyazaki M, Takada T. Long-term and perioperative outcomes of laparoscopic versus open liver resection for hepatocellular carcinoma with propensity score matching: a multi-institutional Japanese study. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:721-7. [PMID: 26096910 DOI: 10.1002/jhbp.276] [Citation(s) in RCA: 184] [Impact Index Per Article: 20.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/17/2015] [Accepted: 06/17/2015] [Indexed: 12/07/2022]
Abstract
BACKGROUND The aim of this study was to compare the long-term outcomes and perioperative outcomes of laparoscopic liver resection (LLR) with those of open liver resection (OLR) for hepatocellular carcinoma (HCC) between well-matched patient groups. METHODS Hepatocellular carcinoma patients underwent primary liver resection between 2000 and 2010, were collected from 31 participating institutions in Japan and were divided into LLR (n = 436) and OLR (n = 2969) groups. A one-to-one propensity case-matched analysis was used with covariates of baseline characteristics, including tumor characteristics and surgical procedures of hepatic resections. Long-term and short-term outcomes were compared between the matched two groups. RESULTS The two groups were well balanced by propensity score matching and 387 patients were matched. There were no significant differences in overall survival and disease-free survival between LLR and OLR. The median blood loss (158 g vs. 400 g, P < 0.001) was significantly less with LLR, and the median postoperative hospital stay (13 days vs. 16 days, P < 0.001) was significantly shorter for LLR. Complication rate (6.7% vs. 13.0%, P = 0.003) was significantly less in LLR. CONCLUSION Compared with OLR, LLR in selected patients with HCC showed similar long-term outcomes, associated with less blood loss, shorter hospital stay, and fewer postoperative complications.
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Affiliation(s)
- Takeshi Takahara
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Go Wakabayashi
- Department of Surgery, Iwate Medical University School of Medicine, Iwate, Japan
| | - Toru Beppu
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Arihiro Aihara
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Naoto Gotohda
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Etsuro Hatano
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Yoshinao Tanahashi
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Toru Mizuguchi
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Toshiya Kamiyama
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Tetsuo Ikeda
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shogo Tanaka
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Nobuhiko Taniai
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Hideo Baba
- Department of Gastroenterological Surgery, Graduate School of Life Sciences, Kumamoto University, Kumamoto, Japan
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan
| | - Masaru Konishi
- Department of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Kashiwa, Chiba, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Atsushi Sugioka
- Department of Surgery, Fujita Health University School of Medicine, Aichi, Japan
| | - Koichi Hirata
- Department of Surgery, Surgical Oncology and Science, Sapporo Medical University School of Medicine, Sapporo, Japan
| | - Akinobu Taketomi
- Department of Gastroenterological Surgery I, Hokkaido University Graduate School of Medicine, Sapporo, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Shoji Kubo
- Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka, Japan
| | - Eiji Uchida
- Department of Gastrointestinal Hepato-Biliary-Pancreatic Surgery, Nippon Medical School, Tokyo, Japan
| | - Hiroaki Miyata
- Department of Healthcare Quality Assessment, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Masafumi Nakamura
- Department of Digestive Surgery, Kawasaki Medical School, Okayama, Japan
| | - Hironori Kaneko
- Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Hiroki Yamaue
- Second Department of Surgery, Wakayama Medical University, School of Medicine, Wakayama, Japan
| | - Masaru Miyazaki
- Department of General Surgery, Chiba University Graduate School of Medicine, Chiba, Japan
| | - Tadahiro Takada
- Japanese Society of Hepato-biliary-Pancreatic Surgery, Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan
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Comparisons of financial and short-term outcomes between laparoscopic and open hepatectomy: benefits for patients and hospitals. Surg Today 2015; 46:535-42. [PMID: 26021453 DOI: 10.1007/s00595-015-1189-0] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/19/2015] [Accepted: 05/11/2015] [Indexed: 12/13/2022]
Abstract
PURPOSES This retrospective analysis compared the cost outcomes for both patients and hospitals, as well as the short-term outcomes, for laparoscopic hepatectomy (LH) and open hepatectomy (OH). METHODS The subjects comprised 70 patients who underwent LH or OH. The total hospital charge was calculated using the Japanese lump-sum payment system according to the diagnosis procedure combination. RESULTS Of the 70 patients, 10 in the LH group and 16 in the OH group underwent primary single limited/anatomic resection or left lateral sectoriectomy. The operation time, blood loss, and postoperative complications did not differ significantly between the two groups. The median [range] time of inflow occlusion was significantly longer [120 (50-194) vs. 57 (17-151) min, P = 0.03] and the postoperative hospital stay was significantly shorter [5 (4-6) vs. 9 (5-12) days, P < 0.01] in the LH group than in the OH group, respectively. The mean ± standard deviation surgical costs (1307 ± 596 vs. 1054 ± 365 US$, P = 0.43) and total hospital charges (12046 ± 1174 vs. 11858 ± 2096 US$, P > 0.99) were similar in the LH and OH groups, respectively, although the charges per day were significantly higher in the LH group than in the OH group (1388 ± 217 vs. 1016 ± 134 US$, P < 0.01). CONCLUSIONS The costs to patients for LH are similar to those for OH. However, LH provides a financial advantage to hospitals due to a reduced hospital stay and comparable surgical costs.
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Lacerda CF, Bertulucci PA, Oliveira ATTD. Totally laparoscopic liver resection: new Brazilian experience. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:191-5. [PMID: 25184770 PMCID: PMC4676382 DOI: 10.1590/s0102-67202014000300008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background Despite the increasing number of laparoscopic hepatectomy, there is little
published experience. Aim To evaluate the results of a series of hepatectomy completely done with
laparoscopic approach. Methods This is a retrospective study of 61 laparoscopic liver resections. Were studied
conversion to open technique; mean age; gender, mortality; complications; type of
hepatectomy; surgical techniques applied; and simultaneous operations. Results The conversion to open technique was necessary in one case (1.6%). The mean age
was 54.7 years (17-84), 34 were men. Three patients (4.9%) had complications. One
died postoperatively (mortality 1.6%) and no deaths occurred intraoperatively. The
most frequent type was right hepatectomy (37.7%), followed by bisegmentectomy
(segments II-III and VI-VII). Were not used hemi-Pringle maneuvers or assisted
technic. Six patients (8.1%) underwent simultaneous procedures (hepatectomy and
colectomy). Conclusion Laparoscopic hepatectomy is feasible procedure and can be considered the gold
standard for various conditions requiring liver resections for both benign to
malignant diseases.
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Murakami K, Naka S, Shiomi H, Akabori H, Kurumi Y, Morikawa S, Tani T. Initial experiences with MR Image-guided laparoscopic microwave coagulation therapy for hepatic tumors. Surg Today 2014; 45:1173-8. [DOI: 10.1007/s00595-014-1042-x] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2014] [Accepted: 09/15/2014] [Indexed: 02/06/2023]
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