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Anselmo A, Sensi B, Bacchiocchi G, Siragusa L, Tisone G. All the Routes for Laparoscopic Liver Segment VIII Resection: A Comprehensive Review of Surgical Techniques. Front Oncol 2022; 12:864867. [PMID: 35433475 PMCID: PMC9010857 DOI: 10.3389/fonc.2022.864867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/28/2022] [Accepted: 02/28/2022] [Indexed: 12/07/2022] Open
Abstract
Liver surgery is highly demanding for anatomical, physiological and technical reasons, and minimally invasive approaches have been implemented at a slower rate. Today, laparoscopic liver resection is a standard of care in many occasions, yet specific operations remain particularly challenging and generally performed in open surgery. In particular, SVIII resection may be considered one of the most difficult due to anatomical characteristics including its sub-diaphragmatic position, the deep-lying Glissonean pedicle and the close contact with the inferior vena cava and right and middle hepatic veins. Many techniques have risen to overcome technical difficulties, and today laparoscopic SVIII resection has been demonstrated to be feasible. This review provides a complete picture of current approaches, focusing on all techniques reported so far with critical appraisal of each, discussing and explaining benefits and pitfalls.
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Vandermeulen M, Lim C, Goumard C, Scatton O. Standardized Technique of Selective Left Liver Vascular Exclusion During Laparoscopic Liver Resection for Benign and Malignant Tumors. J Gastrointest Surg 2021; 25:2720-2725. [PMID: 34131863 DOI: 10.1007/s11605-021-05059-1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/30/2021] [Accepted: 05/25/2021] [Indexed: 01/31/2023]
Abstract
BACKGROUND Tumors located close to major hepatic veins pose a technical challenge to standard laparoscopic liver resection. Hepatic outflow occlusion may reduce the risks of bleeding from hepatic vein and gas embolism. The aim of this study was to detail our standardized laparoscopic approach for a safe extrahepatic control of the common trunk of middle and left hepatic veins during laparoscopic liver resection and to assess its feasibility in patients with tumors located in both right and left lobes of the liver. METHODS Data of 25 consecutive patients who underwent laparoscopic liver resection with extrahepatic control of the common trunk of middle and left hepatic veins were reviewed. RESULTS All patients underwent primary hepatectomy. The vast majority (84%) of patients had malignant tumors. The control of the common trunk of middle and left hepatic veins was achieved in 96% of patients. There were 14 (56%) major hepatectomies and 11 (44%) minor hepatectomies. Some form of vascular clamping was performed in 23 (62%) patients: Pringle maneuver in 17 (median time = 45 min; range, 10-109) and selective vascular exclusion of the liver in 6 patients (median time = 30 min; range, 15-94). The median duration of operation was 254 min (range, 70-441). There was one case (4%) of gas embolism but without any complications during the postoperative course. Conversion to open surgery was performed in 2 (7.7%) patients: 1 for oncologic reason and 1 for non-progression during the transection plane. Perioperative blood transfusion rate was nil. The overall morbidity rate was 24%. CONCLUSIONS The laparoscopic approach for an extrahepatic control of the common trunk of middle and left hepatic veins is reproducible, safe, and effective, and can be applied during laparoscopic liver resection for tumors close to major hepatic veins.
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Affiliation(s)
- Morgan Vandermeulen
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Division of Abdominal Surgery and Transplantation, University of Liege Hospital (CHU ULiège), Liège, Belgium
| | - Chetana Lim
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
| | - Claire Goumard
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France
- Sorbonne Université, Paris, France
- Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France
| | - Olivier Scatton
- Department of Hepato-Biliary and Pancreatic Surgery and Liver Transplantation, AP-HP Pitié-Salpêtrière Hospital, Paris, France.
- Sorbonne Université, Paris, France.
- Centre de Recherche de Saint-Antoine (CRSA), INSERM, UMRS-938, Paris, France.
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Hanzawa S, Monden K, Hioki M, Sadamori H, Ohno S, Takakura N. How-I-do-it: laparoscopic left medial sectionectomy utilizing a cranial approach to the middle hepatic vein and Laennec's capsule. Langenbecks Arch Surg 2021; 406:2091-2097. [PMID: 34331584 PMCID: PMC8481215 DOI: 10.1007/s00423-021-02282-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/07/2021] [Accepted: 07/14/2021] [Indexed: 11/30/2022]
Abstract
Background Laparoscopic anatomic liver resection is technically demanding, given the need to safely isolate the Glissonean pedicles and expose the hepatic veins (HVs) on the liver parenchyma cut surface. Laennec’s capsule is observed around the Glissonean pedicles and root of the HVs. However, its existence, particularly on the peripheral side of the HVs, remains controversial. Herein, we describe Laennec’s capsule-related histopathological findings around the HVs and a safe laparoscopic left medial sectionectomy utilizing Laennec’s capsule. Methods The extrahepatic Glissonean approach was performed by connecting Gates II and III, in accordance with Sugioka’s Gate theory. Liver parenchymal transection commenced along the demarcation line, which is between the medial and lateral sections, and the G4 was dissected during transection. Subsequently, via the outer-Laennec approach, the middle hepatic vein (MHV) was exposed from the root side in cranial view, while Laennec’s capsule was preserved. Parenchymal transection was completed while connecting the MHV with the demarcation line. We obtained the membrane surrounding the HVs and performed histopathological examinations. Results Six patients underwent laparoscopic left medial sectionectomy from February 2012 to November 2020. There were no cases involving complications (Clavien–Dindo classification; grade II or higher), open-surgery conversion, transfusion, or surgery-related death. The histopathological findings showed Laennec’s capsule surrounding both the trunk of the major HVs and the peripheral side of the HVs. Conclusions A cranial approach to the major HVs utilizing Laennec’s capsule is a feasible and advantageous procedure for laparoscopic left medial sectionectomy. We propose that Laennec’s capsule surrounds the entire length of the HVs. Supplementary Information The online version contains supplementary material available at 10.1007/s00423-021-02282-x.
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Affiliation(s)
- Shunya Hanzawa
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, Hiroshima, 721-8511, Japan
| | - Kazuteru Monden
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, Hiroshima, 721-8511, Japan.
| | - Masayoshi Hioki
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, Hiroshima, 721-8511, Japan
| | - Hiroshi Sadamori
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, Hiroshima, 721-8511, Japan
| | - Satoshi Ohno
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, Hiroshima, 721-8511, Japan
| | - Norihisa Takakura
- Department of Gastroenterological Surgery, Fukuyama City Hospital, 5-23-1 Zao, Fukuyama, Hiroshima, 721-8511, Japan
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Monden K, Alconchel F, Berardi G, Ciria R, Akahoshi K, Miyasaka Y, Urade T, García Vázquez A, Hasegawa K, Honda G, Kaneko H, Hoon Kim J, Tanabe M, Yamamoto M, Wakabayashi G. Landmarks and techniques to perform minimally invasive liver surgery: A systematic review with a focus on hepatic outflow. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:66-81. [PMID: 33475254 DOI: 10.1002/jhbp.898] [Citation(s) in RCA: 29] [Impact Index Per Article: 9.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 10/30/2020] [Revised: 12/23/2020] [Accepted: 01/07/2021] [Indexed: 12/31/2022]
Abstract
PURPOSE In this systematic review, we aimed to clarify the useful anatomic structures and assess available surgical techniques and strategies required to safely perform minimally invasive anatomic liver resection (MIALR), with a particular focus on the hepatic veins (HVs). METHODS A systematic review was conducted using MEDLINE/PubMed for English articles and Ichushi databases for Japanese articles through September 2020. The quality assessment of the articles was performed in accordance with the Scottish Intercollegiate Guidelines Network (SIGN). RESULTS A total of 3372 studies were obtained, and 59 were selected and reviewed. Due to the limited number of published comparative studies and case series, the degree of evidence from our review was low. Thirty-two articles examined the anatomic landmarks and crucial structures for approaching HVs. Regarding the direction of HV exposure, 32 articles focused on the techniques and advantages of exposing HVs from either the root or the periphery. Ten articles focused on the techniques to perform a segmentectomy 8 in particularly difficult cases of MIALR. In seven articles, bleeding control from HVs was also discussed. CONCLUSIONS This review may help experts reach a consensus regarding the best approach to the management of hepatic veins during MIALR.
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Affiliation(s)
- Kazuteru Monden
- Department of Surgery, Fukuyama City Hospital, Hiroshima, Japan
| | - Felipe Alconchel
- Department of Surgery and Transplantation, Virgen de la Arrixaca University Hospital (IMIB-Virgen de la Arrixaca), Murcia, Spain
| | - Giammauro Berardi
- Department of General Surgery and Liver Transplantation Service, San Camillo Forlanini Hospital of Rome, Rome, Italy
| | - Ruben Ciria
- Unit of Hepatobiliary Surgery and Liver Transplantation, University Hospital Reina Sofía, IMIBIC, Cordoba, Spain
| | - Keiichi Akahoshi
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Yoshihiro Miyasaka
- Department of Surgery, Fukuoka University Chikushi Hospital, Fukuoka, Japan
| | - Takeshi Urade
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Kobe University, Hyogo, Japan.,Institute of Image-Guided Surgery of Strasbourg, Strasbourg, France
| | | | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan
| | - Goro Honda
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Hironori Kaneko
- Division of General and Gastroenterological Surgery, Department of Surgery, Toho University Faculty of Medicine, Tokyo, Japan
| | - Ji Hoon Kim
- Center for Liver and Pancreatobiliary Cancer, National Cancer Center, Gyeonggi-do, Korea
| | - Minoru Tanabe
- Department of Hepatobiliary and Pancreatic Surgery, Graduate School of Medicine, Tokyo Medical and Dental University, Tokyo, Japan
| | - Masakazu Yamamoto
- Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of Hepatobiliary and Pancreatic Diseases, Ageo Central General Hospital, Saitama, Japan
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Laparoscopic posterior segmental resections: How I do it: Tips and pitfalls. Int J Surg 2020; 82S:178-186. [DOI: 10.1016/j.ijsu.2020.06.052] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2020] [Revised: 06/01/2020] [Accepted: 06/29/2020] [Indexed: 02/08/2023]
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Consideration of Cranial Approach to Major Hepatic Veins in Laparoscopic Anatomic Liver Resection of Segment 8. J Am Coll Surg 2020; 231:498-499. [DOI: 10.1016/j.jamcollsurg.2020.06.011] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/18/2020] [Accepted: 06/17/2020] [Indexed: 11/21/2022]
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Turco C, Lim C, Goumard C, Scatton O. Anticipating Potential Perioperative Complication: In Reply to Monden and Colleagues. J Am Coll Surg 2020; 231:499-500. [PMID: 32778496 DOI: 10.1016/j.jamcollsurg.2020.06.012] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2020] [Accepted: 06/17/2020] [Indexed: 10/23/2022]
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Ome Y, Honda G. An Additional Description of Laparoscopic Anatomic Liver Resection of Segment 8 Using Intrahepatic Glissonean Approach: In Reply to Turco and colleagues. J Am Coll Surg 2020; 231:409-410. [PMID: 32605738 DOI: 10.1016/j.jamcollsurg.2020.05.019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/09/2020] [Accepted: 05/19/2020] [Indexed: 10/24/2022]
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