1
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Seo CH, Choi HJ, You YK. Long-term outcomes of single-port laparoscopic hepatectomy for hepatocellular carcinoma: a retrospective comparative analysis. Ann Surg Treat Res 2024; 106:354-360. [PMID: 38868585 PMCID: PMC11164656 DOI: 10.4174/astr.2024.106.6.354] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/20/2024] [Revised: 03/09/2024] [Accepted: 04/12/2024] [Indexed: 06/14/2024] Open
Abstract
Purpose Numerous efforts have been made to achieve minimally invasive surgery, such as single-port laparoscopic surgery. However, few studies have provided long-term follow-up information, and the number of patients with hepatocellular carcinoma (HCC) in previous studies has been small. The purpose in this study is to compare the long-term oncological outcomes of HCC patients who underwent single-port laparoscopic hepatectomy (SPLH) with those of patients who underwent multiport laparoscopic hepatectomy (MPLH). Methods We retrospectively reviewed the medical records of 135 patients with HCC who underwent laparoscopic liver between January 2008 and December 2018. Of the 135 patients, 53 underwent MPLH, and 82 underwent SPLH. Results From January 2008 to December 2018, 135 patients underwent laparoscopic hepatectomy for HCC. Among them, 82 patients underwent SPLH, and 53 patients underwent MPLH. Neither long-term overall survival (P = 0.849) nor recurrence-free survival (P = 0.057) differed significantly between the 2 groups, even though the recurrence rate was higher in the SPLH group. In the univariable analysis of risk factors for recurrence, multiple tumors, SPLH method, and portal vein invasion were statistically significant (P < 0.05). Multivariable analysis showed that the SPLH method and portal vein invasion were independent adverse prognostic factors for recurrence-free survival. Conclusion In terms of both short-term and long-term outcomes, the SPLH method seems to be a feasible approach for HCC in select patients. Because the potential risk of margin recurrence might produce poor oncological outcomes, strict patient selection is essential to ensure that an adequate safety margin can be secured.
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Affiliation(s)
- Chang Ho Seo
- Department of Surgery, Bucheon St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Ho Joong Choi
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
| | - Young Kyoung You
- Department of Surgery, Seoul St. Mary’s Hospital, College of Medicine, The Catholic University of Korea, Seoul, Korea
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2
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Chern MC, Lin CW, Lin ZH, Tsai TJ. Mid- to long-term outcome of laparoscopic ultrasound-guided radiofrequency ablation for malignant hepatic tumors. J Gastrointest Surg 2024; 28:103-107. [PMID: 38445930 DOI: 10.1016/j.gassur.2023.11.010] [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: 07/20/2023] [Revised: 08/28/2023] [Accepted: 10/28/2023] [Indexed: 03/07/2024]
Abstract
BACKGROUND This study aimed to evaluate the long-term outcomes of fully laparoscopic ultrasound-guided radiofrequency ablation (LURFA) in malignant hepatic tumors that are difficult to curatively treat with the percutaneous approach or laparoscopic liver resection (LLR). METHODS Between 2011 and 2021, 62 patients with malignant hepatic tumors (37 hepatocellular carcinomas [HCCs] and 25 metastatic colorectal cancers [mCRCs]), who were not feasible to be curatively treated by percutaneous radiofrequency ablation or LLR, were enrolled and treated only by LURFA. Patients who underwent concurrent surgical resection were excluded. The cumulative incidence rates of local recurrence (LR) and survival were analyzed. RESULTS All 93 tumors with a median diameter of 22.0 mm (IQR, 8.0-50.0) and a median number of 1.5 tumors (IQR, 1.0-6.0) in 62 patients were successfully treated. According to the IWATE criteria for LLR, 33 of 62 patients (53.2%) had tumors in difficult locations (segments I, VII, VIII, and IVa). Over a median follow-up period of 92.4 months (IQR, 60.0-128.0), the 1-, 2-, 3-, 5-, 8-, and 10-year cumulative incidence rates of LR were 6.9%, 13.8%, 17.2%, 17.2%, 20.9%, and 20.9%, respectively. In patients with HCC, 1-, 3-, 5-, and 8-year survival rates were 97.2%, 80.6%, 55.6%, and 40.1%, respectively. In patients with mCRC, 1-, 3-, 5-, and 8-year survival rates were 100.0%, 36.4%, 27.3%, and 16.4%, respectively. Adverse events of grade 3 occurred in only 3 of 62 patients (4.8%). CONCLUSION Full LURFA is a safe and effective treatment for malignant hepatic tumors, even in difficult percutaneous ablation or LLR areas.
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Affiliation(s)
- Ming-Chih Chern
- Department of Radiology, Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan.
| | - Chung-Wei Lin
- Department of Surgery, Show Chwan Memorial Hospital, Changhua, Taiwan; Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Zoe H Lin
- Department of Radiology, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
| | - Tzu-Jung Tsai
- Department of Surgery, Koo Foundation Sun Yat-Sen Cancer Center, Taipei, Taiwan
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3
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Calderon Novoa F, Ardiles V, de Santibañes E, Pekolj J, Goransky J, Mazza O, Sánchez Claria R, de Santibañes M. Pushing the Limits of Surgical Resection in Colorectal Liver Metastasis: How Far Can We Go? Cancers (Basel) 2023; 15:cancers15072113. [PMID: 37046774 PMCID: PMC10093442 DOI: 10.3390/cancers15072113] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/28/2023] [Revised: 03/24/2023] [Accepted: 03/30/2023] [Indexed: 04/05/2023] Open
Abstract
Colorectal cancer is the third most common cancer worldwide, and up to 50% of all patients diagnosed will develop metastatic disease. Management of colorectal liver metastases (CRLM) has been constantly improving, aided by newer and more effective chemotherapy agents and the use of multidisciplinary teams. However, the only curative treatment remains surgical resection of the CRLM. Although survival for surgically resected patients has shown modest improvement, this is mostly because of the fact that what is constantly evolving is the indication for resection. Surgeons are constantly pushing the limits of what is considered resectable or not, thus enhancing and enlarging the pool of patients who can be potentially benefited and even cured with aggressive surgical procedures. There are a variety of procedures that have been developed, which range from procedures to stimulate hepatic growth, such as portal vein embolization, two-staged hepatectomy, or the association of both, to technically challenging procedures such as simultaneous approaches for synchronous metastasis, ex-vivo or in-situ perfusion with total vascular exclusion, or even liver transplant. This article reviewed the major breakthroughs in liver surgery for CRLM, showing how much has changed and what has been achieved in the field of CRLM.
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Affiliation(s)
- Francisco Calderon Novoa
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Victoria Ardiles
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Eduardo de Santibañes
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Juan Pekolj
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Jeremias Goransky
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Oscar Mazza
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Rodrigo Sánchez Claria
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
| | - Martín de Santibañes
- Department of Surgery, Division of HPB Surgery, Hospital Italiano de Buenos Aires, Buenos Aires C1199, Argentina
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4
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Wang HP, Yong CC, Wu AG, Cherqui D, Troisi RI, Cipriani F, Aghayan D, Marino MV, Belli A, Chiow AK, Sucandy I, Ivanecz A, Vivarelli M, Di Benedetto F, Choi SH, Lee JH, Park JO, Gastaca M, Fondevila C, Efanov M, Rotellar F, Choi GH, Campos RR, Wang X, Sutcliffe RP, Pratschke J, Tang CN, Chong CC, D’Hondt M, Ruzzenente A, Herman P, Kingham TP, Scatton O, Liu R, Ferrero A, Levi Sandri GB, Soubrane O, Mejia A, Lopez-Ben S, Sijberden J, Monden K, Wakabayashi G, Sugioka A, Cheung TT, Long TCD, Edwin B, Han HS, Fuks D, Aldrighetti L, Abu Hilal M, Goh BK, Chan CY, Syn N, Prieto M, Schotte H, De Meyere C, Krenzien F, Schmelzle M, Lee KF, Salimgereeva D, Alikhanov R, Lee LS, Jang JY, Labadie KP, Kojima M, Kato Y, Fretland AA, Ghotbi J, Coelho FF, Pirola Kruger JA, Lopez-Lopez V, Magistri P, Valle BD, Casellas I Robert M, Mishima K, Ettorre GM, Mocchegiani F, Kadam P, Pascual F, Saleh M, Mazzotta A, Montalti R, Giglio M, Lee B, D’Silva M, Nghia PP, Lim C, Liu Q, Lai EC. Factors associated with and impact of open conversion on the outcomes of minimally invasive left lateral sectionectomies: An international multicenter study. Surgery 2022; 172:617-624. [PMID: 35688742 DOI: 10.1016/j.surg.2022.03.037] [Citation(s) in RCA: 9] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/11/2022] [Revised: 03/16/2022] [Accepted: 03/25/2022] [Indexed: 02/07/2023]
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5
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Abu-Zaydeh O, Sawaied M, Berger Y, Mahamid A, Goldberg N, Sadot E, Haddad R. Hand-Assisted Laparoscopic Surgery Is Superior to Open Liver Resection for Colorectal Liver Metastases in the Posterosuperior Segments. Front Surg 2021; 8:746427. [PMID: 34901138 PMCID: PMC8654808 DOI: 10.3389/fsurg.2021.746427] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2021] [Accepted: 10/31/2021] [Indexed: 12/07/2022] Open
Abstract
Introduction: Laparoscopic liver resections (LLR) of colorectal metastasis located in posterosuperior segments (1, 4A, 7 and 8) are challenging and highly demanding. The aim of our study is to determine the safety and feasibility of hand-assisted laparoscopic surgery (HALS) in the resections of the posterosuperior lesions and to compare the peri-operative, short-term and long-term outcomes with the open liver resection (OLR) approach. Methods and Results: A retrospective study of patients who underwent either HALS or OLR for metastatic colorectal cancer (mCRC) located in the posterosuperior segments of the liver between 2008 and 2018 in two university affiliated medical centers. Results: A total of 187 patients were identified, of whom 78 underwent HALS and 109 underwent OLR. There was no difference between the HALS and OLR with regard to preoperative factors (age, primary CRC tumor location, number and anatomical distribution of liver metastasis, pre-operative neo-adjuvant treatment, operative time, blood transfusion rate, and resection margins positivity). On the other hand, HALS compared to OLR had a significantly shorter mean hospital stay (4 vs. 6 days; P = 0.003), and a lower total complications rate (25 vs. 47% P = 0.006). Both groups had no 30-day mortality. Also, patients who underwent HALS vs. OLR had similar liver metastases recurrence (55 vs. 51%. P = 0.65) and 5-year survival (47 vs. 45%. P = 0.72). Conclusions: HALS for mCRC located in posterosuperior liver segments is safe and feasible and it is a preferable approach due to its lower complication rate and shorter hospital stay while not compromising survival and disease recurrence.
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Affiliation(s)
| | - Muneer Sawaied
- Department of Surgery, Carmel Medical Center, Haifa, Israel
| | - Yael Berger
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Ahmad Mahamid
- Department of Surgery, Carmel Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
| | - Natalia Goldberg
- The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel.,Department of Radiology, Carmel Medical Center, Haifa, Israel
| | - Eran Sadot
- Department of Surgery, Rabin Medical Center, Petah Tikva, Israel.,Sackler School of Medicine, Tel Aviv University, Tel Aviv, Israel
| | - Riad Haddad
- Department of Surgery, Carmel Medical Center, Haifa, Israel.,The Ruth and Bruce Rappaport Faculty of Medicine, Technion, Israel Institute of Technology, Haifa, Israel
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6
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Kelly ME, Fahy M, Bolger JC, Boland PA, Neary C, McEntee GP, Conneely JB. Open versus laparoscopic liver resection of colorectal metastases: a meta-analysis of matched patient populations. Ir J Med Sci 2021; 191:1531-1538. [PMID: 34535883 DOI: 10.1007/s11845-021-02780-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2021] [Accepted: 09/08/2021] [Indexed: 11/26/2022]
Abstract
In recent years, the management of colorectal liver metastases (CRLM) has evolved significantly. Laparoscopic liver resection is increasingly being performed, despite a lack of major randomized controlled trial evidence or widespread international consensus. The objective of this review was to compare the short- and long-term outcomes following open and laparoscopic CRLM resection. A systematic review of comparative matched population studies was performed. Evaluated endpoints included surgical outcomes and survival outcomes. Twelve studies were included in this review, reporting on 3095 patients. R0 (negative margins) rates were higher in the laparoscopic CRLM group (89.3% versus 86.9%). In addition, laparoscopic resection was associated with less blood loss (486 mls versus 648 mls, p ≤ 0.0001*) and reduced blood transfusion rates (6.7% vs. 12.2%, OR 2.13, 95% CI 1.08-4.19, p = 0.03*). Major complication rates were higher in the open CRLM group (12.5% vs. 8.1%, OR 1.74, 95% CI 1.30-2.33, p = 0.03*), as was overall hospital length of stay (median 7 versus 5.5 days, p = 0.001*). Perioperative mortality was similar between both groups, and there was no significance in 5-year overall survival for open or laparoscopic CRLM resection groups (58% and 61% respectively). Laparoscopic CRLM resection is associated with less blood loss, lower transfusion rates, major complications, and overall hospital length of stay with comparable oncological outcome.
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Affiliation(s)
- Michael E Kelly
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
- Dept. of Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland.
| | - Matthew Fahy
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Jarlath C Bolger
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Patrick A Boland
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Colm Neary
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - Gerry P McEntee
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
| | - John B Conneely
- Department of Hepatobiliary Surgery, Mater Misericordiae University Hospital, Eccles Street, Dublin 7, Ireland
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7
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Aghayan DL, Kazaryan AM, Fretland ÅA, Røsok B, Barkhatov L, Lassen K, Edwin B. Evolution of laparoscopic liver surgery: 20-year experience of a Norwegian high-volume referral center. Surg Endosc 2021; 36:2818-2826. [PMID: 34036419 PMCID: PMC9001574 DOI: 10.1007/s00464-021-08570-3] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/20/2021] [Accepted: 05/18/2021] [Indexed: 01/22/2023]
Abstract
BACKGROUND Laparoscopic liver surgery has evolved to become a standard surgical approach in many specialized centers worldwide. In this study we present the evolution of laparoscopic liver surgery at a single high-volume referral center since its introduction in 1998. METHODS Patients who underwent laparoscopic liver resection (LLR) between August 1998 and December 2018 at the Oslo University Hospital were analyzed. Perioperative outcomes were compared between three time periods: early (1998 to 2004), middle (2005 to 2012) and recent (2013-2018). RESULTS Up to December 2020, 1533 LLRs have been performed. A total of 1232 procedures were examined (early period, n = 62; middle period, n = 367 and recent period, n = 803). Colorectal liver metastasis was the main indication for surgery (68%). The rates of conversion to laparotomy and hand-assisted laparoscopy were 3.2% and 1.4%. The median operative time and blood loss were 130 min [interquartile range (IQR), 85-190] and 220 ml (IQR, 50-600), respectively. The total postoperative complications rate was 20.3% and the 30-day mortality was 0.3%. The median postoperative stay was two (IQR, 2-4) days. When comparing perioperative outcomes between the three time periods, shorter operation time (median, from 182 to 120 min, p < 0.001), less blood loss (median, from 550 to 200 ml, p = 0.023), decreased rate of conversions to laparotomy (from 8 to 3%) and shorter postoperative hospital stay (median, from 3 to 2 days, p < 0.001) was observed in the later periods, while the number of more complex liver resections had increased. CONCLUSION During the last two decades, the indications, the number of patients and the complexity of laparoscopic liver procedures have expanded significantly. Initially being an experimental approach, laparoscopic liver surgery is now safely implemented across our unit and has become the method of choice for surgical treatment of most liver tumors.
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Affiliation(s)
- Davit L Aghayan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway.
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia.
| | - Airazat M Kazaryan
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of Surgery N1, Yerevan State Medical University After M. Heratsi, Yerevan, Armenia
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Østfold Hospital Trust, Grålum, Norway
- Department of Faculty Surgery, №2I.M. Sechenov First Moscow State Medical University, Moscow, Russia
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Bård Røsok
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Leonid Barkhatov
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of Gastrointestinal Surgery, Haukeland University Hospital, Bergen, Norway
| | - Kristoffer Lassen
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital - Rikshospitalet, 0027, Oslo, Norway
- Institute of Clinical Medicine, Medical Faculty, University of Oslo, Oslo, Norway
- Department of HPB Surgery, Oslo University Hospital - Rikshospitalet, Oslo, Norway
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8
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Murawski M, Łosin M, Gołębiewski A, Sinacka K, Zabolska I, Iżycka-Świeszewska E, Czauderna P. Laparoscopic resection of liver tumors in children. J Pediatr Surg 2021; 56:420-423. [PMID: 33046224 DOI: 10.1016/j.jpedsurg.2020.08.037] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/03/2019] [Revised: 08/25/2020] [Accepted: 08/25/2020] [Indexed: 12/27/2022]
Abstract
BACKGROUND Laparoscopy for the resection of liver tumors in children has remained undeveloped in comparison to adults. Most of the indications for pediatric laparoscopic hepatic surgery have been limited to diagnostic laparoscopy (biopsy). Over the past ten years, however, laparoscopic liver resections for pediatric hepatic diseases have been performed successfully, and many case reports have been published. METHODS The authors report 6 cases of laparoscopic hepatic resection of benign tumors in children. The most important aspects of surgical technique are presented. There were 3 boys and 3 girls, with age between 4 months and 16 years. The lesions were located in the following segments: II and III (4 patients), I (1), V (1). The maximum tumor size was 7 cm. RESULTS One anatomical (left bisegmentectomy) and 5 nonanatomical resections were performed. Conversion to laparotomy was necessary in 1 patient owing to bleeding from the posterior branch of the right hepatic artery. There were no postoperative complications and patients were discharged on postoperative day 4, 5, 5, 5, 7 and 3 accordingly. The postoperative pathology of the specimens confirmed their benign nature: infantile hemangioendothelioma (1), nested stromal epithelial tumor (1), focal nodular hyperplasia (3), mixed benign tumor (hamartoma + vascular malformation) (1). CONCLUSIONS This report demonstrates the feasibility of a laparoscopic hepatic resection in children. On the other hand, laparoscopic liver resection is challenging and teamwork and specific training are necessary.
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Affiliation(s)
- Maciej Murawski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland.
| | - Marcin Łosin
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | - Andrzej Gołębiewski
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
| | | | - Irena Zabolska
- Department of Pediatric Anesthesiology and Intensive Therapy, COPERNICUS LLC, Gdansk, Poland
| | - Ewa Iżycka-Świeszewska
- Department of Pathology and Neuropathology, Medical University of Gdansk, Gdansk, Poland
| | - Piotr Czauderna
- Department of Surgery and Urology for Children and Adolescents, Medical University of Gdansk, Gdansk, Poland
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9
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Learning Curve Under Proctorship of Pure Laparoscopic Living Donor Left Lateral Sectionectomy for Pediatric Transplantation. Ann Surg 2020; 271:542-548. [PMID: 29995683 DOI: 10.1097/sla.0000000000002948] [Citation(s) in RCA: 24] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVE To evaluate the learning curve of an expert liver transplantation surgeon approaching fully laparoscopic living donor left lateral sectionectomy (L-LLS) under proctorship. BACKGROUND Laparoscopic liver resections necessitate a long learning curve trough a stepwise fulfillment of difficulties. L-LLS requires expertise in both living donor liver transplantation and advanced laparoscopic liver surgery. There is currently no data about the learning curve of L-LLS. METHODS A total of 72 pure L-LLS were included in this study. A Broken line model was used to identify the periods of the learning curve. A CUSUM analysis of the operative time was performed to evaluate improvements of outcomes with time. To evaluate the relationship between operative time and progressive number of procedures, a linear regression model was applied. A receiver operating characteristic (ROC) curve was carried out to identify the cutoff for completion of the learning curve. RESULTS Operative time decreased with the progressive increase of procedures. Two cutoffs and 3 different periods were identified: cases 1 to 22, cases 23 to 55, and cases 56 to 72. A significant decrease in blood loss and operative time was noted. The CUSUM analysis showed an increase in operative time in the first period, a stable duration in the second period, and a decrease in the last. Blood loss was significantly associated with an increase in operative time (P = 0.003). According to the ROC curve, the learning curve was completed after 25 procedures. CONCLUSIONS L-LLS is a safe procedure that can be standardized and successfully taught to surgeons with large experience in donor hepatectomy through a proctored learning curve.
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10
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Ledoux G, Amroun K, Rhaiem R, Cagniet A, Aghaei A, Bouche O, Hoeffel C, Sommacale D, Piardi T, Kianmanesh R. Fully laparoscopic thermo-ablation of liver malignancies with or without liver resection: tumor location is an independent local recurrence risk factor. Surg Endosc 2020; 35:845-853. [PMID: 32076859 DOI: 10.1007/s00464-020-07456-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Accepted: 02/11/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND The aim of this study was to analyze risk factors of local recurrence (LR) after exclusive laparoscopic thermo-ablation (TA) with or without associated liver resection. METHODS Between 2012 and 2017, among 385 patients who underwent 820 TA in our department, 65 (17%) patients (HCC = 11, LM = 54) had exclusive laparoscopic TA representing 112 lesions (HCC = 17, LM = 95). TA was associated with other procedures in 57% of cases (liver resection 81%). All TA were done without liver clamping. Median tumor size was 1.8 cm [ranges from 0.3 to 4.5], 18% of the lesions were larger than 3 cm in size and 11% close to major liver vessels. Tumors locations were 77.5% in right liver, 36% in S7&S8, and 46% in S7&S8&S4a. RESULTS Mortality was nil and morbidity rate 15.4% including Dindo-Clavien > II grade 3%. The median follow-up was 24 months [0.77-75]. Per lesion LR rate after TA was 18% (n = 19 patients) with a mean time of 7.6 months. Among patients with LR, 18 (95%) could have been re-treated successfully (new resection = 11, re-TA = 7). Multivariate analyses revealed that tumor location in S7 alone, S7&S8 and/or S7, S8, or S4a were independent risk factors of LR after TA. CONCLUSIONS Exclusive laparoscopic TA is a safe and an effective tool to treat liver malignancies with or without liver resection. Other than classical risk factors, tumor location in upper segments of the liver, are independent risk factors for LR.
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Affiliation(s)
- Geoffrey Ledoux
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Koceila Amroun
- University of Reims Champagne Ardenne, Reims, France.,Department of Surgery, Jean Godinot Cancer Institute, Reims, France
| | - Rami Rhaiem
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France. .,Reims Medical Faculty, Reims, France. .,University of Reims Champagne Ardenne, Reims, France.
| | - Audrey Cagniet
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Arman Aghaei
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Olivier Bouche
- Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France.,Deprtement of Oncology, Robert Debré University- Hospital, Reims, France
| | - Christine Hoeffel
- Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France.,Departement of Radiology, Robert Debré University- Hospital, Reims, France
| | - Daniele Sommacale
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Tullio Piardi
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
| | - Reza Kianmanesh
- Department of HBP and Digestive Oncological Surgery, Robert Debré University- Hospital, Reims, France.,Reims Medical Faculty, Reims, France.,University of Reims Champagne Ardenne, Reims, France
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11
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Berardi G, Igarashi K, Wakabayashi G. Laparoscopic liver resection-education and training. Transl Gastroenterol Hepatol 2019; 4:11. [PMID: 30976714 DOI: 10.21037/tgh.2019.01.10] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2019] [Accepted: 01/25/2019] [Indexed: 12/17/2022] Open
Affiliation(s)
- Giammauro Berardi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan.,Department of Structure and Recovery of Man, Gent University Hospital, Belgium
| | - Kazuharu Igarashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan
| | - Go Wakabayashi
- Center for Advanced Treatment of HBP Diseases, Ageo Central General Hospital, Tokyo, Japan
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12
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Li H, Zheng J, Cai JY, Li SH, Zhang JB, Wang XM, Chen GH, Yang Y, Wang GS. Laparoscopic VS open hepatectomy for hepatolithiasis: An updated systematic review and meta-analysis. World J Gastroenterol 2017; 23:7791-7806. [PMID: 29209120 PMCID: PMC5703939 DOI: 10.3748/wjg.v23.i43.7791] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2017] [Revised: 07/31/2017] [Accepted: 08/15/2017] [Indexed: 02/06/2023] Open
Abstract
AIM To perform a meta-analysis on laparoscopic hepatectomy VS conventional liver resection for treating hepatolithiasis.
METHODS We conducted a systematic literature search on PubMed, Embase, Web of Science and Cochrane Library, and undertook a meta-analysis to compare the efficacy and safety of laparoscopic hepatectomy VS conventional open liver resection for local hepatolithiasis in the left or right lobe. Intraoperative and postoperative outcomes (time, estimated blood loss, blood transfusion rate, postoperative intestinal function recovery time, length of hospital stay, postoperative complication rate, initial residual stone, final residual stone and stone recurrence) were analyzed systematically.
RESULTS A comprehensive literature search retrieved 16 publications with a total of 1329 cases. Meta-analysis of these studies showed that the laparoscopic approach for hepatolithiasis was associated with significantly less intraoperative estimated blood loss [weighted mean difference (WMD): 61.56, 95% confidence interval (CI): 14.91-108.20, P = 0.01], lower blood transfusion rate [odds ratio (OR): 0.41, 95%CI: 0.22-0.79, P = 0.008], shorter intestinal function recovery time (WMD: 0.98, 95%CI: 0.47-1.48, P = 0.01), lower total postoperative complication rate (OR: 0.52, 95%CI: 0.39-0.70, P < 0.0001) and shorter stay in hospital (WMD: 3.32, 95%CI: 2.32-4.32, P < 0.00001). In addition, our results showed no significant differences between the two groups in operative time (WMD: 21.49, 95%CI: 0.27-43.24, P = 0.05), residual stones (OR: 0.79, 95%CI: 0.50-1.25, P = 0.31) and stone recurrence (OR: 0.34, 95%CI: 0.11-1.08, P = 0.07). Furthermore, with subgroups analysis, our results proved that the laparoscopic approach for hepatolithiasis in the left lateral lobe and left side could achieve satisfactory therapeutic effects.
CONCLUSION The laparoscopic approach is safe and effective, with less intraoperative estimated blood loss, fewer postoperative complications, reduced length of hospital stay and shorter intestinal function recovery time than with conventional approaches.
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Affiliation(s)
- Hui Li
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jun Zheng
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jian-Ye Cai
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Shi-Hui Li
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Jun-Bin Zhang
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Xiao-Ming Wang
- Department of Hepatobiliary Surgery, Yijishan Hospital affiliated to Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Gui-Hua Chen
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Yang Yang
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
| | - Gen-Shu Wang
- Department of Hepatic Surgery and Liver Transplantation Center of the Third Affiliated Hospital, Organ Transplantation Institute, Sun Yat-sen University, Organ Transplantation Research Center of Guangdong Province, Guangzhou 510630, Guangdong Province, China
- Guangdong Key Laboratory of Liver Disease Research, Key Laboratory of Liver Disease Biotherapy and Translational Medicine of Guangdong Higher Education Institutes, the Third Affiliated Hospital of Sun Yat-sen University, Guangzhou 510630, Guangdong Province, China
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13
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Maurette RJ, Ejarque MG, Mihura M, Bregante M, Bogetti D, Pirchi D. Laparoscopic liver resection in metastatic colorectal cancer treatment: comparison with long-term results using the conventional approach. Ecancermedicalscience 2017; 11:775. [PMID: 29104612 PMCID: PMC5659829 DOI: 10.3332/ecancer.2017.775] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/19/2017] [Indexed: 11/07/2022] Open
Abstract
Background Laparoscopic liver resections (LLRs) have been shown to be both feasible and safe. However, no randomised control studies have been performed to date comparing results with those of the open surgery approach. Main aim To analyse LLR long-term results and compare them with a similar group of open resections in patients with colorectal carcinoma liver metastasis (CRCLM). Methods Retrospective study on a prospective database. All patients with anatomopathological diagnosis of CRCLM resected between July 2007 and July 2015. Results Twenty-two open resections and 18 laparoscopic resections which presented favourable lesions for laparoscopic approach were analysed. Postoperative grade III morbidity was similar in both groups (p = 0.323). Disease-free survival at 1, 3, and 8 years in the laparoscopy group (n =16) was 81%, 58%, and 58%, respectively, while in the open surgery group (n = 17) it was 64%, 37%, and 19% respectively; no differences were found (p = 0.388). Global survival in the laparoscopy group was 93%, 60%, and 40%, respectively, and 88%, 74.5%, and 58.7%, respectively, in the open surgery group; no differences were found (p = 0.893) with a 37 months average follow-up. Conclusion LLR in patients with technically favourable CRCLM had similar morbidity to open resections and resection margins were not compromised because of laparoscopy.
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Affiliation(s)
- Rafael José Maurette
- General Surgery Department, Hepatobiliopancreatic Surgery Section, Hospital Británico de Buenos Aires (Buenos Aires British Hospital), Buenos Aires 1280, Argentina
| | - Marcos García Ejarque
- General Surgery Department, Hepatobiliopancreatic Surgery Section, Hospital Británico de Buenos Aires (Buenos Aires British Hospital), Buenos Aires 1280, Argentina
| | - Matías Mihura
- General Surgery Department, Hepatobiliopancreatic Surgery Section, Hospital Británico de Buenos Aires (Buenos Aires British Hospital), Buenos Aires 1280, Argentina
| | - Mariano Bregante
- General Surgery Department, Hepatobiliopancreatic Surgery Section, Hospital Británico de Buenos Aires (Buenos Aires British Hospital), Buenos Aires 1280, Argentina
| | - Diego Bogetti
- General Surgery Department, Hepatobiliopancreatic Surgery Section, Hospital Británico de Buenos Aires (Buenos Aires British Hospital), Buenos Aires 1280, Argentina
| | - Daniel Pirchi
- General Surgery Department, Hepatobiliopancreatic Surgery Section, Hospital Británico de Buenos Aires (Buenos Aires British Hospital), Buenos Aires 1280, Argentina
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14
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Berardi G, Van Cleven S, Fretland ÅA, Barkhatov L, Halls M, Cipriani F, Aldrighetti L, Abu Hilal M, Edwin B, Troisi RI. Evolution of Laparoscopic Liver Surgery from Innovation to Implementation to Mastery: Perioperative and Oncologic Outcomes of 2,238 Patients from 4 European Specialized Centers. J Am Coll Surg 2017; 225:639-649. [PMID: 28838869 DOI: 10.1016/j.jamcollsurg.2017.08.006] [Citation(s) in RCA: 71] [Impact Index Per Article: 10.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/13/2017] [Revised: 08/07/2017] [Accepted: 08/07/2017] [Indexed: 02/07/2023]
Abstract
BACKGROUND First seen as an innovation for select patients, laparoscopic liver resection (LLR) has evolved since its introduction, resulting in worldwide use. Despite this, it is still limited mainly to referral centers. The aim of this study was to evaluate a large cohort undergoing LLR from 2000 to 2015, focusing on the technical approaches, perioperative and oncologic outcomes, and evolution of practice over time. STUDY DESIGN The demographics and indications, intraoperative, perioperative, and oncologic outcomes of 2,238 patients were evaluated. Trends in practice and outcomes over time were assessed. RESULTS The percentage of LLR performed yearly has increased from 5% in 2000 to 43% in 2015. Pure laparoscopy was used in 98.3% of cases. Wedge resections were the most common operation; they were predominant at the beginning of LLR and then decreased and remained steady at approximately 53%. Major hepatectomies were initially uncommon, then increased and reached a stable level at approximately 16%. Overall, 410 patients underwent resection in the posterosuperior segments; these were more frequent with time, and the highest percentage was in 2015 (26%). Blood loss, operative time, and conversion rate improved significantly with time. The 5-year overall survival rates were 73% and 54% for hepatocellular carcinoma (HCC) and colorectal liver metastases (CRLM), respectively. The 5-year, recurrence-free survival rates were 50% and 37% for HCC and CRLM, respectively. CONCLUSIONS Since laparoscopy was introduced, a long implementation process has been necessary to allow for standardization and improvement in surgical care, mastery of the technique, and the ability to obtain good perioperative results with safe oncologic outcomes.
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Affiliation(s)
- Giammauro Berardi
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium
| | - Stijn Van Cleven
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium
| | - Åsmund Avdem Fretland
- The Intervention Centre, Oslo University Hospital, Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Leonid Barkhatov
- The Intervention Centre, Oslo University Hospital, Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Mark Halls
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Federica Cipriani
- Hepatobiliary Surgery, Department of Surgery, San Raffaele Hospital Milan, Milan, Italy
| | - Luca Aldrighetti
- Hepatobiliary Surgery, Department of Surgery, San Raffaele Hospital Milan, Milan, Italy
| | - Mohammed Abu Hilal
- Hepatobiliary and Pancreatic Surgical Unit, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Bjørn Edwin
- The Intervention Centre, Oslo University Hospital, Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Roberto I Troisi
- Department of General and Hepatobiliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, Ghent, Belgium.
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15
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Nota CL, Rinkes IHB, Hagendoorn J. Setting up a robotic hepatectomy program: a Western-European experience and perspective. Hepatobiliary Surg Nutr 2017; 6:239-245. [PMID: 28848746 DOI: 10.21037/hbsn.2016.12.05] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
Currently the majority of liver resections are performed via open resection. Nevertheless, minimally invasive liver surgery is gaining ground and conventional laparoscopy has proven to be beneficial in different fields of liver surgery compared to open resections. Still, conventional laparoscopy has a few downsides, from which straight instruments, 2-dimensional view and awkward ergonomics are the most obvious. The robotic surgical system is developed to overcome these limitations. It offers several advantages over conventional laparoscopy to optimize conditions in minimally invasive surgery: instruments are wristed with a wide range of motion and the view is 3-dimensional and magnified. With instruments with a greater range of motion than in laparoscopic surgery, the use of a robotic system potentially broadens indications for minimally invasive liver resection. Here, we discuss the steps of setting up a robotic hepatectomy program against the background of the initial experience at our institution.
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Affiliation(s)
- Carolijn L Nota
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inne H Borel Rinkes
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hagendoorn
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
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16
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Reccia I, Kumar J, Kusano T, Zanellato A, Draz A, Spalding D, Habib N, Pai M. A systematic review on radiofrequency assisted laparoscopic liver resection: Challenges and window to excel. Surg Oncol 2017; 26:296-304. [PMID: 28807250 DOI: 10.1016/j.suronc.2017.06.003] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/16/2017] [Revised: 06/07/2017] [Accepted: 06/13/2017] [Indexed: 12/12/2022]
Abstract
Laparoscopic liver resection has progressively gained acceptance as a safe and effective procedure in the treatment of benign and malignant liver neoplasms. However, blood loss remains the major challenge in liver surgery. Several techniques and devices have been introduced in liver surgery in order to minimize intraoperative haemorrhage during parenchymal transection. Radiofrequency (RF)-assisted liver resection has been shown to be an effective method to minimize bleeding in open and laparoscopic liver resection. A number of RF devices for parenchymal transection have been designed to assist laparoscopic liver resections. Here we have reviewed the results of various RF devices in laparoscopic liver resection. A total 15 article were considered relevant for the evaluation of technical aspects and outcomes of RF-assisted liver resections in laparoscopic procedures. In these studies, 176 patients had laparoscopic liver resection using RF-assisted parenchymal coagulation. Two monopolar and three bipolar devices were employed. Blood loss was limited in most of the studies. The need of blood transfusions was limited to two cases in all the series. Conversion was necessary due to bleeding in 3 cases. Operative and transection times varied between studies. However, RF-assisted resection with bipolar devices appeared to have taken less time in comparison to other RF devices. RF-related complications were minimum, and only one case of in-hospital death due to hepatic failure was reported. Although RF has been used in a small minority of laparoscopic liver resections, laparoscopic RF-assisted liver resection for benign and malignant disease is a safe and feasible procedure associated with reduction in blood loss, low morbidity, and lower hospital mortality rates.
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Affiliation(s)
- Isabella Reccia
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
| | - Jayant Kumar
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Tomokazu Kusano
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Artur Zanellato
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Ahmed Draz
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Duncan Spalding
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Nagy Habib
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK
| | - Madhava Pai
- Department of Surgery and Cancer, Faculty of Medicine, Hammersmith Hospital, Imperial College London, UK.
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17
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Xie SM, Xiong JJ, Liu XT, Chen HY, Iglesia-García D, Altaf K, Bharucha S, Huang W, Nunes QM, Szatmary P, Liu XB. Laparoscopic Versus Open Liver Resection for Colorectal Liver Metastases: A Comprehensive Systematic Review and Meta-analysis. Sci Rep 2017; 7:1012. [PMID: 28432295 PMCID: PMC5430829 DOI: 10.1038/s41598-017-00978-z] [Citation(s) in RCA: 35] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2016] [Accepted: 03/20/2017] [Indexed: 02/05/2023] Open
Abstract
The effects of laparoscopic liver resection (LLR) and open liver resection (OLR) on oncological outcomes for colorectal cancer liver metastases (CCLM) remain inconclusive. Major databases were searched from January 1992 to October 2016. Effects of LLR vs OLR were determined. The primary endpoints were oncological outcomes. In total, 32 eligible non-randomized studies with 4697 patients (LLR: 1809, OLR: 2888) were analyzed. There were higher rates of clear surgical margins (OR: 1.64, 95%CI: 1.32 to 2.05, p < 0.00001) in the LLR group, without significant differences in disease recurrence, 3- or 5-year overall survival(OS) and disease free survival(DFS) between the two approaches. LLR was associated with less intraoperative blood loss (WMD: −147.46 [−195.78 to −99.15] mL, P < 0.00001) and fewer blood transfusions (OR: 0.41 [0.30–0.58], P < 0.00001), but with longer operation time (WMD:14.44 [1.01 to 27.88] min, P < 0.00001) compared to OLR. Less overall morbidity (OR: 0.64 [0.55 to 0.75], p < 0.00001) and shorter postoperative hospital stay (WMD: −2.36 [−3.06 to −1.66] d, p < 0.00001) were observed for patients undergoing LLR, while there was no statistical difference in mortality. LLR appears to be a safe and feasible alternative to OLR in the treatment of CCLM in selected patients.
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Affiliation(s)
- Si-Ming Xie
- Department of Gastrointestinal Surgery, West China Hospital of Sichuan University, Cheng du, China.,People's Hospital of Deyang, Deyang, China
| | - Jun-Jie Xiong
- Departments of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Xue-Ting Liu
- Department of gastrointestinal Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Hong-Yu Chen
- Departments of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China
| | - Daniel Iglesia-García
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Kiran Altaf
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Shameena Bharucha
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Wei Huang
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Quentin M Nunes
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK
| | - Peter Szatmary
- Clinical Directorate of General Surgery, Royal Liverpool and Broadgreen University Hospitals NHS Trust, Liverpool, UK.
| | - Xu-Bao Liu
- Departments of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu, China.
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18
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Tarantino G, Magistri P, Serra V, Berardi G, Assirati G, Ballarin R, Di Benedetto F. Laparoscopic Liver Resection of Right Posterior Segments for Hepatocellular Carcinoma on Cirrhosis. J Laparoendosc Adv Surg Tech A 2017; 27:559-563. [PMID: 28245150 DOI: 10.1089/lap.2016.0506] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND Laparoscopic liver resection (LLR) is now widely adopted for the treatment of liver malignancies. Liver resection with laparoscopic approach was first adopted for tumors located in the peripheral portion of the anterolateral segments of the liver, but recent experiences in literature modified the attitude toward that approach. We herein report our technique and outcomes of LLR for hepatocellular carcinoma (HCC) located in the right-posterior segments of the liver (VI and VII). MATERIALS AND METHODS We retrospectively reviewed our prospectively maintained database, comparing peri- and postoperative outcomes of patients who underwent laparoscopic (13 patients) or open (51 patients) resections for HCC localized in the right-posterior segments between 2000 and 2014. RESULTS The two populations were homogeneous, showing no statistically significant differences in terms of gender, age, body mass index, and cirrhosis prevalence. Alpha-fetoprotein levels were higher in the open group (P = .04) and etiology of cirrhosis varied in a statistically significant manner (P = .01). The laparoscopic group showed an improved perioperative outcome with statistically significant less postoperative morbidity (P = .01) and less in-hospital stay (P = .0001). No differences were found in terms of blood loss or operative time, but any Pringle maneuver was needed (P = .04). CONCLUSIONS Patients affected by HCC localized in the right-posterior segments of the liver can be safely treated with laparoscopic approach. However, this kind of procedure can be challenging and should be performed in tertiary referral hospitals to provide the patient the best care, with the integration of different specialties.
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Affiliation(s)
- Giuseppe Tarantino
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Paolo Magistri
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy .,2 Department of Medical and Surgical Sciences and Translational Medicine, Sapienza-University of Rome , Rome, Italy
| | - Valentina Serra
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Giammauro Berardi
- 2 Department of Medical and Surgical Sciences and Translational Medicine, Sapienza-University of Rome , Rome, Italy
| | - Giacomo Assirati
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Roberto Ballarin
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
| | - Fabrizio Di Benedetto
- 1 Hepato-Pancreato-Biliary Surgery and Liver Transplantation Unit, University of Modena and Reggio Emilia , Modena, Italy
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19
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Nota CLMA, Molenaar IQ, van Hillegersberg R, Borel Rinkes IHM, Hagendoorn J. Robotic liver resection including the posterosuperior segments: initial experience. J Surg Res 2016; 206:133-138. [PMID: 27916352 DOI: 10.1016/j.jss.2016.06.079] [Citation(s) in RCA: 21] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/28/2016] [Revised: 06/13/2016] [Accepted: 06/27/2016] [Indexed: 01/01/2023]
Abstract
BACKGROUND Robot-assisted laparoscopy has been introduced to overcome the limitations of conventional laparoscopy. This technique has potential advantages over laparoscopy, such as increased dexterity, three-dimensional view, and a magnified view of the operative field. Therefore, improved dexterity may make a robotic system particularly suited for liver resections, which require nonlinear manipulation, such as curved parenchymal transection, hilar dissection, and resection of posterosuperior segments. METHODS Between August 2014 and March 2016, 16 patients underwent robot-assisted laparoscopic liver resection at University Medical Center Utrecht. RESULTS Fifteen robot-assisted laparoscopic liver resections were performed in a minimally invasive manner. One procedure was converted. In eight patients, we performed a resection of a posterosuperior segment (segment 7 or 8). Median operating time was 146 (60-265) min, and median blood loss was 150 (5-600) mL. Four patients had a Clavien-Dindo grade III complication. Median length of stay was 4 (1-8) days. There was no mortality. CONCLUSIONS This prospective study reporting on our initial experience with robot-assisted laparoscopic liver resection demonstrates that this technique is easily adopted, safe, and feasible for minor hepatectomies in selected patients. Moreover, it shows that the robotic platform also enables fully laparoscopic resections of the posterior segments.
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Affiliation(s)
- Carolijn L M A Nota
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - I Quintus Molenaar
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Richard van Hillegersberg
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Inne H M Borel Rinkes
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Jeroen Hagendoorn
- Department of Surgical Specialties, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands.
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20
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Nota CL, Rinkes IHB, Molenaar IQ, van Santvoort HC, Fong Y, Hagendoorn J. Robot-assisted laparoscopic liver resection: a systematic review and pooled analysis of minor and major hepatectomies. HPB (Oxford) 2016; 18:113-120. [PMID: 26902129 PMCID: PMC4814602 DOI: 10.1016/j.hpb.2015.09.003] [Citation(s) in RCA: 40] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/28/2015] [Accepted: 09/30/2015] [Indexed: 12/12/2022]
Abstract
BACKGROUND Robotic surgery has been introduced to overcome the limitations of conventional laparoscopy. A systematic review and meta-analysis were performed to assess the safety and feasibility for three subgroups of robot-assisted laparoscopic liver resection: (i) minor resections of easily accessible segments: 2/3, 4B, 5, 6, (ii) minor resections of difficult located segments: 1, 4A, 7, 8 and (iii) major resections: ≥ 4 segments. METHODS A systematic search was performed in PubMed, EMBASE and Cochrane Library. RESULTS Twelve observational, mostly retrospective studies reporting on 363 patients were included. Data were pooled and analyzed. For subgroup (i) (n = 81) the weighted mean operative time was 215 ± 65 min. One conversion (1%) to laparotomy was needed. Weighted mean operative time for subgroup (ii) (n = 17) was 220 ± 60 min. No conversions were needed. For subgroup (iii) (n = 99) the weighted mean operative time was 405 ± 100 min. In this subgroup 8 robotic procedures (8%) were converted to open surgery. CONCLUSION Data show that robot-assisted laparoscopic liver resection is feasible in minor resections of all segments and major resections. Larger, prospective studies are warranted to compare the possible advantages of robot-assisted surgery with conventional laparoscopy and open surgery.
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Affiliation(s)
- Carolijn L Nota
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | | | - Izaak Q Molenaar
- Department of Surgery, University Medical Center Utrecht, The Netherlands
| | - Hjalmar C van Santvoort
- Department of Surgery, University Medical Center Utrecht, The Netherlands; Department of Surgery, St. Antonius Ziekenhuis Nieuwegein, The Netherlands
| | - Yuman Fong
- Department of Surgery, City of Hope Comprehensive Cancer Center, Duarte, CA, USA
| | - Jeroen Hagendoorn
- Department of Surgery, University Medical Center Utrecht, The Netherlands.
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Pais-Costa SR, Araujo SLM, Lima OAT, Teixeira ACP. Laparoscopic hepatectomy: indications and results from 18 resectable cases. EINSTEIN-SAO PAULO 2016; 9:343-9. [PMID: 26761103 DOI: 10.1590/s1679-45082011ao1983] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/07/2011] [Accepted: 06/27/2011] [Indexed: 01/26/2023] Open
Abstract
OBJECTIVE To evaluate the early and late results from laparoscopic hepatectomy procedures at a tertiary hospital in Brasília (DF), Brazil. METHODS The authors report on a series of 18 patients (11 women) who underwent laparoscopic hepatectomy performed by a single surgical team at Santa Lúcia Hospital, in Brasília, between June 2007 and December 2010. Age ranged from 21 to 71 years (median = 43 years). There were eleven women and seven men. Nine patients had benign diseases and nine had malignant lesions. The lesion diameter ranged from 1.8 to 12 cm (mean: 4.96 cm). RESULTS Six major hepatectomy procedures and 12 minor hepatectomy procedures were performed. The mean duration of the operation was 205 minutes (range: 90 to 360 minutes). The mean intraoperative blood loss was 300 mL (range: 100 to 1,500 mL). Two patients received a transfusion (11%). There was one conversion to open surgery. There was no death and no patient underwent reoperation. The postoperative morbidity rate was 11% (n = 2). One patient presented with a minor complication (lobar pneumonia) while other presented with two major complications (intraoperative bleeding and incisional hernia). The median length of hospital stay was 4 days (range: 2 to 11 days). The median time to return to normal activities was 13 days (range: 7 to 40 days). CONCLUSION Laparoscopic hepatectomy is a safe surgical approach for treating both benign and malignant hepatic lesions. This small series showed no mortality, low morbidity and good cosmetic results.
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Laparoscopic Transabdominal With Transdiaphragmatic Access Improves Resection of Difficult Posterosuperior Liver Lesions. Ann Surg 2015; 262:358-65. [PMID: 25848711 DOI: 10.1097/sla.0000000000001015] [Citation(s) in RCA: 51] [Impact Index Per Article: 5.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE We describe the technical details and evaluate the safety, feasibility, and usefulness of a combined lateral and abdominal (CLA) approach for laparoscopic resection of liver segments 7 and 8. BACKGROUND Laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8 is technically challenging, and currently there is no standardized laparoscopic approach. METHODS Through review of a prospectively maintained database, we identified 44 patients who underwent laparoscopic resection of lesions in segment 7 or 8. Twenty-five patients required the CLA approach because their lesions were more posterosuperior and intraparenchymal; 19 patients underwent resection with a regular abdominal-only approach of more accessible anteroinferior lesions. We reviewed operative details and video footage of these operations and compared the outcomes of the 2 groups. RESULTS In the group treated with the CLA approach, deep location was more frequent (88% vs 42%; P = 0.035), median tumor diameter was larger (24.5 mm vs 15 mm; P = 0.114), and the median weight of the excised parenchyma was greater (56.5 g vs 23 g; P = 0.093). Median operative time was longer in the CLA approach group (217.5 minutes vs 165 minutes; P = 0.046), but blood loss, rate of conversion to open surgery, surgical margin status, morbidity, and mortality were similar between the 2 groups. CONCLUSIONS The CLA approach permits safe laparoscopic resection of lesions in the posterosuperior area of segments 7 and 8, allowing surgeons to overcome the difficulties of limited visualization and access to the target lesions.
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Modified hepatic vascular occlusion facilitates hepatectomy for malignant hepatic tumor in laparoscopy. Surg Laparosc Endosc Percutan Tech 2015; 24:506-11. [PMID: 24710260 DOI: 10.1097/sle.0b013e3182a2b08d] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
PURPOSE The parenchymal transection and bleeding are important problems in laparoscopic hepatectomy (LH). The study aimed to evaluate the feasibility and safety of LH for a malignant hepatic tumor (MHT) with hepatic vascular occlusion (HVO) only using a monopolar electrocautery. METHODS A total of 31 patients' profiles, operative data, clinical outcomes, pathologic findings, and follow-up information were collected who underwent LH with HVO. RESULTS The median operative time was 176 minutes and the median postoperative hospital stay was 9 days. The median estimated blood loss was 310 mL. The median tumor size was 4.6 cm and the median surgical margin was 12 mm.The ischemia injury to the liver in patients subjected to selective HVO was less than that in patients subjected to the Pringle maneuver. CONCLUSIONS HVO facilitates LH in transecting liver parenchyma and reduces bleeding, making LH safe and feasible only using monopolar electrocautery in selected patients with malignancies. Moreover, the selective HVO have more advantages over the Pringle maneuver in decreasing ischemic injury.
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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: 1.8] [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.
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Affiliation(s)
- Federica Cipriani
- University Hospital Southampton NHS Foundation Trust, E level, Tremona Road, Southampton, SO166YD, UK
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Comparison of laparoscopic versus open left-sided hepatectomy for intrahepatic duct stones. Surg Endosc 2015; 30:259-65. [PMID: 25861904 DOI: 10.1007/s00464-015-4200-3] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/07/2014] [Accepted: 03/31/2015] [Indexed: 12/23/2022]
Abstract
BACKGROUND Laparoscopic hepatectomy for intrahepatic duct (IHD) stones is limited by technical difficulties caused by adhesion to adjacent tissue or distorted anatomy resulting from recurrent inflammation. This study compared perioperative and clinical outcomes in patients undergoing laparoscopic and open hepatectomy for left IHD stones. METHODS From January 2002 to December 2013, 40 patients underwent laparoscopic left-sided hepatectomy [left hemihepatectomy (n = 7) or left lateral sectionectomy (n = 33)] and 54 patients without combined operations and previous operation histories underwent open left-sided hepatectomy [left hemihepatectomy (n = 24) or left lateral sectionectomy (n = 30)]. Their perioperative and clinical outcomes were compared, including stone clearance rates, stone recurrence rates, and median follow-up duration. RESULTS There was no difference in age (56.8 ± 8.2 vs. 55.6 ± 9.6 years, p = 0.531), sex (1.0:4.0 vs. 1.0:1.8 male:female, p = 0.108), or BMI (22.8 ± 2.8 vs. 22.9 ± 3.0 kg/m(2), p = 0.802) between the laparoscopic and open hepatectomy groups. Lateral sectionectomy was more frequent in the laparoscopic group (33/40 vs. 30/54, p = 0.010). Operation time (174.2 ± 56.6 vs. 210.4 ± 51.6 min, p = 0.002) and postoperative hospital stay (7.9 ± 2.6 vs. 14.3 ± 5.5 days, p < 0.001) were shorter in the laparoscopic group, and complication rate (17.5 vs. 40.7%, p = 0.016), in particular surgical site infection rate (5.0 vs. 18.5%, p = 0.052), was lower in the laparoscopic group than in the open hepatectomy group. Similar results were observed in the hemihepatectomy and lateral sectionectomy subgroups. There was no operation-related mortality. There were no significant differences in follow-up periods (48 ± 33.6 vs. 59.2 ± 41.7 months, p = 0.235) and rates of initial stone clearance (87.5 vs. 75.9%, p = 0.159), final clearance (100 vs. 94.4%, p = 0.130), and stone recurrence (2.5 vs. 5.6%, p = 0.468). CONCLUSION Laparoscopic hepatectomy is safe and effective for well-selected patients with left IHD stones, when performed by experienced surgeons. Laparoscopic hepatectomy resulted in shorter operation time and postoperative hospital stay, and a lower postoperative morbidity rate, than open hepatectomy.
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Gomaa AI, Waked I. Recent advances in multidisciplinary management of hepatocellular carcinoma. World J Hepatol 2015; 7:673-87. [PMID: 25866604 PMCID: PMC4388995 DOI: 10.4254/wjh.v7.i4.673] [Citation(s) in RCA: 64] [Impact Index Per Article: 7.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2014] [Revised: 12/17/2014] [Accepted: 01/15/2015] [Indexed: 02/06/2023] Open
Abstract
The incidence of hepatocellular carcinoma (HCC) is increasing, and it is currently the second leading cause of cancer-related death worldwide. Potentially curative treatment options for HCC include resection, transplantation, and percutaneous ablation, whereas palliative treatments include trans-arterial chemoembolization (TACE), radioembolization, and systemic treatments. Due to the diversity of available treatment options and patients' presentations, a multidisciplinary team should decide clinical management of HCC, according to tumor characteristics and stage of liver disease. Potentially curative treatments are suitable for very-early- and early-stage HCC. However, the vast majority of HCC patients are diagnosed in later stages, where the tumor characteristics or progress of liver disease prevent curative interventions. For patients with intermediate-stage HCC, TACE and radioembolization improve survival and are being evaluated in addition to potentially curative therapies or with systemic targeted therapy. There is currently no effective systemic chemotherapy, immunologic, or hormonal therapy for HCC, and sorafenib is the only approved molecular-targeted treatment for advanced HCC. Other targeted agents are under investigation; trials comparing new agents in combination with sorafenib are ongoing. Combinations of systemic targeted therapies with local treatments are being evaluated for further improvements in HCC patient outcomes. This article provides an updated and comprehensive overview of the current standards and trends in the treatment of HCC.
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Affiliation(s)
- Asmaa I Gomaa
- Asmaa I Gomaa, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
| | - Imam Waked
- Asmaa I Gomaa, Imam Waked, Hepatology Department, National Liver Institute, Menoufiya University, Shebeen El-Kom 35111, Egypt
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Lainas P, Camerlo A, Conrad C, Shivathirthan N, Fuks D, Gayet B. Laparoscopic right hepatectomy combined with partial diaphragmatic resection for colorectal liver metastases: Is it feasible and reasonable? Surgery 2015; 158:128-34. [PMID: 25799466 DOI: 10.1016/j.surg.2015.02.003] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2014] [Revised: 01/20/2015] [Accepted: 02/01/2015] [Indexed: 01/22/2023]
Abstract
BACKGROUND The impact of diaphragmatic invasion in patients with colorectal liver metastases (CRLMs) remains poorly evaluated. We aimed to evaluate feasibility and safety of laparoscopic right hepatectomy (LRH) with or without diaphragmatic resection for CRLM. METHODS From 2002 to 2012, 52 patients underwent LRH for CRLM. Of them, 7 patients had combined laparoscopic partial diaphragmatic resection ("diaphragm" group). Data were retrospectively collected and short and long-term outcomes analyzed. RESULTS Operative time was lower in the control group (272 vs 345 min, P = .06). Six patients required conversion to open surgery. Blood loss and transfusion rate were similar. Portal triad clamping was used more frequently in the "diaphragm" group (42.8% vs 6.6%, P = .02). Maximum tumor size was greater in the "diaphragm" group (74.5 vs 37.1 mm, P = .002). Resection margin was negative in all cases. Mortality was nil and general morbidity similar in the 2 groups. Specific liver-related complications occurred in 2 patients in the "diaphragm" group and 17 in the control group (P = .69). Mean hospital stay was similar (P = 56). Twenty-two (42.3%) patients experienced recurrence. One-, 3-, and 5-year overall survival after surgery in "diaphragm" and control groups were 69%, 34%, 34%, and 97%, 83%, 59%, respectively (P = .103). One- and 3-year disease-free survival after surgery in "diaphragm" and control groups were 57%, 47% and 75%, 54%, respectively (P = .310). CONCLUSION LRH with en-bloc diaphragmatic resection could be reasonably performed for selected patients in expert centers. Technical difficulties related to diaphragmatic invasion must be circumvented. Further experience must be gained to confirm our results.
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Affiliation(s)
- Panagiotis Lainas
- Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Antoine Camerlo
- Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Claudius Conrad
- Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France; Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA
| | - Nayruthia Shivathirthan
- Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - David Fuks
- Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France
| | - Brice Gayet
- Department of Digestive Pathology, Institut Mutualiste Montsouris, Paris Descartes University, Paris, France.
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Are Large Hepatocellular Carcinomas Still a Contraindication for Laparoscopic Liver Resection? J Laparoendosc Adv Surg Tech A 2015; 25:98-102. [DOI: 10.1089/lap.2014.0226] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022] Open
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Cherian PT, Mishra AK, Kumar P, Sachan VK, Bharathan A, Srikanth G, Senadhipan B, Rela MS. Laparoscopic liver resection: Wedge resections to living donor hepatectomy, are we heading in the right direction? World J Gastroenterol 2014; 20:13369-13381. [PMID: 25309070 PMCID: PMC4188891 DOI: 10.3748/wjg.v20.i37.13369] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2014] [Revised: 05/03/2014] [Accepted: 07/16/2014] [Indexed: 02/06/2023] Open
Abstract
Despite inception over 15 years ago and over 3000 completed procedures, laparoscopic liver resection has remained mainly in the domain of selected centers and enthusiasts. Requirement of extensive open liver resection (OLR) experience, in-depth understanding of anatomy and considerable laparoscopic technical expertise may have delayed wide application. However healthy scepticism of its actual benefits and presence of a potential publication bias; concern about its safety and technical learning curve, are probably equally responsible. Given that a large proportion of our work, at least in transplantation is still OLR, we have attempted to provide an entirely unbiased, mature opinion of its pros and cons in the current invited review. We have divided this review into two sections as we believe they merit separate attention on technical and ethical grounds. The first part deals with laparoscopic liver resection (LLR) in patients who present with benign or malignant liver pathology, wherein we have discussed its overall outcomes; its feasibility based on type of pathology and type of resection and included a small section on application of LLR in special scenarios like cirrhosis. The second part deals with the laparoscopic living donor hepatectomy (LDH) experience to date, including its potential impact on transplantation in general. Donor safety, graft outcomes after LDH and criterion to select ideal donors for LLR are discussed. Within each section we have provided practical points to improve safety in LLR and attempted to reach reasonable recommendations on the utilization of LLR for units that wish to develop such a service.
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Chopra SS, Haacke N, Meisel C, Unterwalder N, Fikatas P, Schmidt SC. Postoperative immunosuppression after open and laparoscopic liver resection: assessment of cellular immune function and monocytic HLA-DR expression. JSLS 2014; 17:615-21. [PMID: 24398205 PMCID: PMC3866067 DOI: 10.4293/108680813x13693422519677] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
In an experimental setting, the authors demonstrated a trend toward improved preservation of the immune system after laparoscopic hepatic resection compared with open surgery. Background and Objectives: Major abdominal procedures are strongly associated with postoperative immunosuppression and subsequent increased patient morbidity. It is believed that laparoscopic surgery causes less depletion of the systemic immune function because of the reduced tissue trauma. Various cytokines and monocytic HLA-DR expression have been successfully implemented to assess postoperative immune function. The aim of our study was to show the difference in immunologic profiles after minimally invasive versus conventional liver resection. Methods: Ten animals underwent either laparoscopic or conventional open left lateral liver resection. Flow cytometric characteristics of HLA-DR expression on monocytes and lipopolysaccharide-stimulated cellular secretion of tumor necrosis factor α, interferon γ, interleukin 6, and interleukin 8 were measured and analyzed in ex vivo whole blood samples. Intraoperative and postoperative clinical outcome parameters were also documented and evaluated. Results: All animals survived the procedures. Postoperative complications were fever (n = 3), wound infections (n = 2), and biloma (n = 1). Open surgery showed a morbidity rate of 80% compared with 40% after laparoscopic surgery. Laparoscopic liver resection showed no postoperative immunoparalysis. Major histocompatibility complex class II expression in this group was elevated, whereas the open surgery group showed decreased major histocompatibility complex class II expression on postoperative day 1. Postoperative secretion of tumor necrosis factor α, interleukin 6, and interferon γ was lower in the open surgery group. Elevated transaminase levels after laparoscopy might have resulted from an ischemia/reperfusion injury caused by the capnoperitoneum. Conclusion: Major immunoparalysis depression was not observed in either group. Laparoscopic surgery shows a tendency to improve immunologic recovery after liver resection.
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Affiliation(s)
- Sascha S Chopra
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Augustenburger Platz 1, 13353 Berlin, Germany.
| | - Nadine Haacke
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany
| | - Christian Meisel
- Institute of Medical Immunology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Nadine Unterwalder
- Institute of Medical Immunology, Charité Campus Mitte, University Medicine Berlin, Berlin, Germany
| | - Panagiotis Fikatas
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany
| | - Sven C Schmidt
- Department of General, Visceral, and Transplantation Surgery, Charité Campus Virchow Clinic, University Medicine Berlin, Berlin, Germany
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Luo LX, Yu ZY, Bai YN. Laparoscopic Hepatectomy for Liver Metastases from Colorectal Cancer: A Meta-analysis. J Laparoendosc Adv Surg Tech A 2014; 24:213-22. [PMID: 24571350 DOI: 10.1089/lap.2013.0399] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023] Open
Affiliation(s)
- Li-Xi Luo
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Zhao-Yan Yu
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
| | - Yan-Nan Bai
- Department of Hepatobiliary Pancreatic Surgery, West China Hospital, Sichuan University, Chengdu, Sichuan Province, People's Republic of China
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Medbery RL, Chadid TS, Sweeney JF, Knechtle SJ, Kooby DA, Maithel SK, Lin E, Sarmiento JM. Laparoscopic vs open right hepatectomy: a value-based analysis. J Am Coll Surg 2014; 218:929-39. [PMID: 24680574 DOI: 10.1016/j.jamcollsurg.2014.01.045] [Citation(s) in RCA: 49] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/23/2013] [Revised: 12/30/2013] [Accepted: 01/07/2014] [Indexed: 02/09/2023]
Abstract
BACKGROUND Current literature lacks sufficient data on outcomes after extensive laparoscopic liver resections. We hypothesized that laparoscopic right hepatectomy (LRH) is associated with better clinical outcomes and less overall hospital costs than open right hepatectomy (ORH), supporting the notion that major laparoscopic hepatic resections carry increased value when compared with the open approach. STUDY DESIGN We reviewed medical records of all patients at our institution who underwent elective LRH (n = 48) or ORH (n = 57) from May 16, 2008 to March 1, 2012. Patient demographics, preoperative comorbidities, operative details, and postoperative outcomes were compared between the 2 groups. Hospital billing data were collected for each case to determine the average hospital costs per case. RESULTS Average operative duration, estimated blood loss, intravenous fluid resuscitation requirements, high-grade postoperative complications, the need for postoperative admission to the ICU, and hospital length of stay were significantly less within the LRH cohort. Thirty-day mortality and readmission rates were equivalent between the 2 groups. Despite higher operative costs for LRH ($16,605 vs $10,411, p < 0.001), total postoperative costs were significantly less ($9,075 for LRH vs $16,341 for ORH, p < 0.001), resulting in equivalent overall costs ($25,679 for LRH vs $26,751 for ORH, p = 0.65). CONCLUSIONS Although overall costs between LRH and ORH are equivalent, clinical outcomes after LRH are comparable to those after ORH, supporting the value of laparoscopy in extensive right hepatic resections. Efforts to reduce operative costs of LRH, while maintaining optimal patient outcomes, should be the focus of surgeons and hospitals moving forward.
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Affiliation(s)
- Rachel L Medbery
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Tatiana S Chadid
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - John F Sweeney
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Stuart J Knechtle
- Division of Transplantation, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - David A Kooby
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Shishir K Maithel
- Division of Surgical Oncology, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Edward Lin
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA
| | - Juan M Sarmiento
- Division of General and Gastrointestinal Surgery, Department of Surgery, Emory University School of Medicine, Atlanta, GA.
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A single centre experience of first "one hundred laparoscopic liver resections". HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2014; 2014:930953. [PMID: 24672143 PMCID: PMC3942341 DOI: 10.1155/2014/930953] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 10/07/2013] [Accepted: 12/01/2013] [Indexed: 01/19/2023]
Abstract
Background. Laparoscopic liver resection (LLR) has emerged as an alternative procedure to open liver resection in selected patients. The purpose of this study was to describe our initial experience of 100 patients undergoing LLR.
Methods. We analysed a prospectively maintained hepatobiliary database of 100 patients who underwent LLR between August 2007 and August 2012. Clinicopathological data were reviewed to evaluate surgical outcomes following LLR. Results. The median age was 64 and median BMI 27. Patients had a liver resection for either malignant lesions (n = 74) or benign lesions (n = 26). Commonly performed procedures were segmentectomy/metastectomy (n = 55), left lateral sectionectomy (LLS) (n = 26), or major hepatectomy (n = 19). Complete LLR was performed in 84 patients, 9 were converted to open and 7 hand-assisted. The most common indications were CRLM (n = 62), followed by hepatic adenoma (n = 9) or hepatocellular carcinoma (n = 7). The median operating time was 240 minutes and median blood loss was 250 mL. Major postoperative complications occurred in 9 patients. The median length of stay (LOS) was 5 days. One patient died within 30 days of liver resection. Conclusions. LLR is a safe and oncologically feasible procedure with comparable short-term perioperative outcomes to the open approach. However, further studies are necessary to determine long-term oncological outcomes.
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Drognitz O, Holzner P, Glatz T, Hopt UT, Neeff H. [The surgical technique of laparoscopic right hemihepatectomy. Technical aspects and results]. Chirurg 2014; 85:139-46. [PMID: 24435832 DOI: 10.1007/s00104-013-2672-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
INTRODUCTION This study compared the technical aspects and results for two different techniques of total laparoscopic anatomical right hemihepatectomy. PATIENTS AND METHODS From September 2010 to February 2013 a total of 16 patients underwent total laparoscopic right hemihepatectomy at the University Hospital of Freiburg. Of the patients 8 received an intraglissonian approach (IGA) and the other 8 patients an extraglissonian approach (EGA). In the patients of the IGA group, vascular inflow control of the right liver was accomplished by dissection and dividing the right hepatic artery, the right portal vein and the right bile duct separately before parenchymal dissection. In contrast, vascular control for patients in the EGA group was performed by enclosure and transsection of the whole right pedicle using a vascular linear stapler. RESULTS Indications for right hemihepatectomy were benign tumors in 2 and malignancies in 14 cases. The average maximum tumor diameter was 5.5 cm (range 1.5-10.0 cm). Adequate tumor-free surgical margins (R0) were confirmed in all patients with malignancies. The perioperative mortality rate was 0 %, surgical complications according to Clavien's classification were grade I (n = 1 trocar site superficial wound infection), grade II (n = 2 cholangitis) and grade IIIb (n = 1 wound dehiscence after conversion to open procedure). The median operating time was 366 min (range 265-422 min) and 313 min (range 247-417 min) in the IGA and EGA groups, respectively. Conversion from laparoscopic to open minimal access procedure was necessary in three patients in the IGA group and two patients in the EGA group. Mean intraoperative blood loss was 644 ml (200-1000 ml) and 518 ml (200-1500 ml) in the IGA and EGA groups, respectively. Transfusion of two units of packed red blood cells was necessary for one patient in group EGA. No patient in either group needed a Pringle maneuver. Mean postoperative hospital stay was 11 days (range 7-23 days) and 13 days (range 7-31 days) in the IGA and EGA groups, respectively. CONCLUSIONS Total laparoscopic anatomical right hemihepatectomy is a feasible procedure. The extraglissonian technique can provide shorter operating times by correctly facilitating vascular control of the right liver.
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Affiliation(s)
- O Drognitz
- Abteilung für Allgemein- und Viszeralchirurgie, Universitätsklinikum Freiburg, Freiburg i. Brsg., Deutschland,
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Namgoong JM, Kim KH, Park GC, Jung DH, Song GW, Ha TY, Moon DB, Ahn CS, Hwang S, Lee SG. Comparison of laparoscopic versus open left hemihepatectomy for left-sided hepatolithiasis. Int J Med Sci 2014; 11:127-33. [PMID: 24465157 PMCID: PMC3894396 DOI: 10.7150/ijms.7516] [Citation(s) in RCA: 41] [Impact Index Per Article: 4.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/28/2013] [Accepted: 12/17/2013] [Indexed: 12/11/2022] Open
Abstract
PURPOSE The purpose of this study was to evaluate and compare the perioperative and long-term outcomes of open versus laparoscopic left hemihepatectomy (OLH vs. LLH) for left-sided hepatolithiasis. METHODS Between October 2007 and June 2012, 149 patients with left-sided hepatolithiasis who underwent LLH (n = 37) or OLH (n = 112) were evaluated. The perioperative and long-term outcomes that were reviewed included the stone clearance rate, operative morbidity and mortality, and the stone recurrence rate. RESULTS The mean operative time of the LLH group was significantly longer than that of the OLH group (257±50.4 minutes vs. 237±75.5 minutes, p = 0.022), but the mean hospital stay was significantly shorter (8.8±4.10 vs. 14.1±4.98 days, p < 0.001). Postoperative complications were noted in four and twenty cases among LLH and OLH patients, respectively (p = 0.982). The initial clearance rate of intrahepatic duct (IHD) stones was 100% and 96.4% in the LLH and OLH groups, respectively, but all remnant stones (n = 4, OLH group) were resolved postoperatively. There were two cases of recurrence of IHD stones in OLH patients, but none in LLH patients (p = 0.281). CONCLUSIONS In left-sided hepatolithiasis, LLH was safe and effective: it resulted in low postoperative morbidity, no mortality and a high stone clearance rate, and there were no incidences of recurrence in our study. The potential benefits of LLH include a shorter hospital stay and a faster return to oral intake. If consideration is given to the appropriate indication criteria, including the extent of hepatectomy and the location and distribution of lesions, LLH may be an excellent choice for treatment of left-sided hepatolithiasis.
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Affiliation(s)
- Jung-Man Namgoong
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Ki-Hun Kim
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gil-Chun Park
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Dong-Hwan Jung
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Gi-Won Song
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Tae-Yong Ha
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Duk-Bok Moon
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Chul-Soo Ahn
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Shin Hwang
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
| | - Sung-Gyu Lee
- Department of Surgery, University of Ulsan College of Medicine, Asan Medical Center, Seoul, Korea
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Laparoscopic liver resection: 5-year experience at a single center. Surg Endosc 2013; 28:796-802. [PMID: 24196550 PMCID: PMC3931927 DOI: 10.1007/s00464-013-3259-y] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/21/2013] [Accepted: 09/29/2013] [Indexed: 02/08/2023]
Abstract
Background
Hepatocellular carcinoma (HCC) is a common cancer, especially in the Association of Southeast Asian Nations (ASEAN) region, where the prevalence of hepatitis virus infection is high. Liver resection is a potentially curative and popular therapy for HCC. Laparoscopic surgery using minimally invasive techniques potentially brings benefits to patients who need liver resection for HCC. This study aimed to evaluate the effectiveness, safety, and benefits of laparoscopic liver resection for HCC with long-term follow-up evaluation. Methods This cohort study with 5-year results of total laparoscopic hepatectomy for HCC was conducted in one center. Patients with HCC were selected for laparoscopic liver resection by the same team. The operation also was performed by one team of surgeons. The follow-up protocol was similar to that for open surgery. The patients were scheduled to return for examination every 2 months after the operation. The data for the patients were collected and analyzed using SPSS software. Results From January 2008 to December 2012, 173 enrolled patients with HCC underwent laparoscopic liver resection. The male-to-female ratio was 3:1. The mean age of the patients was 56 years (range 16–83 years). The follow-up period for 130 patients was 21.6 ± 16.0 months (range 0–60 months). The mean tumor size was 3.73 cm (range 2–10 cm). The stages of HCC according to the Barcelona Clinic Liver Cancer (BCLC) categorization were as follows: 0 (6 %), A1 (59.5 %), A2 (6.9 %), A4 (2.9 %), and B (27.2 %). Four patients required conversion to other techniques (2.3 %) because of the potential for major bleeding and tumor perforation. The types of resection were resection of one segment (segments 2, 3, 4, 5, 6, 7, and 8; 43.8 %), resection of two segments (posterior sector, anterior sector, segments 5 and 6, and left lateral sector; 47.9 %), resection of three segments (left and central liver; 4.7 %), and four segments (right liver; 3.6 %). The mean operation time was 112 ± 56 min (range 30–345 min), and the median blood loss was 100 ml (range 20–1,200 ml). The mean hospital stay was 6.5 ± 2.0 days (range, 3–19 days). No perioperative mortality occurred. The overall survival rates were 94.2 % at 1 year, 87 % at 2 years, 72.9 % at 3 years, 72.9 % at 4 years, and 72.9 % at 5 years. The mean overall survival time was 49.7 ± 2.1 months (range 45.5–53.9 months). The disease-free survival rates were 79.1 % at 1 year, 60 % at 2 years, 57 % at 3 years, 52 % at 4 years, and 26.3 % at 5 years. The mean disease-free survival time was 38.9 ± 2.6 months (range 33.9–44.0 months). Conclusion Laparoscopic liver resection for HCC is feasible, safe, and effective, with good oncologic results. Major and anatomic hepatectomy are possible with improved skill and experience. Laparoscopic liver resection is a promising treatment option with minimally invasive benefits for HCC patients.
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Rao AM, Ahmed I. Laparoscopic versus open liver resection for benign and malignant hepatic lesions in adults. Cochrane Database Syst Rev 2013:CD010162. [PMID: 23728700 DOI: 10.1002/14651858.cd010162.pub2] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
BACKGROUND Liver (hepatic) resection refers to removal of the whole liver, or one or more of its vascular segments. Elective liver resection is mainly performed for benign and malignant liver tumours. The operation can be performed as an open procedure or with a laparoscopic approach. With the advancement of laparoscopic skills and equipment, liver resection is selectively being carried out with this approach. A laparoscopic procedure is intended to be less severe, allowing for quicker healing, fewer complications, and a shorter hospital stay as the insult to the body is minimised. However, evidence about the efficacy of this approach when compared to an open procedure is still scattered. Current practice at different hepato-pancreato-biliary centres is based on the clinical judgement of experts in their field, which is highly insufficient in terms of evidence. OBJECTIVES To assess the benefits and harms of laparoscopic versus open liver resection for benign or malignant lesions on the liver in adult patients. SEARCH METHODS We searched the Cochrane Hepato-Biliary Group Controlled Trials Register, Cochrane Central Register of Controlled Trials in The Cochrane Library, MEDLINE, EMBASE, and Science Citation Index Expanded until February 2013. We also conducted searches of reference lists of relevant articles and reviews, conference proceedings, and ongoing trial databases. SELECTION CRITERIA We searched for randomised clinical trials of participants undergoing liver resection for benign or malignant lesions which reported on benefits and harms. We searched for quasi-randomised or observational studies for reports of harm. DATA COLLECTION AND ANALYSIS No data from randomised clinical trials could be collected. MAIN RESULTS Two authors performed study selection independently. We were not able to identify any randomised clinical trials that met the inclusion criteria of our review protocol. We identified two ongoing randomised clinical trials performed in Europe with data yet to be published. We retrieved a few observational studies (prospective and retrospective) with the searches for randomised clinical trials. They included a limited number of participants in whom laparoscopic and open liver resection was compared. Since these studies were non-randomised observational studies, the results for any adverse events are not included in the review as the risk of bias in such studies is high. AUTHORS' CONCLUSIONS No conclusions can be made at this time as no randomised clinical trials are available. In addition to the two ongoing randomised clinical trials for which results are expected to be published in the near future, well-designed, prospective, randomised clinical trials are needed in order to evaluate the benefits and harms of the laparoscopic procedure versus open liver resection.
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Affiliation(s)
- Ahsan M Rao
- Department of Surgery, Aberdeen Royal Infirmary, NHS Grampian, Aberdeen, UK
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Zacharoulis D, Sioka E, Tzovaras G, Jiao LR, Habib N. Laparoscopic left lateral sectionectomy with the use of Habib 4X: technical aspects. J Laparoendosc Adv Surg Tech A 2013; 23:549-52. [PMID: 23621832 DOI: 10.1089/lap.2012.0464] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022] Open
Abstract
INTRODUCTION Various techniques and energy-based devices have been used to minimize the blood loss during transection of the liver parenchyma laparoscopically. The laparoscopic Habib™ 4X sealer (Rita Medical Systems, Inc., Fremont, CA) is a promising device using bipolar radiofrequency energy. The purpose of the study was to test the safety and the efficiency of the device in laparoscopic left lateral sectionectomy. PATIENTS AND METHODS Five patients underwent laparoscopic left lateral sectionectomy using the laparoscopic Habib 4X in a period of 12 months. Indications for liver resection were hepatocellular carcinoma in 2 cirrhotic patients and colorectal cancer liver metastasis in 3 patients. Technical aspects were analyzed. RESULTS All the patients underwent formal laparoscopic left lateral sectionectomy. The Pringle maneuver was not applied in any of the patients. Mean operative time was 75 minutes (range, 60-90 minutes). Bleeding control along the transection line was satisfactory. No conversion to laparotomy was required. Operative blood loss was minimal. No blood transfusion was recorded. The postoperative period was uneventful. Median hospital stay was 3 days (range, 2-5 days). Histopathology revealed that the margins were disease free. CONCLUSIONS Laparoscopic left lateral segmentectomy with the use of Habib 4X proved safe and efficient. This technique may be an initial step for surgeons shifting to laparoscopic liver surgery provided they have previous experience in laparoscopic and liver surgery. Well-designed controlled randomized studies are needed in order to evaluate further the role of the device used in the present study in minimally invasive liver surgery.
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Han HS, Yoon YS, Cho JY, Hwang DW. Laparoscopic liver resection for hepatocellular carcinoma: korean experiences. Liver Cancer 2013; 2:25-30. [PMID: 24159593 PMCID: PMC3747549 DOI: 10.1159/000346224] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
The development of laparoscopic liver resection (LLR) has been slow due to technical difficulties. Therefore, LLR has been limited to easily accessible lesions. Recently, this procedure has been well applied to hepatocellular carcinoma. However, until now, the indications for LLR have been tumors in the peripheral portion of the anterolateral segments of the liver (segments II, III, V and VI and the inferior part of IV according to the classification of Couinaud). Due to the growing interest in LLR, there have been many attempts to apply this technique in difficult locations. The lesions in the posterior or superior part of the liver (segments I, VII, VIII and the superior part of IV), which are considered to be poor indications for LLR, have been reported to be successfully operated on by laparoscopic surgery. Accordingly, this laparoscopic approach has become similar to open surgery in many ways. One of the major advancements of LLR is anatomic liver resection including major and minor resection. Laparoscopic mono- and bisegmentectomies have also become possible with growing experience. There are a variety of monosegmentectomies and bisegmentectomies. The common representatives of bisegmentectomies are left lateral sectionectomy, right anterior sectionectomy and right posterior sectionectomy. The common operative types of monosegmentectomies are S4, S5, and S6 monosegmentectomies, etc. Central bi-sectionectomy will also be discussed. The Glissonian approach has been useful for these types of anatomic liver resection. The difficulty of controlling hemorrhage has been overcome by performing meticulous surgical techniques with newly developed instruments, and intraoperative sonography has been used to locate the lesions and guide the resection plane even for deep-seated or invisible lesions. Further accumulation of experience and technical refinements will make theses challenging procedures more reproducible and safer.
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Affiliation(s)
- Ho-Seong Han
- *Ho-Seong Han, MD, PhD, Department of Surgery, Seoul National University Bundang Hospital, 166 Gumi-ro, Bundang-gu, Seongnam-si, Gyeonggi-do 463-707 (Korea), E-Mail
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Gumbs AA, Gayet B. Adopting Gayet's Techniques of Totally Laparoscopic Liver Surgery in the United States. Liver Cancer 2013; 2:5-15. [PMID: 24159591 PMCID: PMC3747545 DOI: 10.1159/000346213] [Citation(s) in RCA: 21] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
Professor Brice Gayet of the Institut Mutualiste Montsouris in Paris, France, has developed totally laparoscopic techniques for all segments of the liver. As a pioneer in the field of minimally invasive hepato-pancreato-biliary surgery, he started a Minimally Invasive Hepato-Pancreato-Biliary Fellowship in 2006. A retrospective review of all hepatic cases performed by a single surgeon since completing this Fellowship was undertaken. From November 2007 to October 2012, a total of 80 liver resections were done, of which 73 were begun with the intention of completing the case laparoscopically. Of these, more than 90% were completed laparoscopically and 88% were for malignant disease. One of the foundations of Professor Gayet's techniques is the low lithotomy or 'French' position and the utilization of a small robotically controlled laparoscope holder that is sterilizeable and considerably more economic than complete surgical systems. Prototypes exist of robotically controlled hand-held laparoscopic instruments that, unlike the complete surgical system, enable surgeons to maintain a sense of touch (haptics). Proper training in minimally invasive hepato-pancreato-biliary techniques can be obtained with surgeons able to independently perform laparoscopic major hepatectomies without senior minimally invasive backup. Furthermore, miniature and more affordable robotics may enable more surgeons to enjoy the benefits of minimally invasive surgery while maintaining patient safety and minimizing the rising burden of health-care costs worldwide.
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Affiliation(s)
- Andrew A. Gumbs
- Department of Surgical Oncology, Summit Medical Group, Berkeley Heights, N.J., USA,*Andrew A. Gumbs, MD, FACS, Director of Minimally Invasive HPB Surgery, Department of Surgical Oncology, Summit Medical Group, 1 Diamond Hill Rd., Bensley Pavilion, 4th Floor, Berkeley Heights, NJ 07922 (USA), E-Mail
| | - Brice Gayet
- Department of Digestive Diseases, Institut Mutualiste Montsouris, Paris, France
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Minimally Invasive Surgery of the Liver: An Update. Updates Surg 2013. [DOI: 10.1007/978-88-470-2664-3_2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/07/2022]
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Mise Y, Sakamoto Y, Ishizawa T, Kaneko J, Aoki T, Hasegawa K, Sugawara Y, Kokudo N. A worldwide survey of the current daily practice in liver surgery. Liver Cancer 2013; 2:55-66. [PMID: 24159597 PMCID: PMC3747552 DOI: 10.1159/000346225] [Citation(s) in RCA: 66] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023] Open
Abstract
BACKGROUND Liver resection remains the mainstay of curative treatment for liver malignancies. A variety of preoperative assessments and surgical techniques have improved the short- and long-term outcomes of liver resection in patients with liver tumors. Recently, laparoscopic hepatectomies have been increasingly performed. The aim of the present study is to survey the current practice of liver surgery in high-volume centers in the world. METHODS A questionnaire on the preoperative assessment for liver surgery, open hepatectomy, and laparoscopic hepatectomy was sent to 94 liver centers in the world. RESULTS Forty-two centers (45%) responded to this survey (29 Asian, 9 European, and 4 North American centers). All but one of the centers evaluated the future liver remnant (FLR) volume, and 95% of them performed preoperative portal vein embolization to increase the FLR volume. In half of the centers, the required FLR volume was over 30% in patients with normal liver and 50% in patients with cirrhotic liver. To reduce the intraoperative blood loss, half of the centers routinely used Pringle's maneuver, and 85% restricted the intraoperative fluid infusion to reduce the central venous pressure. More than 10 laparoscopic hepatectomies were performed per year in 62% of the centers, and more than 30 were performed in 26%, respectively. Laparoscopic major hepatectomies were performed in 24%. Two-thirds answered that the laparoscopic approach would be feasible in donor hepatectomy. CONCLUSION The evaluation of FLR volume in patients with normal or cirrhotic liver and the usage of preoperative portal vein embolization have become essential practice in more than 90% of the centers. Reduced blood loss has been achieved using Pringle's maneuver, restriction of fluid infusion, and a variety of surgical devises. The laparoscopic approach is increasingly extended to major hepatectomy or donor hepatectomy.
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Affiliation(s)
| | | | | | | | | | | | | | - Norihiro Kokudo
- *Norihiro Kokudo, MD, PhD, Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery Graduate School of Medicine, University of Tokyo, 7-3-1 Hongo, Bunkyo-ku, Tokyo 113-8655 (Japan), E-Mail
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Abstract
Hepatocellular carcinoma (HCC) is one of the most common malignancies, with an increasing incidence. With advances in surgical techniques and instrumentation and the development of molecular-target drugs, a number of potentially curative treatments have become available. Management of HCC patients depends on the stage of their tumor. Liver resection remains the first choice for very early-stage HCC, but it is being challenged by local ablative therapy. For early-stage HCC that meet the Milan criteria, liver transplantation still offers a better outcome; however, local ablative therapy can be a substitute when transplantation is not feasible. Local ablation is also used as a bridging therapy toward liver transplantation. HCC recurrence is the main obstacle to successful treatment, and there is currently no effective means of preventing or treating HCC recurrence. Transarterial therapy is considered suitable for intermediate-stage HCC, while sorafenib is recommended for advanced-stage HCC. This stage-based approach to therapy not only provides acceptable outcomes but also improves the quality of life of HCC patients. Because of the complexity of HCC, therapeutic approaches must be adapted according to the characteristics of each individual patient. This review discusses the current standards and trends in the treatment of HCC.
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Affiliation(s)
| | | | - Peter Schemmer
- *Deptment of General and Transplant Surgery, Ruprecht-Karls-University, Im Neuenheimer Feld 110, Heidelberg 69120 (Germany), Tel. +49 0 6221 56 6110, E-Mail
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Hwang DW, Han HS, Yoon YS, Cho JY, Kim JH, Kwon Y. Totally Anatomic Laparoscopic Right Anterior Sectionectomy. J Laparoendosc Adv Surg Tech A 2012; 22:913-6. [DOI: 10.1089/lap.2012.0196] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/11/2022] Open
Affiliation(s)
- Dae Wook Hwang
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ho-Seong Han
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yoo-Seok Yoon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Jai Young Cho
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Ji Hoon Kim
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
| | - Yujin Kwon
- Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea
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Costi R, Scatton O, Haddad L, Randone B, Andraus W, Massault PP, Soubrane O. Lessons learned from the first 100 laparoscopic liver resections: not delaying conversion may allow reduced blood loss and operative time. J Laparoendosc Adv Surg Tech A 2012; 22:425-31. [PMID: 22670635 DOI: 10.1089/lap.2011.0334] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
Abstract
BACKGROUND The laparoscopic approach to liver resective surgery is slowly spreading to specialized centers. Little is known about factors influencing the immediate postoperative outcome. STUDY DESIGN The purpose of the study was to evaluate the immediate outcome of laparoscopic liver resection (LLR), with particular emphasis on intraoperative bleeding and conversion. A retrospective analysis of demographic, clinical, and surgical data, including conversion, morbidity/mortality, and hospital stay, of the first 100 patients at our institution undergoing LLR from February 1997 through March 2007 was performed. RESULTS Indication for LLR was benign lesion in 28 patients, malignancy in 33, and living donation in 39. Seventy-five resections involved two or more segments. Mean blood loss was 120 ± 127.6 mL. One patient (1%) required transfusion. Mean operative time was 253 ± 91.6 minutes. No patient died. Postoperative complications occurred in 21 patients. The conversion rate was 17%. Variables related to conversion were American Society of Anesthesiologists Class II, body mass index, cirrhosis, necessity for the Pringle maneuver, and intraoperative blood loss. Conversion did not influence the operative time. Patients with conversion had more complications and a longer hospital stay. CONCLUSIONS Liver resection by laparoscopy is feasible and safe, implying low intraoperative blood loss. Not perfect physical conditions, cirrhosis, high body mass index, and, intraoperatively, blood loss and the necessity of a Pringle maneuver should be considered risk factors for conversion. A meticulous dissection by bipolar coagulation, Harmonic(®) (Ethicon) scalpel, and ultrasound dissector, other than the attitude not to delay conversion in difficult cases, may allow for low blood loss without prolongation of operative time, with a possible, slight increase of the conversion rate.
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Affiliation(s)
- Renato Costi
- Department of Hepatobiliary Surgery and Liver Transplantation, Saint Antoine Hospital, Public Assistance Hospitals of Paris, University of Paris Pierre et Marie Curie, Paris, France
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Toro A, Gagner M, Di Carlo I. Has laparoscopy increased surgical indications for benign tumors of the liver? Langenbecks Arch Surg 2012; 398:195-210. [PMID: 23053460 DOI: 10.1007/s00423-012-1012-y] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/31/2012] [Accepted: 09/25/2012] [Indexed: 12/17/2022]
Abstract
BACKGROUND We aimed to analyze the risk of an increased surgical indication rate in patients with benign tumors of the liver since the development of laparoscopy. Previous articles have reported increased numbers of laparoscopic procedures in different surgical fields. METHODS A literature search of MEDLINE (PubMed), Google Scholar, and The Cochrane Library was carried out. All articles that analyzed benign liver tumors (hemangiomas, focal nodular hyperplasia, and adenoma) were divided in two groups: group I included all manuscripts with open procedures between 1971 at 1990, and group II included all manuscripts with open or laparoscopic procedures between 1991 and 2010. Group II articles were divided into two subgroups. Subgroup IIA patients were treated by open or laparoscopic procedures between 1991 and 2000, and subgroup IIB patients were treated by open or laparoscopic procedures between 2001 and 2010. RESULTS Specific analysis of each kind of tumor observed in the two groups showed fewer surgically treated patients for hepatic hemangioma and hepatic adenoma in group II compared with group I and a greater number of patients for focal nodular hyperplasia. Fewer patients were treated with laparoscopic procedures in subgroup IIA than in subgroup IIB. A chi-square test with Yates' correction gave a P value of <0.001. CONCLUSION Laparoscopy has increased the rate of hepatic resection for benign tumors with doubtful indications.
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Affiliation(s)
- Adriana Toro
- Department of Surgical Sciences, Organ Transplantation and Advanced Technologies, Cannizzaro Hospital, University of Catania, Via Messina 829, Catania, Italy
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Cannon RM, Scoggins CR, Callender GG, McMasters KM, Martin RCG. Laparoscopic versus open resection of hepatic colorectal metastases. Surgery 2012; 152:567-73; discussion 573-4. [PMID: 22943842 DOI: 10.1016/j.surg.2012.07.013] [Citation(s) in RCA: 76] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/10/2012] [Accepted: 07/10/2012] [Indexed: 12/11/2022]
Abstract
BACKGROUND This study was undertaken to assess the safety and efficacy of laparoscopic versus open resection of hepatic colorectal metastases (CRM). METHODS We reviewed retrospectively of all patients undergoing initial resection of CRM at a single institution between 1995 and 2010. The study cohort consisted of all patients undergoing laparoscopic resection and a cohort of patients undergoing open resection matched on a 4:1 basis by propensity scoring. Variables analyzed included patient and tumor characteristics, short-term outcomes, and OS and disease-free (DFS) survivals. RESULTS The 35 patients in the laparoscopic cohort and 140 patients in the open cohort were equivalent in terms of age, Charlson Comorbidity Index, tumor characteristics, and Clinical Risk Score. Similar proportions of patients in the laparoscopic and open groups underwent synchronous colectomy (9% in both; P = .976) and major hepatectomy (54% vs 51%; P = .705). Blood loss (202 vs 385 mL; P < .001), complications (23% vs 50%; P = .004), and duration of stay (4.8 vs 8.3 days; P < .001) were less in the laparoscopic cohort. Five-year OS (36% vs 42%; P = .818) and DFS (15% vs 22%; P = .346) were also similar in the laparoscopic and open groups. CONCLUSION Laparoscopic resection of hepatic CRM seems to be a beneficial alternative to open surgery in appropriately selected patients.
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Affiliation(s)
- Robert M Cannon
- University of Louisville, Department of Surgery, Division of Surgical Oncology, Louisville, KY 40202, USA
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Jeong CY, Kim KJ, Hong SC, Jeong SH, Ju YT, Lee YJ, Choi SK, Ha WS, Park ST, Jung EJ. Laparoscopic left hemihepatectomy for left intrahepatic duct stones. JOURNAL OF THE KOREAN SURGICAL SOCIETY 2012; 83:149-54. [PMID: 22977761 PMCID: PMC3433551 DOI: 10.4174/jkss.2012.83.3.149] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/30/2012] [Revised: 05/31/2012] [Accepted: 06/17/2012] [Indexed: 12/20/2022]
Abstract
Purpose The feasibility of laparoscopic left hemihepatectomy for the management of intrahepatic duct (IHD) stones was evaluated. Methods The clinical data of 26 consecutive patients who underwent total laparoscopic left hemihepatectomy for IHD stones at Gyeongsang National University Hospital between January 2009 and June 2011 were reviewed retrospectively. Results The mean operation time was 312.1 ± 63.4 minutes and the mean postoperative hospital stay was 11.8 ± 5.0 days. There were 2 cases of postoperative bile leakage and 3 cases of intra-abdominal fluid collection, which were successfully managed conservatively. Remnant stones were detected in 2 patients. The initial success rate of stone clearance was 92.3% (24 of 26). The remnant stones were located in the common bile duct in both cases and were removed by endoscopic retrograde cholangiopancreatography and endoscopic sphincterotomy. Therefore, the final success rate of stone clearance was 100% (26 of 26). During a mean follow-up of 22 months (range, 7 to 36 months), there was no patient with recurrent stone. Conclusion Laparoscopic surgery could be an effective treatment modality for the management of IHD stones in select patients.
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Affiliation(s)
- Chi-Young Jeong
- Department of Surgery, Gyeongsang National University School of Medicine, Jinju, Korea
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Pan M, Jiang Z, Cheng Y, Xu X, Zhang Z, Zhou C, He G, Xu T, Liu H, Gao Y. Single-incision laparoscopic hepatectomy for benign and malignant hepatopathy: initial experience in 8 Chinese patients. Surg Innov 2012; 19:446-51. [PMID: 22474017 DOI: 10.1177/1553350612438412] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/18/2022]
Abstract
BACKGROUND The single-incision laparoscopic surgery (SILS) technique has been used in many surgical procedures, but there are few reports regarding liver surgeries. The purpose of this study was to perform single-incision laparoscopic hepatectomy (SILH) using standard laparoscopic instrumentation in 8 Chinese patients. The advantages and prospective future applications of SILH are also described. METHODS Selected patients were hospitalized between December 2009 and November 2011. The procedure was accomplished through a 2.5-cm transabdominal wall incision using a laparoscope and 2 other instruments without the assistance of any articulating instruments or single multiport trocar. RESULTS All procedures were successfully performed without the need for supplemental trocars. Postoperative pathological examinations were supportive of the preoperative diagnoses. No complications such as perioperative hemorrhage or infections occurred. CONCLUSION SILH appears to be a safe approach and the results are cosmetically favorable. The accumulation of SILH experience and the development of instrumentation are needed for extensive use of this technique in hepatectomies.
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Affiliation(s)
- Mingxin Pan
- Department of Hepatobiliary Surgery of Zhujiang Hospital, Southern Medical University, Guang Zhou, China
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Minimally invasive evaluation and treatment of colorectal liver metastases. Int J Surg Oncol 2012; 2011:686030. [PMID: 22312518 PMCID: PMC3263653 DOI: 10.1155/2011/686030] [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: 01/07/2011] [Accepted: 05/05/2011] [Indexed: 12/07/2022] Open
Abstract
Minimally invasive techniques used in the evaluation and treatment of colorectal liver metastases (CRLMs) include ultrasonography (US), computed tomography, magnetic resonance imaging, percutaneous and operative ablation therapy, standard laparoscopic techniques, robotic techniques, and experimental techniques of natural orifice endoscopic surgery. Laparoscopic techniques range from simple staging laparoscopy with or without laparoscopic intraoperative US, through intermediate techniques including simple liver resections (LRs), to advanced techniques such as major hepatectomies. Hereins, we review minimally invasive evaluation and treatment of CRLM, focusing on a comparison of open LR (OLR) and minimally invasive LR (MILR). Although there are no randomized trials comparing OLR and MILR, nonrandomized data suggest that MILR compares favorably with OLR regarding morbidity, mortality, LOS, and cost, although significant selection bias exists. The future of MILR will likely include expanding criteria for resectability of CRLM and should include both a patient registry and a formalized process for surgeon training and credentialing.
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