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Muaddi H, Gudmundsdottir H, Cleary S. Current Status of Laparoscopic Liver Resection. Adv Surg 2024; 58:311-327. [PMID: 39089784 DOI: 10.1016/j.yasu.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/04/2024]
Abstract
The evolution of laparoscopic liver surgery, originating in the 1990s, has been marked by significant advancements and milestones, overcoming initial technical hurdles and gaining widespread acceptance within the surgical community as a precise and safe alternative to open procedures. Along this journey, numerous challenges emerged, leading to the accumulation of evidence and the development of guidelines aimed at assisting surgeons in determining the safety, suitability, and complexity of laparoscopic liver resection. This chapter provides a thorough examination of key aspects of laparoscopic liver resection, including difficulty scoring systems, criteria for patient selection, technical considerations, outcomes across different types of liver lesions, and the innovative solutions developed to address challenges, thus offering a comprehensive overview of laparoscopic liver resection, and highlighting its evolving significance in modern hepatobiliary surgery.
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Affiliation(s)
- Hala Muaddi
- Division of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester, MN, USA
| | | | - Sean Cleary
- Division of Hepatobiliary and Pancreas Surgery, University of Toronto, Toronto, Ontario, Canada.
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2
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Toriguchi K, Kaihara S, Kitamura K, Ishikawa T, Oshima N, Kondo M, Kobayashi H, Hashida H, Uryuhara K. Efficacy of surgical staple line reinforcement in Glissonean stapling: A single-center pilot study. Asian J Endosc Surg 2024; 17:e13293. [PMID: 38452773 DOI: 10.1111/ases.13293] [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: 11/01/2023] [Revised: 01/18/2024] [Accepted: 02/06/2024] [Indexed: 03/09/2024]
Abstract
Vascular staplers are routinely used in laparoscopic liver resection, which has become a standard procedure in advanced medical facilities. Although previous reports have outlined the benefits of staple line reinforcement (SLR), its application in Glissonean pedicle transection during hepatic resection remains poorly studied. This study investigated surgical SLR as a tool to enhance staple line strength and improve perioperative hemostasis. Here, 10 patients who underwent laparoscopic liver resection using the Tri-StapleTM2.0 Reinforced Reload were included. Patient characteristics, surgical details, and outcomes were assessed. The results demonstrated successful outcomes with no complications related to bile leakage or injuries during staple insertion. Overall, our findings suggest that SLR can be safely utilized in Glissonean pedicle transection during laparoscopic liver resections. Further studies are required to comprehensively evaluate its benefits compared with conventional surgical staplers.
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Affiliation(s)
- Kan Toriguchi
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Satoshi Kaihara
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Koji Kitamura
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Tatsuki Ishikawa
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Nobu Oshima
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Masato Kondo
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Hiroyuki Kobayashi
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Hiroki Hashida
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
| | - Kenji Uryuhara
- Department of Surgery, Kobe Medical Center General Hospital, Kobe city, Hyogo, Japan
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Serednicki WA, Hołówko W, Major P, Małczak P, Pędziwiatr M. Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review. Wideochir Inne Tech Maloinwazyjne 2023; 18:213-223. [PMID: 37680740 PMCID: PMC10481434 DOI: 10.5114/wiitm.2022.124088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/30/2022] [Accepted: 12/19/2022] [Indexed: 09/09/2023] Open
Abstract
Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.
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Affiliation(s)
- Wojciech A. Serednicki
- Department of Medical Education, Faculty of Medicine, Jagiellonian University Medical College, Krakow, Poland
| | - Wacław Hołówko
- Department of General, Transplant, and Liver Surgery, Medical University of Warsaw, Warsaw, Poland
| | - Piotr Major
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Piotr Małczak
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
| | - Michał Pędziwiatr
- 2 Department of General Surgery, Jagiellonian University Medical College, Krakow, Poland
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Wu Y, Tian L, Li C, Liu M, Qiao S, Zhang W, Tian S, Chen G. Factors affecting sufentanil consumption for intravenous controlled analgesia after hepatectomy: retrospective analysis. BMC Anesthesiol 2021; 21:308. [PMID: 34876004 PMCID: PMC8650516 DOI: 10.1186/s12871-021-01526-z] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/27/2020] [Accepted: 11/23/2021] [Indexed: 11/23/2022] Open
Abstract
Background Pain control after hepatectomy is usually achieved by opioids. There are significant individual differences in the amount of opioids used after hepatectomy, and the metabolism of opioids is liver-dependent. The purpose of our study was to explore the possible risk factors for opioid consumption during the first 48 h after surgery. Methods In a retrospective study design involving 562 patients undergoing open or laparoscopic hepatectomy, all patients were treated with intravenous patient-controlled analgesia (IV-PCA) along with continuous and bolus doses of sufentanil for a duration of 48 h after surgery during the time period of August 2015 and February 2019. The primary endpoint was high sufentanil consumption 48 h after hepatectomy, and patients were divided into two groups: those with or without a high PCA sufentanil dosage depending on the third quartile (Q3). The secondary endpoint was the effect of a high PCA sufentanil dosage on various possible clinical risk factors. The relevant parameters were collected, and correlation and multivariate regression analyses were performed. Results The median operation time was 185 min (range, 115–250 min), and the median consumption of sufentanil 48 h after the operation was 91 μg (IQR, 64.00, 133.00). Factors related to the consumption of sufentanil at 48 h after hepatectomy included age, operation time, blood loss, intraoperative infusion (red blood cells and fresh-frozen plasma), pain during movement after surgery (day 1 and day 2), preoperative albumin, and postoperative blood urea nitrogen. Age (≤ 60 and > 60 years), extent of resection (minor hepatic resection and major hepatic resection), surgical approach (laparoscope and open) and operation time (min) were independent risk factors for sufentanil consumption at 48 h postoperatively. Conclusion Age younger than 60 years, major hepatic resection, an open approach and a longer operation are factors more likely to cause patients to require higher doses of sufentanil after hepatectomy, and the early identification of such patients can increase the efficacy of perioperative pain management.
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Affiliation(s)
- Yue Wu
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, 3 Qingchun Road East, ShangCheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Lina Tian
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, 3 Qingchun Road East, ShangCheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Chunye Li
- Department of Pain, Affiliated Hospital of Jiangsu University, 438 Jiefang Road, Zhenjiang, 212001, Jiangsu, People's Republic of China
| | - Minjun Liu
- Department of Nursing Education, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, 3 Qingchun Road East, ShangCheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Shina Qiao
- Department of Nursing Education, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, 3 Qingchun Road East, ShangCheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Weibo Zhang
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, 3 Qingchun Road East, ShangCheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Suming Tian
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, 3 Qingchun Road East, ShangCheng District, Hangzhou, 310016, Zhejiang, People's Republic of China
| | - Gang Chen
- Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejang University, 3 Qingchun Road East, ShangCheng District, Hangzhou, 310016, Zhejiang, People's Republic of China.
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Efanov M, Kazakov I, Alikhanov R, Vankovich A, Koroleva A, Kovalenko D, Salimgereeva D, Tsvirkun V, Khatkov I. A randomized prospective study of the immediate outcomes of the use of a hydro-jet dissector and an ultrasonic surgical aspirator for laparoscopic liver resection. HPB (Oxford) 2021; 23:1332-1338. [PMID: 33618991 DOI: 10.1016/j.hpb.2021.01.010] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/25/2020] [Revised: 01/14/2021] [Accepted: 01/20/2021] [Indexed: 12/12/2022]
Abstract
BACKGROUND No prospective randomized trials comparing transection techniques for the liver parenchyma transection during laparoscopic liver resection have been performed. The aim of the study was to compare the immediate outcomes of hydro-jet dissection with ultrasonic surgical aspirator in laparoscopic liver parenchyma transection in a prospective randomized single-center study. METHODS Consecutive patients with liver benign and malignant tumors presenting to a single center from May 2017 to May 2020 were enrolled in the study. The primary endpoint was the intraoperative estimated blood loss. The secondary endpoints included duration of parenchymal transection, morbidity, and overall hospital stay. RESULTS A total of 68 patients were enrolled in the study, with 34 patients in each group. There were no differences between groups in the difficulty of resection (according to IWATE criteria and IMM score) and other basic surgical parameters. No differences were found in all primary and secondary endpoints except the expenditure. The cost of equipment was significantly higher in the group of ultrasonic aspirator. CONCLUSION Despite the wider use of the ultrasonic aspirator in laparoscopic liver surgery, hydro-jet and ultrasonic surgical aspirators have shown similar efficacy and safety for transection of the liver parenchyma during laparoscopic resection.
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Affiliation(s)
- Mikhail Efanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia.
| | - Ivan Kazakov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
| | - Ruslan Alikhanov
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
| | - Andrey Vankovich
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
| | - Anna Koroleva
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
| | - Dmitry Kovalenko
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
| | - Diana Salimgereeva
- Department of Hepato-Pancreato-Biliary Surgery, Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
| | - Victor Tsvirkun
- Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
| | - Igor Khatkov
- Moscow Clinical Scientific Center, 11123, Shosse Entuziastov, 86, Moscow, Russia
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The Italian Consensus on minimally invasive simultaneous resections for synchronous liver metastasis and primary colorectal cancer: A Delphi methodology. Updates Surg 2021; 73:1247-1265. [PMID: 34089501 DOI: 10.1007/s13304-021-01100-9] [Citation(s) in RCA: 31] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/03/2021] [Accepted: 05/12/2021] [Indexed: 12/17/2022]
Abstract
At the time of diagnosis synchronous colorectal cancer, liver metastases (SCRLM) account for 15-25% of patients. If primary tumour and synchronous liver metastases are resectable, good results may be achieved performing surgical treatment incorporated into the chemotherapy regimen. So far, the possibility of simultaneous minimally invasive (MI) surgery for SCRLM has not been extensively investigated. The Italian surgical community has captured the need and undertaken the effort to establish a National Consensus on this topic. Four main areas of interest have been analysed: patients' selection, procedures, techniques, and implementations. To establish consensus, an adapted Delphi method was used through as many reiterative rounds were needed. Systematic literature reviews were conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses instructions. The Consensus took place between February 2019 and July 2020. Twenty-six Italian centres participated. Eighteen clinically relevant items were identified. After a total of three Delphi rounds, 30-tree recommendations reached expert consensus establishing the herein presented guidelines. The Italian Consensus on MI surgery for SCRLM indicates possible pathways to optimise the treatment for these patients as consensus papers express a trend that is likely to become shortly a standard procedure for clinical pictures still on debate. As matter of fact, no RCT or relevant case series on simultaneous treatment of SCRLM are available in the literature to suggest guidelines. It remains to be investigated whether the MI technique for the simultaneous treatment of SCRLM maintain the already documented benefit of the two separate surgeries.
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Zhang EL, Huang ZY, Chen XP. Rationality and necessity of vascular stapler application during liver resection (Review). Exp Ther Med 2021; 21:498. [PMID: 33791007 PMCID: PMC8005682 DOI: 10.3892/etm.2021.9929] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2020] [Accepted: 02/17/2021] [Indexed: 12/07/2022] Open
Abstract
Liver resection (LR) is the primary treatment method for patients with hepatocellular carcinoma (HCC). Improving surgical safety and reducing surgical morbidity and mortality is important for patients receiving LR. Various devices have been developed to facilitate vascular transection to reduce intraoperative blood loss, which is considered to be a predictor of poor surgical outcomes in patients undergoing LR. Vascular staplers have been widely applied for the division of major vascular and biliary structures in the process of LR; however, when and how to use these tools remains controversial. This review aims to report the rationality and necessity of using vascular staplers in vessel transection during liver surgery. Due to the risk of intraoperative and postoperative hemorrhage and biliary fistula, the process of transection of the portal pedicle and hepatic vein is a crucial step during LR. Stapling represents a vascular dissection technique that is widely used in laparoscopic LR and has then been popularized in open LR. Advocates argue that stapler transection methods provide several advantages, including diminished blood loss, fewer transfusion requirements and shorter operative times. However, other studies have failed to demonstrate those benefits when using these tools compared with the simple clamp-crushing technique. Using the stapler vascular transection method resulted in smaller surgical margins and similar surgical outcomes compared with those of the clamp-crushing vascular transection method. However, the intraoperative use of vascular staplers may significantly increase the financial burden of liver resection for patients with HCC, while not improving short- and long-term outcomes. Therefore, it has been suggested that vascular staplers should not be routinely used in LR. The current review discussed the above points and recommended that the stapling transection of the portal pedicle and hepatic vein should be applied during laparoscopic LR in a rational manner. However, the suturing ligation method should be routinely used in open LR.
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Affiliation(s)
- Er-Lei Zhang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Zhi-Yong Huang
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
| | - Xiao-Ping Chen
- Hepatic Surgery Center, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, Hubei 430030, P.R. China
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Michael AE, Case JB, Massari F, Giuffrida MA, Mayhew PD, Carvajal JL, Regier PJ, Runge JJ, Singh A. Feasibility of laparoscopic liver lobectomy in dogs. Vet Surg 2021; 50 Suppl 1:O89-O98. [PMID: 33576085 DOI: 10.1111/vsu.13566] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Revised: 11/16/2020] [Accepted: 11/24/2020] [Indexed: 12/15/2022]
Abstract
OBJECTIVE To determine the feasibility of laparoscopic liver lobectomy (LLL) in dogs by using canine cadavers and to describe the clinical application in dogs with liver disease. STUDY DESIGN Ex vivo experiment and descriptive case series. SAMPLE POPULATION Twelve canine cadavers and six client-owned dogs. METHODS Cadavers underwent LLL with an endoscopic stapler. The percentage of liver lobe resected was determined by volume. The distance from the staple line to hilus was measured. Medical records of dogs undergoing LLL were reviewed. RESULTS In cadavers ≤15 kg, left lateral lobectomy completeness was 87.3% (84.6%-96.6%), and remaining median (interquartile range) hilar length was 1 cm (0.25-1.75). Left medial lobectomy completeness was 72.5% (66.7%-80%), and remaining hilar length was 1.6 cm (0.47-1.75). Central division resection completeness was 68.3% (60%-92.9%), and remaining hilar length was 2.7 cm (0.8-5). Laparoscopic liver lobectomy was not feasible for right division lobes and in cadavers >15 kg. Five dogs with peripheral quadrate or left lateral lobe masses underwent stapled, partial laparoscopic lobectomy (30%-90%). One dog underwent stapled, left lateral lobectomy (90%) after open procedure conversion. Histopathological diagnoses included hepatocellular carcinoma (3), nodular hyperplasia (1), biliary cyst adenoma (1), and fibrosis (1). CONCLUSION Laparoscopic liver lobectomy of the left and central divisions is feasible in cadavers ≤15 kg with an endoscopic stapler. Partial LLL of the left and central divisions is feasible in select dogs with liver disease. CLINICAL SIGNIFICANCE Laparoscopic liver lobectomy may be a viable alternative to laparotomy in small-to-medium size dogs with peripheral liver masses of the left and central divisions.
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Affiliation(s)
- Aleisha E Michael
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - J Brad Case
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | | | - Michelle A Giuffrida
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Philipp D Mayhew
- Department of Surgical and Radiological Sciences, School of Veterinary Medicine, University of California-Davis, Davis, California
| | - Jose L Carvajal
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Penny J Regier
- Department of Small Animal Clinical Sciences, College of Veterinary Medicine, University of Florida, Gainesville, Florida
| | - Jeffrey J Runge
- Department of Surgery, Guardian Veterinary Specialists, Brewer, New York
| | - Ameet Singh
- Department of Clinical Studies, Ontario Veterinary College, University of Guelph, Guelph, Ontario, Canada
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Predicting the Risk of Postoperative Complications in Patients Undergoing Minimally Invasive Resection of Primary Liver Tumors. J Clin Med 2021; 10:jcm10040685. [PMID: 33578875 PMCID: PMC7916554 DOI: 10.3390/jcm10040685] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2020] [Revised: 01/23/2021] [Accepted: 02/07/2021] [Indexed: 12/15/2022] Open
Abstract
Minimal-invasive techniques are increasingly applied in clinical practice and have contributed towards improving postoperative outcomes. While comparing favorably with open surgery in terms of safety, the occurrence of severe complications remains a grave concern. To date, no objective predictive system has been established to guide clinicians in estimating complication risks as the relative contribution of general patient health, liver function and surgical parameters remain unclear. Here, we perform a single-center analysis of all consecutive patients undergoing laparoscopic liver resection for primary hepatic malignancies since 2010. Among the 210 patients identified, 32 developed major complications. Several independent predictors were identified through a multivariate analysis, defining a preoperative model: diabetes, history of previous hepatectomy, surgical approach, alanine aminotransferase levels and lesion entity. The addition of operative time and whether conversion was required significantly improved predictions and were thus incorporated into the postoperative model. Both models were able to identify patients with major complications with acceptable performance (area under the receiver-operating characteristic curve (AUC) for a preoperative model = 0.77 vs. postoperative model = 0.80). Internal validation was performed and confirmed the discriminatory ability of the models. An easily accessible online tool was deployed in order to estimate probabilities of severe complication without the need for manual calculation.
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Smith AA, Monlezun DJ, Martinie J, Iannitti D, Konstantinidis I, Darden M, Parker G, Fong Y, Buell JF. Bile Leak Reduction with Laparoscopic Versus Open Liver Resection: A Multi-institutional Propensity Score-Adjusted Multivariable Regression Analysis. World J Surg 2021; 44:1578-1585. [PMID: 31897695 DOI: 10.1007/s00268-019-05343-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
INTRODUCTION The reported rate of postoperative bile leak is variable between 3 and 33%. Recent data would suggest a minimally invasive approach to liver surgery has decreased this incidence. METHODS This multi-institutional case-control study utilized databases from three high-volume surgeons. All consecutive open and minimally invasive liver resection cases were analyzed in a propensity score-adjusted multivariable regression. A p value < 0.05 was considered significant. RESULTS In 1388 consecutive liver resections, the average age was 56.9 ± 14.0 years, 730 (52.59%) were male gender, and 599 (43.16%) underwent minimally invasive liver resection. Thirty-nine (2.81%) in the series were identified with post-resection bile duct leaks. Leaks were associated with major resections and increased blood loss (p < 0.05). Propensity score-adjusted multivariable regression identified minimally invasive liver resection significantly and independently reduced the odds of bile duct leak (OR 0.48, p = 0.046) even controlling for BMI, ASA, cirrhosis, major resection, and resection year. CONCLUSIONS Our data suggest the incidence of bile leaks in a large-volume center series is far less than previously reported and that a minimally invasive approach to liver resection reduces the incidence of postoperative bile leak.
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Affiliation(s)
- Alison A Smith
- Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, SL-22, New Orleans, LA, 70112, USA.
| | - Dominique J Monlezun
- Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, SL-22, New Orleans, LA, 70112, USA
| | - John Martinie
- Division of HPB Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | - David Iannitti
- Division of HPB Surgery, Carolinas Medical Center, Charlotte, NC, USA
| | | | - Michael Darden
- Carey Business School, Johns Hopkins University, Baltimore, MD, USA
| | - Geoffrey Parker
- Thayer School of Engineering, Dartmouth College, Hanover, USA
| | - Yuman Fong
- City of Hope National Medical Center, Los Angeles, CA, USA
| | - Joseph F Buell
- Department of Surgery, Tulane University School of Medicine, 1430 Tulane Ave, SL-22, New Orleans, LA, 70112, USA
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Schmelzle M, Krenzien F, Schöning W, Pratschke J. Laparoscopic liver resection: indications, limitations, and economic aspects. Langenbecks Arch Surg 2020; 405:725-735. [PMID: 32607841 PMCID: PMC7471173 DOI: 10.1007/s00423-020-01918-8] [Citation(s) in RCA: 36] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/16/2020] [Accepted: 06/23/2020] [Indexed: 12/13/2022]
Abstract
Background Minimally invasive techniques have increasingly found their way into liver surgery in recent years. A multitude of mostly retrospective analyses suggests several advantages of laparoscopic over open liver surgery. Due to the speed and variety of simultaneous technical and strategic developments, it is difficult to maintain an overview of the current status and perspectives in laparoscopic liver surgery. Purpose This review highlights up-to-date aspects in laparoscopic liver surgery. We discuss established indications with regard to their development over time as well as continuing limitations of applied techniques. We give an assessment based on the current literature and according to our own center experiences, not least with regard to a highly topical cost discussion. Conclusions While in the beginning mainly benign tumors were laparoscopically operated on, liver metastasis and hepatocellular carcinoma are now among the most frequent indications. Technical limitations remain and should be evaluated with the overall aim not to endanger quality standards in open surgery. Financial aspects cannot be neglected with the necessity of cost-covering reimbursement.
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Affiliation(s)
- Moritz Schmelzle
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany.
| | - Felix Krenzien
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery, Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin, Corporate Member of Freie Universität Berlin, Humboldt-Universität zu Berlin, Augustenburger Platz 1, 13353, Berlin, Germany
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12
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Abstract
Laparoscopic liver surgery has gained wide acceptance resulting in a paradigm shift of liver surgery. Technical innovations and accumulation of surgeon's experience have allowed laparoscopic liver resection (LLR) to become an effective procedure with favorable peri- and post-operative outcomes. Through the overall process of LLR, liver parenchymal transection remains the most critical step with the aim of minimizing blood loss and secures the appropriate cutting line, i.e., securing major vessels and obtaining adequate surgical margin clearance for malignancies. Multiple preoperative imaging modalities and intraoperative ultrasonography findings may contribute to the best determination of the appropriate cutting line during the LLR; however, technical expertise in minimizing and controlling bleeding during liver parenchymal transection is still a challenge for safe LLR, and therefore represents a major concern for hepatobiliary surgeons. Along with the historical fact that the technique of liver parenchymal transection itself is chosen according to surgeon's preference and "savoir-faire", the best technical modality in laparoscopic liver parenchymal transection remains to be determined. However, better understanding the technical issue may serve a contribution to the standardization of LLR. This review article therefore focuses on the technical aspects of the laparoscopic liver parenchymal transection.
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Affiliation(s)
- Tomoaki Yoh
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
| | - François Cauchy
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
| | - Olivier Soubrane
- Department of Hepato-Pancreatico-Biliary Surgery and Liver Transplantation, Beaujon Hospital, Clichy, France.,Assistance Publique, Hôpitaux de Paris, Paris, France.,Université Paris VII Denis Diderot, Paris, France
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13
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Goh BKP, Lee S, Koh Y, Kam J, Chan C. Minimally invasive major hepatectomies: a Southeast Asian single institution contemporary experience with its first 120 consecutive cases. ANZ J Surg 2019; 90:553-557. [DOI: 10.1111/ans.15563] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2019] [Revised: 10/12/2019] [Accepted: 10/14/2019] [Indexed: 02/06/2023]
Affiliation(s)
- Brian K. P. Goh
- Department of Hepatopancreatobiliary and Transplant SurgerySingapore General Hospital Singapore
- Office of Clinical SciencesDuke‐NUS Medical School Singapore
| | - Ser‐Yee Lee
- Department of Hepatopancreatobiliary and Transplant SurgerySingapore General Hospital Singapore
- Office of Clinical SciencesDuke‐NUS Medical School Singapore
| | - Ye‐Xin Koh
- Department of Hepatopancreatobiliary and Transplant SurgerySingapore General Hospital Singapore
- Office of Clinical SciencesDuke‐NUS Medical School Singapore
| | - Juinn‐Huar Kam
- Department of Hepatopancreatobiliary and Transplant SurgerySingapore General Hospital Singapore
| | - Chung‐Yip Chan
- Department of Hepatopancreatobiliary and Transplant SurgerySingapore General Hospital Singapore
- Office of Clinical SciencesDuke‐NUS Medical School Singapore
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14
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Mehrabi A, Hoffmann K, Nagel AJ, Ghamarnejad O, Khajeh E, Golriz M, Büchler MW. Technical Aspects of Stapled Hepatectomy in Liver Surgery: How We Do It. J Gastrointest Surg 2019; 23:1232-1239. [PMID: 30820793 DOI: 10.1007/s11605-019-04159-3] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2018] [Accepted: 02/05/2019] [Indexed: 01/31/2023]
Abstract
There are diverse approaches to parenchymal transection and the preferred approach remains controversial among liver surgeons. Stapling devices, which were initially established for vascular control, have been the standard parenchymal transection technique in many departments for more than 15 years. This article describes the technical aspects, tips, and tricks of stapled hepatectomy using right hemihepatectomy as an example. The existing literature on this topic is also reviewed.
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Affiliation(s)
- Arianeb Mehrabi
- Division of Liver Surgery, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany.
| | - Katrin Hoffmann
- Division of Liver Surgery, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Alexander Johannes Nagel
- Division of Liver Surgery, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Omid Ghamarnejad
- Division of Liver Surgery, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Elias Khajeh
- Division of Liver Surgery, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Mohammad Golriz
- Division of Liver Surgery, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
| | - Markus W Büchler
- Division of Liver Surgery, Department of General, Visceral, and Transplant Surgery, Ruprecht Karls University, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany
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15
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Macacari RL, Coelho FF, Bernardo WM, Kruger JAP, Jeismann VB, Fonseca GM, Cesconetto DM, Cecconello I, Herman P. Laparoscopic vs. open left lateral sectionectomy: An update meta-analysis of randomized and non-randomized controlled trials. Int J Surg 2018; 61:1-10. [PMID: 30496866 DOI: 10.1016/j.ijsu.2018.11.021] [Citation(s) in RCA: 23] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2018] [Revised: 09/28/2018] [Accepted: 11/14/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Left lateral sectionectomy (LLS) is thought to be the anatomical liver resection most suitable for the laparoscopic approach. Despite increasing popularity, comparative analysis of laparoscopic and open LLS are mostly limited to retrospective, underpowered studies with small sample size. Recent population-based studies and prospective trials have generated new data; however, this new body of knowledge has not been submitted systematic reviews or meta-analyses and high quality evidence regarding the actual benefits of minimally invasive LLS is lacking. METHODS Systematic review of studies published until December 31st, 2017 and indexed in Medline, EMBASE, Cochrane Library Central and Scielo/LILACS databases. Randomized controlled trials and observational studies comparing perioperative results of laparoscopic and open LLS were included. Studies with patients submitted to LLS for living donation were excluded. Treatment outcomes, including conversion rates, estimated blood loss, transfusion rates, operative time, length of in-hospital stay, morbidity and mortality rates, were evaluated. RESULTS The primary search yielded 2838 articles, 23 of which (21 observational studies and 2 randomized controlled trials; 3415 patients) were included in the meta-analysis. Overall conversion rate was 7.4%. Patients submitted to laparoscopic LLS had less blood loss (mean difference, MD = -119.81 ml, 95% CI = -127.90, -111.72, P < .00001, I2 = 32%, N = 618), lower transfusion rates (4.1% vs. 10.1%; risk difference, RD = - 0.06, 95% CI = - 0.08, - 0.05, P < .00001, I2 = 13%, N = 2968) and shorter length of in-hospital stay (MD = - 2.02 days, 95% CI = - 2.15, - 1.89, P < .00001, I2 = 77%, N = 3160) compared to those undergoing open surgery. Marginally decreased overall complication (21.4% vs. 27.5%; RD = - 0.03, 95% CI = - 0.06, 0.00, P = .05, I2 = 0%, N = 3268) and perioperative mortality (0.3% vs. 1.5%; RD = - 0.01, 95% CI = - 0.02, - 0.00, P = .01, I2 = 0%; N = 3332) rates were also observed. Operative time and biliary, cardiac or pulmonary complication rates did not differ significantly between groups. CONCLUSION Current evidence supports the safety and feasibility of laparoscopic LLS. The laparoscopic approach is associated with reduced blood loss, lower transfusion rates and shorter length of in-hospital stay and should be considered the gold-standard for LLS.
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Affiliation(s)
- Rodrigo Luiz Macacari
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil.
| | - Fabricio Ferreira Coelho
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Wanderley Marques Bernardo
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Jaime Arthur Pirola Kruger
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil; Digestive Surgery Division, Department of Gastroenterology, Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Vagner Birk Jeismann
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil; Digestive Surgery Division, Department of Gastroenterology, Instituto do Câncer do Estado de Sao Paulo (ICESP), Sao Paulo, Brazil
| | - Gilton Marques Fonseca
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Danielle Menezes Cesconetto
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Ivan Cecconello
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
| | - Paulo Herman
- Digestive Surgery Division, Department of Gastroenterology, University of São Paulo Medical School, Sao Paulo, Brazil
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16
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A new technique for hepatic parenchymal transection using an articulating bipolar 5 cm radiofrequency device: results from the first 100 procedures. HPB (Oxford) 2018; 20:829-833. [PMID: 29661564 DOI: 10.1016/j.hpb.2018.03.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2017] [Revised: 02/18/2018] [Accepted: 03/18/2018] [Indexed: 02/06/2023]
Abstract
BACKGROUND Parenchymal transection(PT) still remains a challenge in liver resection. The outcomes of the first experience of a novel vessel-sealer for hepatic transection were assessed. METHODS A bipolar articulating vessel-sealer (Caiman®, Aesculap Inc., Center Valley, PA) was used in 100 liver resections through both open (OLR) and laparoscopic (LLR) approaches. All data were prospectively collected into an IRB-approved department database, and clinical, surgical and perioperative parameters were analyzed. RESULTS Fifty patients underwent OLR and 50 patients underwent LLR. Eighty hepatectomies were performed for malignancy. Median number of tumors was 1, with the largest focus measuring an average of 5.1 cm. Forty-nine of the procedures were major liver resections. Parenchymal transection time was 29.9 ± 3.1 min in OLR and 29.9 ± 3.6 min in LLR. Median estimated blood loss was 300 cc (Inter-quartile range (IQR) 100-575 cc). Median hospital stay was 6 days for open and 3 days for laparoscopic procedures. Ninety-day complication rate was 8% without any mortality. Bile leak rate was 4%. Staplers were used for parenchymal transection in 16 cases. CONCLUSION This study introduces a new multifunctional device into the armamentarium of the liver surgeon. In our experience, this device facilitated the parenchymal transection by adding speed and consolidating the amount of instrumentation used in liver resection without increasing complications.
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17
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Enhanced recovery after surgery for laparoscopic hepatectomy: Consensus of Chinese experts (2017). LAPAROSCOPIC, ENDOSCOPIC AND ROBOTIC SURGERY 2018. [DOI: 10.1016/j.lers.2018.07.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/28/2022] Open
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18
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Jia C, Li H, Wen N, Chen J, Wei Y, Li B. Laparoscopic liver resection: a review of current indications and surgical techniques. Hepatobiliary Surg Nutr 2018; 7:277-288. [PMID: 30221155 DOI: 10.21037/hbsn.2018.03.01] [Citation(s) in RCA: 29] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
Laparoscopic liver resection (LLR) has been the most impressive development in the field of liver surgery in recent two decades. Technical innovations and experience accumulation have made LLR a safe and effective procedure with faster postoperative recovery. Despite the fast spreading of the procedure, details regarding the indications, oncological outcomes and technical essentials were still disputable. To address these issues, two international consensus conferences were hold to update the knowledge in this field. The statements of the both conferences were not conclusive and more high-quality researches are required. In this article, we reviewed the development and the current state of LLR. Indications, outcomes, surgical techniques and devices used in LLR were also discussed.
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Affiliation(s)
- Chenyang Jia
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Hongyu Li
- Department of Pancreatic Surgery, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Ningyuan Wen
- College of Clinical Medicine, Sichuan University, Chengdu 610065, China
| | - Junhua Chen
- Department of General surgery, Chengdu First People's Hospital, Chengdu 610200, China
| | - Yonggang Wei
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, China
| | - Bo Li
- Department of Liver Surgery, Center of Liver Transplantation, West China Hospital of Sichuan University, Chengdu 610041, China
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19
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[Technical aspects of laparoscopic liver surgery : Transfer from open to laparoscopic liver surgery]. Chirurg 2018; 89:984-992. [PMID: 29971460 DOI: 10.1007/s00104-018-0684-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
BACKGROUND Laparoscopic surgery has become the standard for most visceral surgery procedures in many hospitals. Now, liver resections are also being increasingly carried out laparoscopically. The advantages of the laparoscopic technique have been demonstrated in numerous case series and in a recent randomized controlled trial. AIMS The aim of this review article is to present the available techniques for laparoscopic liver surgery (LLS). METHODS The technical variations reported in the literature as well as the own experience with LLS are reported. RESULTS Optimal patient and trocar positions are crucial for successful LLS and they are chosen according to the planned type of liver surgery: the literature offers several options in particular for surgery of the cranial and dorsal liver segments. As for open liver surgery, a restrictive volume management and the application of the Pringle maneuver are helpful to reduce intraoperative blood loss in LLS. In addition, several dissection techniques have been adopted from open liver surgery. The Cavitron Ultrasound Surgical Aspirator (CUSA™) is particularly suitable for parenchymal dissection close to major vascular structures, since it guarantees a meticulous parenchymal dissection with minimal vascular injuries. CONCLUSION The developments of minimally invasive surgery nowadays allow complex liver resections, which can mostly be performed comparable to open liver surgery. Hopefully, minimally invasive liver surgery will further develop in Germany in the near future, since it offers several advantages over open liver surgery.
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20
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Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D'Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D. The Southampton Consensus Guidelines for Laparoscopic Liver Surgery: From Indication to Implementation. Ann Surg 2018; 268:11-18. [PMID: 29064908 DOI: 10.1097/sla.0000000000002524] [Citation(s) in RCA: 437] [Impact Index Per Article: 72.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
OBJECTIVE The European Guidelines Meeting on Laparoscopic Liver Surgery was held in Southampton on February 10 and 11, 2017 with the aim of presenting and validating clinical practice guidelines for laparoscopic liver surgery. BACKGROUND The exponential growth of laparoscopic liver surgery in recent years mandates the development of clinical practice guidelines to direct the speciality's continued safe progression and dissemination. METHODS A unique approach to the development of clinical guidelines was adopted. Three well-validated methods were integrated: the Scottish Intercollegiate Guidelines Network methodology for the assessment of evidence and development of guideline statements; the Delphi method of establishing expert consensus, and the AGREE II-GRS Instrument for the assessment of the methodological quality and external validation of the final statements. RESULTS Along with the committee chairman, 22 European experts; 7 junior experts and an independent validation committee of 11 international surgeons produced 67 guideline statements for the safe progression and dissemination of laparoscopic liver surgery. Each of the statements reached at least a 95% consensus among the experts and were endorsed by the independent validation committee. CONCLUSION The European Guidelines Meeting for Laparoscopic Liver Surgery has produced a set of clinical practice guidelines that have been independently validated for the safe development and progression of laparoscopic liver surgery. The Southampton Guidelines have amalgamated the available evidence and a wealth of experts' knowledge taking in consideration the relevant stakeholders' opinions and complying with the international methodology standards.
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Affiliation(s)
| | | | | | - Bjorn Edwin
- The Intervention Centre, Department of HBP surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | | | | | | | | | | | - Brice Gayet
- Institut Mutualiste Montsouris, Paris, France
| | | | | | | | - Peter Lodge
- Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | | | | | | | | | | | - Ronald Van Dam
- Maastricht University Medical Centre, Maastricht, Nehterlands
| | - Steve White
- Newcastle upon Tyne NHS Foundation Trust, Newcastle, UK
| | | | | | | | - Ruben Ciria
- University Hospital Reina, Sofia Cordoba, Spain
| | - Leonid Barkhatov
- The Intervention Centre, Department of HBP surgery, Oslo University Hospital and Institute of Clinical Medicine, Oslo University, Oslo, Norway
| | | | | | - Andrew Cook
- Southampton Clinical Trials Unit, University Hospital Southampton, Southampton, UK
| | - Joseph Buell
- Louisiana State University and Medical Center, New Orleans, LA
| | | | | | | | | | - Hauke Lang
- Mainz University Hospital, Mainz, Germany
| | | | | | | | | | | | - Daniel Cherqui
- Hepatobiliary Centre-Paul Brousse Hospital, Villejuif-Paris, France
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21
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Chen XP, Cheng B. Key techniques and procedure optimization of laparoscopic hepatectomy for hepatolithiasis. Shijie Huaren Xiaohua Zazhi 2018; 26:892-897. [DOI: 10.11569/wcjd.v26.i15.892] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/06/2023] Open
Abstract
Hepatolithiasis is a common and refractory benign biliary tract disease in China. Meta-analyses show that laparoscopic hepatectomy (LH) is safe and effective for this disease. LH for hepatolithiasis has its distinctive techniques and procedures due to its unique clinicopathological characteristic in the era of precise hepatecomy and enhanced recovery after surgery. The key techniques include individualized selection of operating hole, hepatic inflow occlusion, anatomical hepatectomy, fine dissection, and other combined techniques. As for procedures, hepatecomy should be completed before extrahepatic bile duct choledocholithotomy is performed, and the portal hepatis should be preferentially dissected before the perihepatic ligaments are separated.
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Affiliation(s)
- Xiao-Peng Chen
- Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China
| | - Bin Cheng
- Department of Hepatobiliary Surgery, Affiliated Yijishan Hospital of Wannan Medical College, Wuhu 241001, Anhui Province, China
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22
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Badawy A, Seo S, Toda R, Fuji H, Ishii T, Taura K, Yasuchika K, Kaido T, Uemoto S. Evaluation of a new energy device for parenchymal transection in laparoscopic liver resection. Asian J Endosc Surg 2018; 11:123-128. [PMID: 29027381 DOI: 10.1111/ases.12432] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2017] [Revised: 08/08/2017] [Accepted: 08/20/2017] [Indexed: 11/29/2022]
Abstract
INTRODUCTION THUNDERBEAT (TB) is a novel device that uses both ultrasonic and advanced bipolar energies for hemostasis. Several recent human studies have proved the safety and efficacy of TB in different surgical procedures, but there have been no similar studies about its efficacy in hepatic parenchymal transection. Therefore, the aim of the study was to assess the safety and efficacy of the TB device in laparoscopic liver resection. METHODS This retrospective study compared TB and ultrasonic Harmonic devices in 80 patients who underwent laparoscopic liver resection from 2010 to 2016 in our institution. To reduce the selection bias, the two groups were matched in a 1-to-2 ratio on the basis of propensity scores. RESULTS There were no differences in the preoperative patient characteristics between the two groups. The extent of liver resection was comparable between the groups. Although the Harmonic group's intraoperative blood loss and operative time were less than that of the TB group, the differences were not statistically significant (P = 0.08, P = 0.32, respectively). Postoperative complications, mortality within 90 days, and hospital stay were comparable between the two groups. CONCLUSION TB is as safe and effective for parenchymal transection in laparoscopic hepatectomy as ultrasonic devices, but it is not a superior alternative.
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Affiliation(s)
- Amr Badawy
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan.,General Surgery Department, Alexandria University, Alexandria, Egypt
| | - Satoru Seo
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Rei Toda
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Hiroaki Fuji
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Takamichi Ishii
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kojiro Taura
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Kentaro Yasuchika
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Toshimi Kaido
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
| | - Shinji Uemoto
- Department of Surgery, Graduate School of Medicine, Kyoto University, Kyoto, Japan
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23
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McCluney SJ, Giakoustidis A, Segler A, Bissel J, Valente R, Hutchins RR, Abraham AT, Bhattacharya S, Kocher HM. Neutrophil: Lymphocyte ratio as a method of predicting complications following hepatic resection for colorectal liver metastasis. J Surg Oncol 2018; 117:1058-1065. [DOI: 10.1002/jso.24996] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/30/2023]
Affiliation(s)
- Simon J. McCluney
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
- Barts Cancer Institute-Cancer Research UK Centre of Excellence; Queen Mary UK
| | - Alexandros Giakoustidis
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Angela Segler
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Juliane Bissel
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Roberto Valente
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Robert R. Hutchins
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Ajit T. Abraham
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Satyajit Bhattacharya
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
| | - Hemant M. Kocher
- Barts and The London HPB Centre, Department of Surgery, The Royal London Hospital; Barts Health NHS Trust; Whitechapel London UK
- Barts Cancer Institute-Cancer Research UK Centre of Excellence; Queen Mary UK
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24
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Tian ZQ, Su XF, Lin ZY, Wu MC, Wei LX, He J. Meta-analysis of laparoscopic versus open liver resection for colorectal liver metastases. Oncotarget 2018; 7:84544-84555. [PMID: 27811369 PMCID: PMC5356680 DOI: 10.18632/oncotarget.13026] [Citation(s) in RCA: 25] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/08/2016] [Accepted: 10/24/2016] [Indexed: 12/11/2022] Open
Abstract
Background To compare surgical and oncological outcomes of laparoscopic versus open liver resection for colorectal liver metastases. Results A total of 14 retrospective studies with 1679 colorectal liver metastases patients were analyzed: 683 patients treated with laparoscopic liver resection and 996 patients with open liver resection. With respect to surgical outcomes, laparoscopic compared with open liver resection was associated with lower blood loss (MD, -216.7, 95% CI, -309.4 to -124.1; P < 0.00001), less requiring blood transfusion (OR, 0.36; 95% CI, 0.23 to 0.55; P < 0.00001), lower postoperative complication morbidity (OR, 0.61; 95% CI, 0.47 to 0.80; P = 0.003), and shorter hospitalization time (MD, -3.85, 95% CI, -5.00 to -2.71; P < 0.00001). However, operation time and postoperative mortality were no significant difference between the two approaches. With respect to oncological outcomes, laparoscopic liver resection group was prone to lower recurrence rate (OR, 0.78; 95% CI, 0.61−0.99; P = 0.04), but surgical margins R0, overall survival and disease-free survival were no significant difference. Materials and Methods We performed a systematic search in MEDLINE, EMBASE, and CENTRAL for all relevant studies. All statistical analysis was performed using Review Manager version 5.3. Dichotomous data were calculated by odds ratio (OR) and continuous data were calculated by mean difference (MD) with 95% confidence intervals (CI). Conclusions Laparoscopic and open liver resection for colorectal liver metastases have the same effect on oncological outcomes, but laparoscopic liver resection achieves better surgical outcomes.
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Affiliation(s)
- Zhi-Qiang Tian
- Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China.,Department of General Surgery, Wuxi People's Hospital Affiliated Nanjing Medical University, Wuxi, Jiangsu 214023, China
| | - Xiao-Fang Su
- Department of Rehabilitation and Physiotherapy Medicine, Wuxi Taihu Hospital (101 Hospital of Chinese People's Liberation Army), Wuxi, Jiangsu 214044, China
| | - Zhi-Yong Lin
- Department of Health Statistics, The Second Military Medical University, Shanghai 200433, China
| | - Meng-Chao Wu
- Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China
| | - Li-Xin Wei
- Tumor Immunology and Gene Therapy Center, Eastern Hepatobiliary Surgery Hospital, The Second Military Medical University, Shanghai 200438, China
| | - Jia He
- Department of Health Statistics, The Second Military Medical University, Shanghai 200433, China
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25
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Vecchio R, Catalano R, Basile F, Spataro C, Caputo M, Intagliata E. Topical hemostasis in laparoscopic surgery. G Chir 2017; 37:266-270. [PMID: 28350974 DOI: 10.11138/gchir/2016.37.6.266] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
A major goal during any surgical intervention is minimization of blood loss, which reduces the need for blood transfusion. In open surgery, the possibility for the surgeon to use the hands directly in contact with the bleeding tissues for hemostasis, makes mechanical methods, such as compression, ligatures or sutures, important to achieve proper hemostasis. In laparoscopic surgery, where the intervention is performed by means of small incisions through which the surgeon's hand cannot directly achieve the tissues, the problem of hemostasis is critical and needs more attention. Either in open or in laparoscopic surgery, significant bleeding during surgery is controlled through vessel ligation, suturing, and electrocautery. Topical hemostatic agents are useful adjuncts to surgical hemostasis for controlling non-specific bleeding. The introduction of different devices and topical agents has made possible to perform more complex interventions also in laparoscopy. The Authors discuss about the type, the field of application, the side effects of the hemostatic devices and of the topical hemostatic agents.
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26
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Li M, Zhang T, Wang L, Li B, Ding Y, Zhang C, He S, Yang Z. Selective Hemihepatic Vascular Occlusion Versus Pringle Maneuver in Hepatectomy for Primary Liver Cancer. Med Sci Monit 2017; 23:2203-2210. [PMID: 28486436 PMCID: PMC5436411 DOI: 10.12659/msm.900859] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
Background This study was conducted to compare the clinical effects of two techniques used for inflow occlusion during hepatectomy (selective hemihepatic vascular occlusion vs. Pringle maneuver) for the treatment of primary liver cancer. Material/Methods A total of 63 patients with primary hepatocellular carcinoma who underwent hepatectomy during June 2006 and June 2011 were included in this retrospective study. A total of 26 patients in group A accepted selective hemihepatic vascular occlusion, and 37 patients in group B underwent the Pringle maneuver during hepatectomy. The intraoperative conditions, postoperative liver function recovery, and complication rates were compared between these two groups. Results There were no significant differences in intraoperative blood loss, blood transfusion, occlusion time, and postoperative complication rates between group A and group B (P>0.05). However, postoperative serum levels of alanine transaminase (ALT), aspartate transaminase (AST), total bilirubin (TBIL), and albumin (ALB) in group A were significantly lower than those in group B (P<0.05). Moreover, there were noteworthy differences in peripheral artery pressure and sphygmus (P<0.05). Conclusions During hepatectomy, selective hemihepatic vascular occlusion benefits the patients with primary hepatocellular carcinoma by reducing the hepatic damage and improving postoperative hepatic function recovery, compared with the Pringle maneuver.
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Affiliation(s)
- Minghao Li
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
| | - Tao Zhang
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
| | - Liyun Wang
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
| | - Baoding Li
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
| | - Yang Ding
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
| | - Chunyan Zhang
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
| | - Saiwu He
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
| | - Zhiqi Yang
- Department of Hepatobiliary Surgery, Ningxia People's Hospital, Yinchuan, Ningxia, China (mainland)
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Evolution of a laparoscopic liver resection program: an analysis of 203 cases. Surg Endosc 2017; 31:4150-4155. [PMID: 28364151 DOI: 10.1007/s00464-017-5468-2] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/03/2016] [Accepted: 02/15/2017] [Indexed: 02/06/2023]
Abstract
BACKGROUND Techniques for laparoscopic liver resection (LLR) have been developed over the past two decades. The aim of this study is to analyze the outcomes and trends of LLR. METHODS 203 patients underwent LLR between 2006 and 2015. Trends in techniques and outcomes were assessed dividing the experience into 2 periods (before and after 2011). RESULTS Tumor type was malignant in 62%, and R0 resection was achieved in 87.7%. Procedures included segmentectomy/wedge resection in 64.5%. Techniques included a purely laparoscopic approach in 59.1% and robotic 12.3%. Conversion to open surgery was necessary in 6.4% cases. Mean hospital stay was 3.7 ± 0.2 days. 90-day mortality was 0% and morbidity 20.2%. Pre-coagulation and the robot were used less often, while the performance of resections for posteriorly located tumors increased in the second versus the first period. CONCLUSION This study confirms the safety and efficacy of LLR, while describing the evolution of a program regarding patient and technical selection. With building experience, the number of resections performed for posteriorly located tumors have increased, with less reliance on pre-coagulation and the robot.
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Yao DB, Wu SD. Application of stapling devices in liver surgery: Current status and future prospects. World J Gastroenterol 2016; 22:7091-7098. [PMID: 27610019 PMCID: PMC4988303 DOI: 10.3748/wjg.v22.i31.7091] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/21/2016] [Revised: 06/07/2016] [Accepted: 06/15/2016] [Indexed: 02/06/2023] Open
Abstract
The liver is a vascular-rich solid organ. Safe and effective dissection of the vessels and liver parenchyma, and control of intraoperative bleeding are the main concerns when performing liver resection. Several studies have confirmed that intraoperative blood loss and postoperative transfusion are predictors of postoperative morbidity and mortality in liver surgery. Various methods and instruments have been developed during hepatectomy. Stapling devices are crucial for safe and rapid anastomosis. They are used to divide hepatic veins and portal branches, and to transect liver parenchyma in open liver resection. In recent years, laparoscopic liver surgery has developed rapidly, and is now preferred by many surgeons. Stapling devices have also been gradually introduced in laparoscopic liver surgery, from dividing vascular and biliary structures to parenchymal transection. This may be because staplers make manipulation more simple, rapid and safe. Even in single incision laparoscopic surgery, which is recognized as a new minimally invasive technique, staplers are also utilized, especially in left lateral hepatectomy. For safe application of stapling devices in liver surgery, more related designs and modifications, such as application of a suitable laparoscopic articulating liver tissue crushing device, a staple line reinforcement technique with the absorbable polymer membrane or radiofrequency ablation assistance, are still needed. More randomized studies are needed to demonstrate the benefits and find broader indications for the use of stapling devices, to help expand their application in liver surgery.
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Egger ME, Gottumukkala V, Wilks JA, Soliz J, Ilmer M, Vauthey JN, Conrad C. Anesthetic and operative considerations for laparoscopic liver resection. Surgery 2016; 161:1191-1202. [PMID: 27545995 DOI: 10.1016/j.surg.2016.07.011] [Citation(s) in RCA: 23] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2016] [Revised: 07/06/2016] [Accepted: 07/09/2016] [Indexed: 02/06/2023]
Abstract
We enumerate the broad range of anesthetic considerations that affect the outcome of patients undergoing laparoscopic liver resection. Key elements for excellent outcomes after laparoscopic liver resection are careful patient selection and risk stratification, appropriate monitoring, techniques to reduce blood loss and transfusion, and active recovery management. Although some of these key elements are the same for open liver operation, there are specific anesthetic considerations of which both the surgical and anesthesia teams must be aware to achieve optimal patient outcomes after laparoscopic liver resection. While unique advantages of laparoscopic liver resection typically include decreased intraoperative bleeding, transfusion requirements, and a lower incidence of postoperative ascites, specific challenges include management of the complicated interplay between low-volume anesthesia and increased intraabdominal pressure due to pneumoperitoneum, with additional considerations regarding circulatory support to treat acute blood loss with need for emergent conversion in some cases. This article will address in detail the preoperative, intraoperative, and postoperative anesthetic considerations for patients undergoing laparoscopic liver resection that both the surgical and anesthesia team should be aware of to optimize outcomes.
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Affiliation(s)
- Michael E Egger
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Vijaya Gottumukkala
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jonathan A Wilks
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jose Soliz
- Department of Anesthesiology and Perioperative Medicine, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Matthias Ilmer
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Jean Nicolas Vauthey
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX
| | - Claudius Conrad
- Department of Surgical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
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Hackl C, Schlitt HJ, Renner P, Lang SA. Liver surgery in cirrhosis and portal hypertension. World J Gastroenterol 2016; 22:2725-2735. [PMID: 26973411 PMCID: PMC4777995 DOI: 10.3748/wjg.v22.i9.2725] [Citation(s) in RCA: 60] [Impact Index Per Article: 7.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/22/2015] [Revised: 11/01/2015] [Accepted: 12/30/2015] [Indexed: 02/06/2023] Open
Abstract
The prevalence of hepatic cirrhosis in Europe and the United States, currently 250 patients per 100000 inhabitants, is steadily increasing. Thus, we observe a significant increase in patients with cirrhosis and portal hypertension needing liver resections for primary or metastatic lesions. However, extended liver resections in patients with underlying hepatic cirrhosis and portal hypertension still represent a medical challenge in regard to perioperative morbidity, surgical management and postoperative outcome. The Barcelona Clinic Liver Cancer classification recommends to restrict curative liver resections for hepatocellular carcinoma in cirrhotic patients to early tumor stages in patients with Child A cirrhosis not showing portal hypertension. However, during the last two decades, relevant improvements in preoperative diagnostic, perioperative hepatologic and intensive care management as well as in surgical techniques during hepatic resections have rendered even extended liver resections in higher-degree cirrhotic patients with portal hypertension possible. However, there are few standard indications for hepatic resections in cirrhotic patients and risk stratifications have to be performed in an interdisciplinary setting for each individual patient. We here review the indications, the preoperative risk-stratifications, the morbidity and the mortality of extended resections for primary and metastatic lesions in cirrhotic livers. Furthermore, we provide a review of literature on perioperative management in cirrhotic patients needing extrahepatic abdominal surgery and an overview of surgical options in the treatment of hepatic cirrhosis.
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Safety and Efficacy of a New Bipolar Energy Device for Parenchymal Dissection in Laparoscopic Liver Resection. Surg Laparosc Endosc Percutan Tech 2016; 26:21-4. [DOI: 10.1097/sle.0000000000000223] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/19/2023]
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Hazrah P, Sharma D, Borgharia S, Kumar P, Lal R. Appraisal of Laparoscopic Liver Resection in the Treatment of Liver Metastasis with Special Reference to Outcome in Colorectal Malignancies. Indian J Surg 2015; 76:392-401. [PMID: 26396473 DOI: 10.1007/s12262-013-0944-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/02/2013] [Accepted: 06/26/2013] [Indexed: 11/30/2022] Open
Abstract
Treatment of metastatic liver disease is at the crossroads of an evolutionary transformation with more and more reports reiterating the benefits of resectional therapy in various cancers. A quest for application of laparoscopic approaches to the management of liver metastasis has arisen due to the projected benefits of less morbidity, early recovery, and equivalent oncological outcome in selected malignancies. However, the diverse and heterogenous data on indications, operative technique, and outcome evaluation make a comparative analysis of these studies difficult. This review is an appraisal of technique and outcome of minimally invasive liver resection as reported in the current literature with special reference to treatment of metastatic colorectal cancers.
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Affiliation(s)
- Priya Hazrah
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Deborshi Sharma
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India ; Type V/17, Block III, Lodhi Road Complex, New Delhi, 110003 India
| | - Saurabh Borgharia
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Pawan Kumar
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
| | - Romesh Lal
- Department of Surgery, Lady Hardinge Medical College & associated Dr Ram Manohar Lohia Hospital, New Delhi, 110001 India
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Total abdominal approach for postero-superior segments (7, 8) in laparoscopic liver surgery: a multicentric experience. Updates Surg 2015; 67:169-75. [PMID: 26076916 DOI: 10.1007/s13304-015-0305-4] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/20/2015] [Accepted: 05/26/2015] [Indexed: 12/23/2022]
Abstract
Laparoscopic liver resections are frequently performed for peripheral lesions located in the antero-inferior segments. Resection of postero-superior segments is more demanding and dangerous than other segmentectomies, resulting in a longer operation time and increased blood loss. To reduce technical challenges, some authors advocated a modified surgical approach for these segments with the patient placed in the left lateral decubitus with the right arm suspended and suggested technical variations like the use of an additional intercostal trocar, the placement of one or two additional trans-thoracic trocars, a hand-assisted approach or a hybrid method with a median laparotomy. In the present series of 88 patients from four hepatobiliary centers with high volume of activity in Italy, a standard lithotomic position has been routinely used without the need for left lateral decubitus or semi-prone position and through abdominal wall without use of trans-thoracic trocars. This approach allows a more comfortable use of the Pringle maneuver that we used routinely in hepatic resection for PS segments; and, a very short time is needed for conversion, whenever it is required. In our series, laparoscopic resection of liver tumors located in the postero-superior segments of the liver with a total abdominal approach is technically feasible and safe with short-term results similar to other laparoscopic liver resections.
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Lacerda CF, Bertulucci PA, Oliveira ATTD. Totally laparoscopic liver resection: new Brazilian experience. ABCD-ARQUIVOS BRASILEIROS DE CIRURGIA DIGESTIVA 2015; 27:191-5. [PMID: 25184770 PMCID: PMC4676382 DOI: 10.1590/s0102-67202014000300008] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 01/09/2014] [Accepted: 03/25/2014] [Indexed: 12/30/2022]
Abstract
Background Despite the increasing number of laparoscopic hepatectomy, there is little
published experience. Aim To evaluate the results of a series of hepatectomy completely done with
laparoscopic approach. Methods This is a retrospective study of 61 laparoscopic liver resections. Were studied
conversion to open technique; mean age; gender, mortality; complications; type of
hepatectomy; surgical techniques applied; and simultaneous operations. Results The conversion to open technique was necessary in one case (1.6%). The mean age
was 54.7 years (17-84), 34 were men. Three patients (4.9%) had complications. One
died postoperatively (mortality 1.6%) and no deaths occurred intraoperatively. The
most frequent type was right hepatectomy (37.7%), followed by bisegmentectomy
(segments II-III and VI-VII). Were not used hemi-Pringle maneuvers or assisted
technic. Six patients (8.1%) underwent simultaneous procedures (hepatectomy and
colectomy). Conclusion Laparoscopic hepatectomy is feasible procedure and can be considered the gold
standard for various conditions requiring liver resections for both benign to
malignant diseases.
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Fretland ÅA, Kazaryan AM, Bjørnbeth BA, Flatmark K, Andersen MH, Tønnessen TI, Bjørnelv GMW, Fagerland MW, Kristiansen R, Øyri K, Edwin B. Open versus laparoscopic liver resection for colorectal liver metastases (the Oslo-CoMet Study): study protocol for a randomized controlled trial. Trials 2015; 16:73. [PMID: 25872027 PMCID: PMC4358911 DOI: 10.1186/s13063-015-0577-5] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/31/2014] [Accepted: 01/22/2015] [Indexed: 12/11/2022] Open
Abstract
BACKGROUND Laparoscopic liver resection is used in specialized centers all over the world. However, laparoscopic liver resection has never been compared with open liver resection in a prospective, randomized trial. METHODS/DESIGN The Oslo-CoMet Study is a randomized trial into laparoscopic versus open liver resection for the surgical management of hepatic colorectal metastases. The primary outcome is 30-day perioperative morbidity. Secondary outcomes include 5-year survival (overall, disease-free and recurrence-free), resection margins, recurrence pattern, postoperative pain, health-related quality of life, and evaluation of the inflammatory response. A cost-utility analysis of replacing open surgery with laparoscopic surgery will also be performed. The study includes all resections for colorectal liver metastases, except formal hemihepatectomies, resections where reconstruction of vessels/bile ducts is necessary and resections that need to be combined with ablation. All patients will participate in an enhanced recovery after surgery program. A biobank of liver and tumor tissue will be established and molecular analysis will be performed. DISCUSSION After 35 months of recruitment, 200 patients have been included in the trial. Molecular and immunology data are being analyzed. Results for primary and secondary outcome measures will be presented following the conclusion of the study (late 2015). The Oslo-CoMet Study will provide the first level 1 evidence on the benefits of laparoscopic liver resection for colorectal liver metastases. TRIAL REGISTRATION The trial was registered in ClinicalTrals.gov (NCT01516710) on 19 January 2012.
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Otsuka Y, Kaneko H, Cleary SP, Buell JF, Cai X, Wakabayashi G. What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd International Consensus Conference on Laparoscopic Liver Resection. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:363-70. [PMID: 25631462 DOI: 10.1002/jhbp.216] [Citation(s) in RCA: 44] [Impact Index Per Article: 4.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/14/2014] [Accepted: 12/18/2014] [Indexed: 12/25/2022]
Abstract
The continuing evolution of technique and devices used in laparoscopic liver resection (LLR) has allowed successful application of this minimally invasive surgery for the treatment of liver disease. However, the type of instruments by energy sources and technique used vary among each institution. We reviewed the literature to seek the best technique for parenchymal transection, which was proposed as one of the important clinical question in the 2nd International Consensus Conference on LLR held on October 2014. While publications have described transection techniques used in LLR from 1991 to June 2014, it is difficult to specify the best technique and device for laparoscopic hepatic parenchymal transection, owing to a lack of randomized trials with only a small number of comparative studies. However, it is clear that instruments should be used in combination with others based on their functions and the depth of liver resection. Most authors have reported using staplers to secure and divide major vessels. Preparation for prevention of unexpected hemorrhaging particularly in liver cirrhosis, the Pringle's maneuver and prompt technique for hemostasis should be performed. We conclude that hepatobiliary surgeons should select techniques based on their familiarity with a concrete understanding of instruments and individualize to the procedure of LLR.
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Affiliation(s)
- Yuichiro Otsuka
- Department of Surgery, Toho University Faculty of Medicine, 6-11-1 Omorinishi, Ota-ku, Tokyo, 143-8541, Japan
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Scatton O, Brustia R, Belli G, Pekolj J, Wakabayashi G, Gayet B. What kind of energy devices should be used for laparoscopic liver resection? Recommendations from a systematic review. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2015; 22:327-34. [PMID: 25624116 DOI: 10.1002/jhbp.213] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 12/18/2014] [Indexed: 12/23/2022]
Abstract
Transection methods and hemostasis achievement have an impact on blood loss, and consequently on outcome and survival. However, no consensus exists on parenchymal transection or hemostasis techniques in laparoscopic liver resection (LLR). The aim of this review is to clarify the role of energy devices (ED) in LLR. ED is a generator of mechanic or electric energy transfer to an operating tool, used for transection, sealing or both. Searches were performed in PubMed, PubMed Central, Cochrane, Embase, Google Scholar in human or animal experimental models. Each study quality was graded following the GRADE system. From 1996 to 2014, 30 studies were found: five comparative, one prospective, two case-control, and 16 case series and some case reports, with level of evidence ranging from Moderate to Very Low. Since 2012, the Research and Development of new tools raised quicker than clinical studies could follow. The two main techniques emerged are blind transection versus sharp dissection: due to the low quality and heterogeneity of the studies, no firm conclusion can be drawn, but meticulous dissection of vessels usually never leads to vascular damage. As a matter of fact, ED, though efficient and reliable, cannot replace the basic skills of hepatic surgery: sharp dissection, vascular control and elective sealing.
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Affiliation(s)
- Olivier Scatton
- Department of Hepatobiliary and Liver Transplantation Surgery, Hôpital Pitié-Salpêtrière, 47-83 Boulevard de l'Hôpital, Paris 75013, France; Université Pierre et Marie Curie, Paris, France
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Laparoscopic versus Open Liver Resection: Differences in Intraoperative and Early Postoperative Outcome among Cirrhotic Patients with Hepatocellular Carcinoma-A Retrospective Observational Study. HPB SURGERY : A WORLD JOURNAL OF HEPATIC, PANCREATIC AND BILIARY SURGERY 2014; 2014:871251. [PMID: 25548432 PMCID: PMC4274825 DOI: 10.1155/2014/871251] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/07/2014] [Accepted: 11/17/2014] [Indexed: 02/06/2023]
Abstract
Introduction. Laparoscopic liver resection is considered risky in cirrhotic patients, even if minor surgical trauma of laparoscopy could be useful to prevent deterioration of a compromised liver function. This study aimed to identify the differences in terms of perioperative complications and early outcome in cirrhotic patients undergoing minor hepatic resection for hepatocellular carcinoma with open or laparoscopic technique. Methods. In this retrospective study, 156 cirrhotic patients undergoing liver resection for hepatocellular carcinoma were divided into two groups according to type of surgical approach: laparoscopy (LS group: 23 patients) or laparotomy (LT group: 133 patients). Perioperative data, mortality, and length of hospital stay were recorded. Results. Groups were matched for type of resection, median number of nodules, and median diameter of largest lesions. Groups were also homogeneous for preoperative liver and renal function tests. Intraoperative haemoglobin decrease and transfusions of red blood cells and fresh frozen plasma were significantly lower in LS group. MELD score lasted stable after laparoscopic resection, while it increased in laparotomic group. Postoperative liver and renal failure and mortality were all lower in LS group. Conclusions. Lower morbidity and mortality, maintenance of liver function, and shorter hospital stay suggest the safety and benefit of laparoscopic approach.
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Postriganova N, Kazaryan AM, Røsok BI, Fretland ÅA, Barkhatov L, Edwin B. Margin status after laparoscopic resection of colorectal liver metastases: does a narrow resection margin have an influence on survival and local recurrence? HPB (Oxford) 2014; 16:822-9. [PMID: 24308605 PMCID: PMC4159455 DOI: 10.1111/hpb.12204] [Citation(s) in RCA: 35] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/22/2013] [Accepted: 10/30/2013] [Indexed: 12/12/2022]
Abstract
OBJECTIVES Recent studies of margin-related recurrence have raised questions on the necessity of ensuring wide resection margins in the resection of colorectal liver metastases. The aim of the current study was to determine whether resection margins of 10 mm provide a survival benefit over narrower resection margins. METHODS A total of 425 laparoscopic liver resections were carried out in 351 procedures performed in 317 patients between August 1998 and April 2012. Primary laparoscopic liver resections for colorectal metastases were included in the study. Two-stage resections, procedures accompanied by concomitant liver ablations and one case of perioperative mortality were excluded. A total of 155 eligible patients were classified into four groups according to resection margin width: Group 1, margins of < 1 mm [n = 33, including 17 patients with positive margins (Group 1a)]; Group 2, margins of 1 mm to < 3 mm (n = 31); Group 3, margins of ≥ 3 mm to <10 mm (n = 55), and Group 4, margins of ≥ 10 mm (n = 36). Perioperative and survival data were compared across the groups. Median follow-up was 31 months (range: 2-136 months). RESULTS Perioperative outcomes were similar in all groups. Unfavourable intraoperative incidents occurred in 9.7% of procedures (including 3.2% of conversions). Postoperative complications developed in 11.0% of patients. Recurrence in the resection bed developed in three (1.9%) patients, including two (6.1%) patients in Group 1. Rates of actuarial 5-year overall, disease-free and recurrence-free survival were 49%, 41% and 33%, respectively. Median survival was 65 months. Margin status had no significant impact on patient survival. The Basingstoke Predictive Index (BPI) generally underestimated survival. This underestimation was especially marked in Group 1 when postoperative BPI was applied. CONCLUSIONS Patients with margins of <1 mm achieved survival comparable with that in patients with margins of ≥ 10 mm. When modern surgical equipment that generates an additional coagulation zone is applied, the association between resection margin and survival may not be apparent. Further studies in this field are required. Postoperative BPI, which includes margin status among the core factors predicting postoperative survival, seems to be less precise than preoperative BPI.
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Affiliation(s)
- Nadya Postriganova
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Hospital Surgery, Moscow State University of Medicine and DentistryMoscow, Russia,Correspondence, Nadya Postriganova, Intervention Centre, Oslo University Hospital – Rikshospitalet, Oslo 0027, Norway. Tel: + 47 23070100. Fax: + 47 23070110. E-mail:
| | - Airazat M Kazaryan
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Surgery, Telemark HospitalSkien, Norway
| | - Bård I Røsok
- Department of Hepatopancreatobiliary Surgery, Oslo University Hospital – RikshospitaletOslo, Norway
| | - Åsmund A Fretland
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Hepatopancreatobiliary Surgery, Oslo University Hospital – RikshospitaletOslo, Norway
| | - Leonid Barkhatov
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway
| | - Bjørn Edwin
- Intervention Centre, Oslo University Hospital – RikshospitaletOslo, Norway,Department of Hepatopancreatobiliary Surgery, Oslo University Hospital – RikshospitaletOslo, Norway,Institute of Clinical Medicine, Medical Faculty, University of OsloOslo, Norway
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40
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Affiliation(s)
- John McCall
- Department of Surgical Science, Dunedin School of Medicine, University of Otago, Dunedin, New Zealand.
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41
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Gaillard M, Tranchart H, Dagher I. Laparoscopic liver resections for hepatocellular carcinoma: Current role and limitations. World J Gastroenterol 2014; 20:4892-4899. [PMID: 24803800 PMCID: PMC4009520 DOI: 10.3748/wjg.v20.i17.4892] [Citation(s) in RCA: 38] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/26/2013] [Accepted: 01/20/2014] [Indexed: 02/07/2023] Open
Abstract
Liver resection for hepatocellular carcinoma (HCC) is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis. The aim of this review is to assess current indications, advantages and limits of laparoscopic surgery for HCC resections. We also discussed the possible evolution of this surgical approach in parallel with new technologies.
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Montalti R, Berardi G, Laurent S, Sebastiani S, Ferdinande L, Libbrecht LJ, Smeets P, Brescia A, Rogiers X, de Hemptinne B, Geboes K, Troisi RI. Laparoscopic liver resection compared to open approach in patients with colorectal liver metastases improves further resectability: Oncological outcomes of a case-control matched-pairs analysis. Eur J Surg Oncol 2014; 40:536-544. [PMID: 24555996 DOI: 10.1016/j.ejso.2014.01.005] [Citation(s) in RCA: 78] [Impact Index Per Article: 7.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/01/2013] [Revised: 12/23/2013] [Accepted: 01/05/2014] [Indexed: 02/07/2023] Open
Abstract
AIMS Liver resection is considered the standard treatment of colorectal metastases (CRLM). However, to date, no long term oncological results and data regarding repeat hepatectomy after laparoscopic approach are known. The aim of this study is to analyze single center long-term surgical and oncological outcomes after liver resection for CRLM. METHODS A total of 57 open resections (OR) were matched with 57 laparoscopic resections (LR) for CRLM. Matching was based mainly on number of metastases, tumor size, segmental position of lesions, type of hepatectomy and type of resection. RESULTS Morbidity rate was significantly less in the LR group (p = 0.002); the length of hospital stay was 6.5 ± 5 days for the LR group and 9.2 ± 4 days for the OR group (p = 0.005). After a median follow up of 53.7 months for the OR group and 40.9 months for the LR group, the 5-y overall survival rate was 65% and 60% respectively (p = 0.36) and the 5-y disease free survival rate was 38% and 29% respectively (p = 0.24). More patients in the LR group received a third hepatectomy for CRLM relapse than in the OR group (80% vs. 14.3% respectively; p = 0.015). CONCLUSIONS Laparoscopic resection for CRLM offers advantages in terms of reduced blood loss, morbidity rate and hospital stay. It provides comparable long-term oncological outcomes but can improve further resectability in patients with recurrent disease.
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Affiliation(s)
- R Montalti
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - G Berardi
- Dept. of General Surgery, Sant'Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - S Laurent
- Dept. of Gastroenterology-Abdominal Oncology Unit, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - S Sebastiani
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - L Ferdinande
- Dept. of Pathology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - L J Libbrecht
- Dept. of Pathology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - P Smeets
- Dept. of Radiology, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - A Brescia
- Dept. of General Surgery, Sant'Andrea Hospital, "La Sapienza" University of Rome, Italy
| | - X Rogiers
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - B de Hemptinne
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium
| | - K Geboes
- Dept. of Gastroenterology-Abdominal Oncology Unit, Ghent University Hospital and Medical School, De Pintelaan 185, 9000 Ghent, Belgium
| | - R I Troisi
- Dept. of General & Hepato-Biliary Surgery, Liver Transplantation Service, Ghent University Hospital and Medical School, De Pintelaan 185, 2K12 IC, 9000 Ghent, Belgium.
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Kirchberg J, Reißfelder C, Weitz J, Koch M. Laparoscopic surgery of liver tumors. Langenbecks Arch Surg 2013; 398:931-8. [PMID: 24046095 DOI: 10.1007/s00423-013-1117-y] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/01/2013] [Accepted: 09/05/2013] [Indexed: 02/06/2023]
Abstract
INTRODUCTION Despite initial concerns regarding safety and oncological adequacy, the use of laparoscopic liver resections for benign and malignant diseases has spread worldwide. As in open liver surgery, anatomical orientation and the ability to control intraoperative challenges as bleeding have to be combined with expertise in advanced laparoscopic techniques. METHODS In this review, we provide an overview regarding the literature on laparoscopic liver resection for benign and malignant liver tumors with the aim to discuss the current standards and define remaining challenges. Although numerous case series and meta-analyses have addressed the evolving field of laparoscopic liver surgery recently, data from randomized controlled trials are still not available. RESULTS AND CONCLUSIONS Laparoscopic liver resection is feasible and safe in selected patients and experienced hands. Even major liver resections can be performed laparoscopically. The minimal invasive approach offers benefits in perioperative short-term outcome without compromising oncological outcomes compared to open liver resections. Further randomized trials are needed to formally prove these statements and to define the optimal indication and techniques for the individual patient.
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Affiliation(s)
- Johanna Kirchberg
- Department of General, Thoracic and Vascular Surgery, University Hospital Carl Gustav Carus, Technical University Dresden, Dresden, Germany,
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