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Yang Y, Yu CY, Lin F, Sun DL, Wu KJ, Cai HH, Shi LQ, Zhu Q. Application of Laennec extrathecal blockade combined with indocyanine green fluorescence imaging in laparoscopic anatomic hepatectomy. ANZ J Surg 2024; 94:655-659. [PMID: 38553889 DOI: 10.1111/ans.18907] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2023] [Revised: 01/31/2024] [Accepted: 02/01/2024] [Indexed: 04/17/2024]
Abstract
OBJECTIVE To investigate the safety and application value of combining Laennec extracapsular occlusion with ICG fluorescence imaging in laparoscopic anatomic hepatectomy. METHODS Complete laparoscopic dissection was performed outside the Laennec sheath, blocking Glisson's pedicle of the corresponding liver segment or lobe. An appropriate amount of indocyanine green (ICG) dye was intravenously injected, and the boundary line between the pre-cut liver segment and liver lobe was identified using fluorescence laparoscopy. Complete resection of the liver segment or lobe was performed based on anatomical markers. Clinical data, including operation time, intraoperative blood loss, postoperative hospital stay, and postoperative complications, were collected. RESULTS A total of 14 cases were included in the study, including seven cases of primary liver cancer, three cases of metastatic liver cancer, three cases of intrahepatic bile duct calculi, and one case of hepatic hemangioma. All 14 patients underwent anatomic hepatectomy under fluorescent laparoscopy, with four cases involving the right liver, seven cases involving the left liver, two cases involving the right anterior lobe, and one case involving the right posterior lobe. CONCLUSION Combining laparoscopic follow-up of the Laennec membrane with Glisson outer sheath block and intraoperative ICG fluorescence imaging provides real-time guidance for locating the resection boundaries during anatomic hepatectomy. This approach helps in controlling intraoperative bleeding, reducing operation time, and ensuring high safety. It holds significant value in clinical application.
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Affiliation(s)
- Yong Yang
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Chong-Yuan Yu
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Fang Lin
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
| | - Dong-Lin Sun
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Ke-Jia Wu
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Hui-Hua Cai
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Long-Qing Shi
- Department of Hepatobiliary and Pancreatic Surgery, The Third Affiliated Hospital of Soochow University, Changzhou, China
| | - Qiang Zhu
- Department of General Surgery, Children's Hospital of Nanjing Medical University, Nanjing, China
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Kajiwara M, Ishii F, Sasaki T, Nakashima R, Hasegawa S. Crucial Roles of the Assistant Surgeon During Laparoscopic Left Hemihepatectomy. Cureus 2022; 14:e24050. [PMID: 35573504 PMCID: PMC9095429 DOI: 10.7759/cureus.24050] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/08/2022] [Indexed: 11/05/2022] Open
Abstract
Background Although left hemihepatectomy has been widely performed via the laparoscopic approach, the roles of the assistant surgeon have not been well-documented so far. We herein present our standardized procedures of laparoscopic left hemihepatectomy without Spiegel’s lobe resection, focusing on the crucial roles of the assistant surgeon. Methods During laparoscopic left hemihepatectomy without Spiegel’s lobe resection, countertraction by the assistant surgeon is quite important especially during isolating the left Glissonean pedicle and transecting liver parenchyma. When securing the left hepatic pedicle using the Glissonean approach, the assistant surgeon pushes Segment 4 of the liver cranially and pulls the tape encircling the hepatoduodenal ligament caudally in the opposite way, orthogonal to the direction of the laparoscopic forceps toward the left portal triad. During liver parenchymal transection, the assistant surgeon pulls the hanging tape across the left lobe of the liver in order to provide a wide and stable liver transection plane. With this standardized technique, nine cases of laparoscopic left hemihepatectomy were performed over the last two years in our department, and the perioperative data were retrospectively analyzed. Results The median age of the nine patients was 70 years (range: 58 - 84 years). Most of the patients were males (77.8%). Five of nine patients were diagnosed with colorectal liver metastasis, two with hepatocellular carcinoma (HCC), one with inflammatory pseudotumor, and the other one with hepaticolithiasis. There were no conversions to open surgery. The median operative time and estimated blood loss were 337 minutes (range: 219 - 478 minutes) and 100 ml (range: 41 - 375 ml), respectively. The median length of postoperative hospital stay was nine days (range: 7 - 16 days). Major complications (Clavien-Dindo classification grade III or more) were not encountered in our cohort postoperatively. Conclusion We presented here our standardized assistant roles during laparoscopic left hemihepatectomy without Spiegel’s lobe resection, which was revealed to be safe and feasible in our cohort.
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Hu W, Zhang G, Chen M, Zhong C, Li M, Sun X, Li K, Wang Z. Laennec's approach for laparoscopic anatomical hemihepatectomy. World J Surg Oncol 2021; 19:295. [PMID: 34615531 PMCID: PMC8496013 DOI: 10.1186/s12957-021-02404-1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2021] [Accepted: 09/20/2021] [Indexed: 12/19/2022] Open
Abstract
Background Laennec’s capsule has been found for about 200 years. However, laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using Laennec’s approach are rarely reported. Methods We retrospectively analyzed the technical details and the surgical outcomes of 15 patients who underwent LAH via Laennec’s approach between May 2017 and July 2020. The operation time, intraoperative blood loss, postoperative complications, and hospital stay were recorded and analyzed. Results Four of 15 patients were diagnosed with hepatic hemangioma, 2 had hepatolithiasis, and 9 patients had primary liver cancer. During the surgery, Laennec’s approach was used for LAH without conversion to open surgery. Four patients were treated with LARH, and 11 patients were cured with LALH. The mean age of the patients was 62.1 ± 6.5 years, and four were male. The mean operative time, blood loss, and length of the postoperative hospital stay were 193 ± 49 min, 247 ± 120 mL, and 8.7 ± 2.0 days, respectively. There was no incidence of postoperative bile leakage and bleeding. No mortality occurred. We also demonstrated that Laennec’s capsule does exist around the peripheral hepatic veins with histological confirmation. Conclusions Laennec’s approach is safe and feasible for LAH. Precise isolation of Laennec’s approach based on Laennec’s capsule helps to standardize the surgical techniques for laparoscopic anatomical hepatectomy.
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Affiliation(s)
- Wei Hu
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, 222001, Jiangsu, China.,Department of Hepatobiliary Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222001, Jiangsu, China
| | - Gongming Zhang
- Department of Pathology, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, 222001, Jiangsu, China
| | - Meng Chen
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, 222001, Jiangsu, China.,Department of Hepatobiliary Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222001, Jiangsu, China
| | - Chengcheng Zhong
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, 222001, Jiangsu, China.,Department of Hepatobiliary Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222001, Jiangsu, China
| | - Mingxu Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, 222001, Jiangsu, China.,Department of Hepatobiliary Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222001, Jiangsu, China
| | - Xitai Sun
- Department of Hepatobiliary Surgery, Nanjing Drum Tower Hospital, The Affiliated Hospital of Nanjing University Medical School, Nanjing, 210093, Jiangsu, China
| | - Kai Li
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, 222001, Jiangsu, China. .,Department of Hepatobiliary Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222001, Jiangsu, China.
| | - Zhong Wang
- Department of Hepatobiliary Surgery, The First Affiliated Hospital of Kangda College of Nanjing Medical University, Nanjing, 222001, Jiangsu, China. .,Department of Hepatobiliary Surgery, Affiliated Lianyungang Hospital of Xuzhou Medical University, Lianyungang, 222001, Jiangsu, China.
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