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Rengers T, Warner S. Surgery for colorectal liver metastases: Anatomic and non-anatomic approach. Surgery 2023:S0039-6060(23)00121-6. [PMID: 37029016 DOI: 10.1016/j.surg.2023.02.032] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Revised: 02/22/2023] [Accepted: 02/24/2023] [Indexed: 04/09/2023]
Abstract
Liver resection is potentially curative for patients with colorectal liver metastasis, but an advanced understanding of tumor biology and improved adjuvant therapies have facilitated an ongoing evolution of metastatic resection, even in the setting of a significant metastatic disease burden. As indications for surgery have expanded, preferred techniques and timing have been debated. This commentary reviews the merits of anatomic versus non-anatomic approaches to colorectal liver metastasis resection, considering oncologic outcomes, overall survival, and conflicting theories in the pathophysiology of the metastatic liver spread.
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Affiliation(s)
- Timothy Rengers
- Mayo Clinic, Mayo Clinic Alix School of Medicine, Rochester, MN. https://twitter.com/timrengers
| | - Susanne Warner
- Department of Hepatobiliary and Pancreas Surgery, Mayo Clinic, Rochester.
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2
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Krass S, Lassen-Schmidt B, Schenk A. Computer-assisted image-based risk analysis and planning in lung surgery - a review. Front Surg 2022; 9:920457. [PMID: 36211288 PMCID: PMC9535081 DOI: 10.3389/fsurg.2022.920457] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2022] [Accepted: 09/08/2022] [Indexed: 11/16/2022] Open
Abstract
In this paper, we give an overview on current trends in computer-assisted image-based methods for risk analysis and planning in lung surgery and present our own developments with a focus on computed tomography (CT) based algorithms and applications. The methods combine heuristic, knowledge based image processing algorithms for segmentation, quantification and visualization based on CT images of the lung. Impact for lung surgery is discussed regarding risk assessment, quantitative assessment of resection strategies, and surgical guiding. In perspective, we discuss the role of deep-learning based AI methods for further improvements.
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Affiliation(s)
- Stefan Krass
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- Correspondence: Stefan Krass
| | | | - Andrea Schenk
- Fraunhofer Institute for Digital Medicine MEVIS, Bremen, Germany
- Department of Diagnostic and Interventional Radiology, Hannover Medical School, Hannover, Germany
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3
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Rela M, Rajalingam R, Shetty G, Cherukuru R, Rammohan A. Robotic monosegment donor hepatectomy for pediatric liver transplantation: First report. Pediatr Transplant 2022; 26:e14110. [PMID: 34383361 DOI: 10.1111/petr.14110] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/06/2021] [Revised: 07/19/2021] [Accepted: 07/27/2021] [Indexed: 12/11/2022]
Abstract
BACKGROUND LT for infants less than 5 kg remains a challenge with high technical complication rates, which is further compounded by large-for-size grafts requiring hyper-reduction. The benefits of MIDH especially for standard left lateral segment (LLS) resection have been unequivocally demonstrated. However, given the fine margins of error, the highly challenging technical aspects of anatomical graft reduction test the limits of safety and may not be routinely feasible with the conventional laparoscopic approach. CASE REPORT A 14-month-old girl weighing 4.4 kg with extrahepatic biliary atresia was referred to our unit for an LT. Her mother volunteered to donate and the calculated volume of the LLS was 342 ml, with an estimated GRWR of 7.6. Given the extremely high GRWR, a segment II monosegment graft was planned. A RMDH was performed, with a final GRWR of 4. The donor and recipient were discharged on the 5th and 12th post-operative days, respectively. CONCLUSION We present the first-ever report of an RMDH. Our report highlights the fact that robotic surgery can safely replicate a highly precise surgical operation, thereby safely pushing the limits of MIDH.
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Affiliation(s)
- Mohamed Rela
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
| | - Rajesh Rajalingam
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
| | - Guruprasad Shetty
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
| | - Ramkiran Cherukuru
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
| | - Ashwin Rammohan
- The Institute of Liver Disease & Transplantation, Dr. Rela Institute & Medical Centre, Bharath Institute of Higher Education & Research, Chennai, India
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4
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Semenkov AV, Subbot VS. [Systematic review of current trends in preoperative planning of surgery for liver tumors]. Khirurgiia (Mosk) 2021:84-97. [PMID: 34363450 DOI: 10.17116/hirurgia202108184] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/18/2022]
Abstract
The purpose of the study was a systematic review of current trends in preoperative planning of surgery for liver tumors. These data will be valuable to determine the advantages and disadvantages of 3D modeling, augmented reality technology and 3D printing in preoperative planning of surgery for focal liver lesions.
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Affiliation(s)
- A V Semenkov
- Sklifosovsky Institute for Emergency Care, Moscow, Russia.,Sechenov First Moscow State Medical University, Moscow, Russia
| | - V S Subbot
- Sklifosovsky Institute for Emergency Care, Moscow, Russia.,Sechenov First Moscow State Medical University, Moscow, Russia
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5
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Park SJ, Cho EJ, Lee JH, Yu SJ, Kim YJ, Yoon JH, Kang HJ, Yoon JH, Lee DH, Kim SH, Lee JY, Lee JM. Switching Monopolar No-Touch Radiofrequency Ablation Using Octopus Electrodes for Small Hepatocellular Carcinoma: A Randomized Clinical Trial. Liver Cancer 2021; 10:72-81. [PMID: 33708641 PMCID: PMC7923899 DOI: 10.1159/000512338] [Citation(s) in RCA: 19] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/27/2020] [Accepted: 10/15/2020] [Indexed: 02/04/2023] Open
Abstract
INTRODUCTION A switching monopolar no-touch radiofrequency ablation (RFA) technique is used for small hepatocellular carcinoma (HCC); however, there have not been any randomized clinical trials comparing this technique to the conventional RFA technique. OBJECTIVE This study aims to compare the results of two RFA techniques, and to comparatively identify more effective methods to reduce the progression of local tumors associated with small HCC (≤2.5 cm). METHODS This prospective randomized clinical trial (NCT03375281) recruited a total of 116 participants (M:F, 93:23; 68.3 ± 8.4 years) between October 2016 and September 2017. The primary outcome was the cumulative incidence of local tumor progression (LTP) after RFA. Secondary outcomes included technical success rate, technique efficacy, and RFA procedure characteristics. Kaplan-Meier analysis and the Cox proportional hazard regression model were used. RESULTS The mean follow-up period was 24.1 months. A sufficient ablative margin was more frequently achieved in the no-touch RFA group (57/60 = 95%) than in the conventional RFA group (50/64 = 78.1%) on immediate follow-up CT (p = 0.01). The cumulative incidence of LTP in the no-touch RFA group was significantly lower than that in the conventional RFA group (p = 0.02). In multivariable analysis, no-touch RFA was the only predictive factor for LTP (p = 0.04, hazard ratio = 0.2, 95% confidence interval = 0.04-0.94). CONCLUSIONS A switching monopolar no-touch RFA technique is a favorable treatment option and provides lower LTP after RFA compared with conventional RFA for small HCC.
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Affiliation(s)
- Sae-Jin Park
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eun Ju Cho
- Department of Internal Medicine and Liver Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jeong-Hoon Lee
- Department of Internal Medicine and Liver Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Su Jong Yu
- Department of Internal Medicine and Liver Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Yoon Jun Kim
- Department of Internal Medicine and Liver Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Jung-Hwan Yoon
- Department of Internal Medicine and Liver Research Institute, College of Medicine, Seoul National University, Seoul, Republic of Korea
| | - Hyo-Jin Kang
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea
| | - Jeong Hee Yoon
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Dong Ho Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Se Hyung Kim
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea
| | - Jae Young Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea
| | - Jeong Min Lee
- Department of Radiology, Seoul National University Hospital, Seoul, Republic of Korea,Department of Radiology, Seoul National University College of Medicine, Seoul, Republic of Korea,Institute of Radiation Medicine, Seoul National University Medical Research Center, Seoul, Republic of Korea,*Jeong Min Lee, MD, Department of Radiology, Seoul National University Hospital, 101 Daehak-ro, Jongno-gu, Seoul 03080 (Republic of Korea),
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6
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Procopio F, Torzilli G, Franchi E, Cimino M, Viganò L, Donadon M, Del Fabbro D. Ultrasound-guided anatomical liver resection using a compression technique combined with indocyanine green fluorescence imaging. HPB (Oxford) 2021; 23:206-211. [PMID: 32565040 DOI: 10.1016/j.hpb.2020.05.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/23/2019] [Revised: 01/20/2020] [Accepted: 05/18/2020] [Indexed: 12/12/2022]
Abstract
BACKGROUND Anatomical resection (AR) is a recommended surgical treatment for hepatocellular carcinoma (HCC). However, the conventional procedure (dye injection) for AR is difficult to reproduce. As an alternative, the tumour-feeding portal pedicle compression technique (finger-compression technique) has been proposed as an easy and reversible procedure. Here, we propose a new method combining indocyanine green (ICG) imaging with the finger-compression technique. METHODS Eligible patients were prospectively enrolled to undergo ICG compression (ICG-C) anatomical hepatectomy for HCC. RESULTS Fifteen patients underwent AR using the ICG-C technique. Overall, the surgical procedures included six segmentectomies, seven subsegmentectomies, and two right posterior sectionectomies. The median tumour size was 5.8 cm (range 2-7 cm). All procedures had an R0 margin. There were no major complications among patients, and minor morbidity occurred in three patients. CONCLUSIONS ICG-C is a safe, feasible and effective technique for patients eligible for AR.
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Affiliation(s)
- Fabio Procopio
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, MI, Italy
| | - Guido Torzilli
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, MI, Italy.
| | - Eloisa Franchi
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, MI, Italy
| | - Matteo Cimino
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, MI, Italy
| | - Luca Viganò
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, MI, Italy
| | - Matteo Donadon
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, MI, Italy
| | - Daniele Del Fabbro
- Division of Hepatobiliary & General Surgery, Department of Surgery, Humanitas Research Hospital - IRCCS, Humanitas University, Rozzano, MI, Italy
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7
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de Morais-Pinto L, Pereira VP, de Souza Vencato M, de Oliveira A, Miglino MA. Venous hepatic segmentation in dogs (Canis lupus familiaris-L. 1758). Anat Histol Embryol 2020; 50:224-233. [PMID: 32960487 DOI: 10.1111/ahe.12619] [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: 05/08/2020] [Revised: 08/14/2020] [Accepted: 09/01/2020] [Indexed: 10/23/2022]
Abstract
The external shape of the liver is varied and determines specific vascular arrangements. This morphological relationship is important to establish hepatic segmentation in different species submitted to surgeries that aim to preserve a larger area of liver parenchyma. After observing 60 livers injected with Neoprene Latex and three plastic moulds obtained by corrosion, eight hepatic venous segments were identified, drained by six hepatic veins agrouped into segmental veins, which drained one sector (segments I, VI, VII and VIII) and intersegmental veins, which drained more than one sector (segments II/III and IV/V). They were described as follows: left intersegmental vein, formed by a segmental vein from the papillary process (segment I), two to three lateral left segmental veins that drained the segment II, and one to five left paramedian segmental veins that drained the segment III; sagittal intersegmental vein, formed by the confluence between segmental vein of the quadrate lobe (segment IV) and the medial right paramedian segmental vein, which derived from the segment V; lateral right paramedian vein drained the dorsocranial sector of the segment VI; the lateral right segmental vein, formed by one to four vessels that drained segment VII, and the segmental vein of the caudate process, which drained the segment VIII. Understanding the number and disposition of the hepatic veins in lobate livers is essential to reduce bleeding risks in surgeries. The nomenclature based on segmentation analogy of non-lobate liver could be less confusing and, therefore, be more useful in the surgical approaches of lobate livers.
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Affiliation(s)
| | - Vítor Pires Pereira
- Departamento de Morfologia, Universidade Federal de Santa Maria, Santa Maria, Brasil
| | | | - Alzido de Oliveira
- Faculdade de Medicina Veterinária, Universidade de Alfenas, Minas Gerais, Brasil
| | - Maria Angelica Miglino
- Departamento de Cirurgia, Faculdade de Medicina Veterinária e Zootecnia, Universidade de São Paulo, São Paulo, Brasil
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8
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Zharikov YO, Kovalenko YA, Zharikova TS, Shkerdina MI, Nikolenko VN. [Surgical anatomy of liver segment iv and its importance in hepatobiliary surgery]. Khirurgiia (Mosk) 2019:93-99. [PMID: 31714537 DOI: 10.17116/hirurgia201911193] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/05/2023]
Abstract
The purpose of this article was to describe clinical anatomy of liver segment IV and determine its significance in liver resection surgery and within integrated approach in the treatment of malignancies of this area.
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Affiliation(s)
- Yu O Zharikov
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia
| | - Yu A Kovalenko
- Vishnevsky National Medical Research Center for Surgery, Moscow, Russia
| | - T S Zharikova
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia
| | - M I Shkerdina
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia
| | - V N Nikolenko
- Sechenov First Moscow State Medical University of the Ministry of Health, Moscow, Russia; Lomonosov Moscow State University, Moscow, Russia
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9
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Garg S, Kumar KH, Sahni D, Yadav TD, Aggarwal A, Gupta T. Anatomy of the hepatic arteries and their extrahepatic branches in the human liver: A cadaveric study. Ann Anat 2019; 227:151409. [PMID: 31400446 DOI: 10.1016/j.aanat.2019.07.010] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/18/2019] [Revised: 06/11/2019] [Accepted: 07/22/2019] [Indexed: 12/20/2022]
Abstract
BACKGROUND To describe the hepatic arterial anatomy in detail, tracing the individual hepatic arteries from their origin, extrahepatic course, branching to their segmental territorial supply as applicable to the vascular mapping for hepatic endovascular procedures. METHODS The study was conducted on 100 formalin fixed adult cadaveric livers. The hepatic arterial anatomy was dissected from the origin of hepatic arteries up to their segmental branching. RESULTS The origin of hepatic arteries was standard in 72% and aberrant in 28% livers. In livers with standard origin, extrahepatic branching of the main hepatic artery was close to the hepatic hilum in 48% and was in the lower part of the hepatoduodenal ligament in 24% livers. The pattern of extrahepatic branching in each type was three and five respectively. Aberrant arterial anatomy was broadly categorized into three groups. The mapping of segmental arterial vascularization of individual hepatic arteries in each type was also done. CONCLUSIONS In the present study, an attempt was made to systematically describe the complex hepatic arterial anatomy in a clinically applicable fashion. High variability was seen in the hepatic arterial anatomy at each level, a lot of which could not be included in the current classification systems. The information provided is an important prerequisite for performing accurate intra-arterial hepatic interventions.
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Affiliation(s)
- Shallu Garg
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - K Hemanth Kumar
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Daisy Sahni
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Thakur Deen Yadav
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
| | - Anjali Aggarwal
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India.
| | - Tulika Gupta
- Post Graduate Institute of Medical Education and Research, Chandigarh, Chandigarh, India
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10
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Oldhafer KJ, Peterhans M, Kantas A, Schenk A, Makridis G, Pelzl S, Wagner KC, Weber S, Stavrou GA, Donati M. [Navigated liver surgery : Current state and importance in the future]. Chirurg 2019; 89:769-776. [PMID: 30225532 DOI: 10.1007/s00104-018-0713-3] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
Abstract
The preoperative computer-assisted resection planning is the basis for every navigation. Thanks to modern algorithms, the prerequisites have been created to carry out a virtual resection planning and a risk analysis. Thus, individual segment resections can be precisely planned in any conceivable combination. The transfer of planning information and resection suggestions to the operating theater is still problematic. The so-called stereotactic liver navigation supports the exact intraoperative implementation of the planned resection strategy and provides the surgeon with real-time three-dimensional information on resection margins and critical structures during the resection. This is made possible by a surgical navigation system that measures the position of surgical instruments and then presents them together with the preoperative surgical planning data. Although surgical navigation systems have been indispensable in neurosurgery and spinal surgery for many years, these procedures have not yet become established as standard in liver surgery. This is mainly due to the technical challenge of navigating a moving organ. As the liver is constantly moving and deforming during surgery due to respiration and surgical manipulation, the surgical navigation system must be able to measure these alterations in order to adapt the preoperative navigation data to the current situation. Despite these advances, further developments are required until navigated liver resection enters clinical routine; however, it is already clear that laparoscopic liver surgery and robotic surgery will benefit most from navigation technology.
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Affiliation(s)
- K J Oldhafer
- Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Deutschland. .,Semmelweis Universität Budapest, Campus Hamburg, Hamburg, Deutschland.
| | | | - A Kantas
- Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Deutschland.,Semmelweis Universität Budapest, Campus Hamburg, Hamburg, Deutschland
| | - A Schenk
- Fraunhofer-Institut für Bildgestützte Medizin MEVIS, Bremen, Deutschland
| | - G Makridis
- Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Deutschland.,Semmelweis Universität Budapest, Campus Hamburg, Hamburg, Deutschland
| | - S Pelzl
- apoQlar, Hamburg, Deutschland
| | - K C Wagner
- Klinik für Allgemein- und Viszeralchirurgie, Asklepios Klinik Barmbek, Hamburg, Deutschland.,Semmelweis Universität Budapest, Campus Hamburg, Hamburg, Deutschland
| | - S Weber
- University of Bern, ARTORG Center for Biomedical Engineering Research, Bern, Schweiz
| | - G A Stavrou
- Klinik für Allgemein‑, Viszeralchirurgie, Thorax- und Kinderchirurgie, Klinikum Saarbrücken, Saarbrücken, Deutschland
| | - M Donati
- Semmelweis Universität Budapest, Campus Hamburg, Hamburg, Deutschland.,Department of Surgery and Medical Surgical Specialties, University of Catania, Catania, Italien
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11
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Garg S, Kumar H, Sahni D, Yadav TD, Aggarwal A, Gupta T. Rare anatomic variations of the right hepatic biliary system. Surg Radiol Anat 2019; 41:1087-1092. [PMID: 31115596 DOI: 10.1007/s00276-019-02260-5] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/29/2019] [Accepted: 05/17/2019] [Indexed: 01/27/2023]
Abstract
PURPOSE To report rare and clinically significant anatomic variations in the biliary drainage of right hepatic lobe. METHODS Unique variations in the extra- and intrahepatic biliary drainage of right hepatic lobe were observed in 6 cadaveric livers during dissection on 100 formalin-fixed en bloc cadaveric livers. RESULTS There was presence of aberrant drainage of right segmental and sectorial ducts in four cases and of accessory right posterior sectorial duct in two cases. CONCLUSIONS We encountered some extensively complicated biliary drainage of right hepatic lobe, unsuccessful recognition of which can lead to serious biliary complications during hepatobiliary surgeries and biliary interventions.
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Affiliation(s)
- Shallu Garg
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Hemanth Kumar
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Daisy Sahni
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India.
| | - T D Yadav
- Department of General Surgery, Postgraduate Institute of Medical Education and Research, Chandigarh, India
| | - Anjali Aggarwal
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
| | - Tulika Gupta
- Department of Anatomy, Postgraduate Institute of Medical Education and Research, Chandigarh, 160012, India
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12
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Kruepunga N, Hakvoort TB, Hikspoors JP, Köhler SE, Lamers WH. Anatomy of rodent and human livers: What are the differences? Biochim Biophys Acta Mol Basis Dis 2019; 1865:869-878. [DOI: 10.1016/j.bbadis.2018.05.019] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2018] [Revised: 04/30/2018] [Accepted: 05/22/2018] [Indexed: 12/17/2022]
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Abstract
Diffuse liver disease is a substantial world-wide problem. With the combination of conventional ultrasound of the abdomen and elastography-appropriate staging of the patient can be assessed. This information allows for the detection of fibrosis as well as prognosis, surveillance, and prioritization for treatment. With the potential for reversibility with appropriate treatment, accurate assessment for the stage of chronic liver disease is critical.
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14
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Buettner S, ten Cate DWG, Bagante F, Alexandrescu S, Marques HP, Lamelas J, Aldrighetti L, Gamblin TC, Maithel SK, Pulitano C, Margonis GA, Weiss M, Bauer TW, Shen F, Poultsides GA, Marsh JW, IJzermans JNM, Pawlik TM, Koerkamp BG. Survival after Resection of Multiple Tumor Foci of Intrahepatic Cholangiocarcinoma. J Gastrointest Surg 2019; 23:2239-2246. [PMID: 30887301 PMCID: PMC6831534 DOI: 10.1007/s11605-019-04184-2] [Citation(s) in RCA: 23] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/23/2018] [Accepted: 02/25/2019] [Indexed: 01/31/2023]
Abstract
BACKGROUND Multiple tumor foci of intrahepatic cholangiocarcinoma (ICC) are often considered a contra-indication for resection. We sought to define long-term outcomes after resection of ICC in patients with multiple foci. METHODS Patients who underwent resection for ICC between 1990 and 2017 were identified from 12 major HPB centers. Outcomes of patients with solitary lesions, multiple lesions (ML), and oligometastases (OM) were compared. OM were defined as extrahepatic metastases spread to a single organ. RESULTS One thousand thirteen patients underwent resection of ICC. On final pathology, 185 patients (18.4%) had ML and 27 (2.7%) had OM. Median survival of patients with a solitary tumor was 43.2 months, while the median survival of patients with 2 tumors was 21.2 months; the median survival of patients with 3 or more tumors was 15.3 months (p < 0.001). Five-year survival was 43.3%, 28.0%, and 8.6%, respectively. The median survival of patients without OM was 37.8 months versus 14.9 months among patients with OM (p < 0.001); estimated 5-year survival was 39.3% and 10.6%, respectively. In multivariable analysis, the presence of two lesions was not an independent poor prognostic factor for OS (HR 1.19; 95%CI 0.90-1.57; p = 0.229). However, the presence of three or more tumors was an independent poor prognostic factor for OS (HR 1.97; 95%CI 1.48-2.64; p < 0.001). CONCLUSION Resection of multiple liver tumors for patients with ICC did not preclude 5-year survival: in particular, estimated 5-year OS for resection of two tumors was 28.0%.
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Affiliation(s)
- Stefan Buettner
- Department of Surgery, Erasmus MC University Medical Center, ‘s Gravendijkwal 230, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | - David W. G. ten Cate
- Department of Surgery, Erasmus MC University Medical Center, ‘s Gravendijkwal 230, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | - Fabio Bagante
- The Ohio State University Wexner Medical Center, Columbus, OH USA
| | | | | | | | | | | | | | | | | | | | | | - Feng Shen
- Eastern Hepatobiliary Surgery Hospital, Shanghai, China
| | | | | | - Jan N. M. IJzermans
- Department of Surgery, Erasmus MC University Medical Center, ‘s Gravendijkwal 230, PO Box 2040, 3000 CA Rotterdam, Netherlands
| | | | - Bas Groot Koerkamp
- Department of Surgery, Erasmus MC University Medical Center, ‘s Gravendijkwal 230, PO Box 2040, 3000 CA Rotterdam, Netherlands
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15
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Viganò L, Procopio F, Mimmo A, Donadon M, Terrone A, Cimino M, Fabbro DD, Torzilli G. Oncologic superiority of anatomic resection of hepatocellular carcinoma by ultrasound-guided compression of the portal tributaries compared with nonanatomic resection: An analysis of patients matched for tumor characteristics and liver function. Surgery 2018; 164:1006-1013. [PMID: 30195402 DOI: 10.1016/j.surg.2018.06.030] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/11/2018] [Revised: 06/07/2018] [Accepted: 06/12/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND The superiority of anatomic resection compared with nonanatomic resection for hepatocellular carcinoma remains a matter of debate. Further, the technique for anatomic resection (dye injection) is difficult to reproduce. Anatomic resection using a compression technique is an easy and reversible procedure based on liver discoloration after ultrasound-guided compression of the tumor-feeding portal tributaries. We compared the oncologic efficacy of compression technique anatomic resection with that of nonanatomic resection. METHODS Among patients with resected hepatocellular carcinoma, patients who underwent compression technique anatomic resection were matched 1-to-2 with nonanatomic resection cases based on the Child-Pugh class, Model for End-Stage Liver Disease score, cirrhosis, hepatocellular carcinoma number (1/>1), and hepatocellular carcinoma size (>30, 30-50, and >50 mm). The exclusion criteria were nonanatomic resection because of severe cirrhosis, major hepatectomy, 90-day mortality (0 compression technique anatomic resection), non-cancer-related death, and follow-up <12 months. A total of 47 patients who underwent compression technique anatomic resection were matched with 94 nonanatomic resection cases. RESULTS All patients were Child-Pugh A, and 53% were cirrhotic. Liver function tests and signs of portal hypertension were similar between the groups. There was 1 hepatocellular carcinoma in 81% of the patients, and the hepatocellular carcinoma was ≥30 mm in 68%. Patients undergoing anatomic resection with compression had better 5-year survival (77% vs 60%; risk ratio = 0.423; P = .032; multivariable analysis), less local recurrences (4% vs 20%; P = .012), and better 2-year local recurrence-free survival (94% vs 78%; P = .012). Nonlocal recurrence-free survival was similar between the groups. The compression technique anatomic resection group more often had repeat radical treatment for recurrence (68% vs 28%; P = .0004) and had better 3-year survival after recurrence (65% vs 42%; P = .043). CONCLUSION Compression technique anatomic resection appears to provide a more complete removal of the hepatocellular carcinoma-bearing portal territory. Local disease control and survival are better with compression technique anatomic resection than with nonanatomic resection.
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Affiliation(s)
- Luca Viganò
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Fabio Procopio
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Antonio Mimmo
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Matteo Donadon
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Alfonso Terrone
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Matteo Cimino
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Daniele Del Fabbro
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy
| | - Guido Torzilli
- Division of Hepatobiliary and General Surgery, Department of Surgery, Humanitas Reseach Hospital, Humanitas University, Rozzano, Milan, Italy.
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16
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Viganò L, Laurenzi A, Solbiati L, Procopio F, Cherqui D, Torzilli G. Open Liver Resection, Laparoscopic Liver Resection, and Percutaneous Thermal Ablation for Patients with Solitary Small Hepatocellular Carcinoma (≤30 mm): Review of the Literature and Proposal for a Therapeutic Strategy. Dig Surg 2018; 35:359-371. [PMID: 29890512 DOI: 10.1159/000489836] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/03/2018] [Accepted: 05/05/2018] [Indexed: 12/13/2022]
Abstract
BACKGROUND Patients with a single hepatocellular carcinoma (HCC) ≤3 cm and preserved liver function have the highest likelihood to be cured if treated. The most adequate treatment methods are yet a matter that is debated. METHODS We reviewed the literature about open anatomic resection (AR), laparoscopic liver resection (LLR), and percutaneous thermal ablation (PTA). RESULTS PTA is effective as resection for HCC < 2 cm, when they are neither subcapsular nor perivascular. PTA in HCC of 2-3 cm is under evaluation. AR with the removal of the tumor-bearing portal territory is recommended for HCC > 2 cm, except for subcapsular ones. In comparison with open surgery, LRR has better short-term outcomes and non-inferior long-term outcomes. LLR is standardized for superficial limited resections and for left-sided AR. CONCLUSIONS According to the available evidences, the following therapeutic proposal can be advanced. Laparoscopic limited resection is the standard for any subcapsular HCC. PTA is the first-line treatment for deep-located HCC < 2 cm, except for those in contact with Glissonean pedicles. Laparoscopic AR is the standard for deep-located HCC of 2-3 cm of the left liver, while open AR is the standard for deep-located HCC of 2-3 cm in the right liver. HCC in contact with Glissonean pedicles should be scheduled for resection (open or laparoscopic) independent of their size. Liver transplantation is reserved to otherwise untreatable patients or as a salvage procedure at recurrence.
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Affiliation(s)
- Luca Viganò
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - Andrea Laurenzi
- Department of Surgery, Centre Hépatobiliaire, Paul Brousse Hospital, Villejuif, France
| | - Luigi Solbiati
- Department of Radiology, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
| | - Fabio Procopio
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy
| | - Daniel Cherqui
- Department of Surgery, Centre Hépatobiliaire, Paul Brousse Hospital, Villejuif, France
| | - Guido Torzilli
- Department of Surgery, Division of Hepatobiliary and General Surgery, Humanitas Research Hospital, IRCCS, Rozzano, Milano, Italy.,Department of Biomedical Sciences, Humanitas University, Rozzano, Milano, Italy
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17
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Hikspoors JPJM, Peeters MMJP, Kruepunga N, Mekonen HK, Mommen GMC, Köhler SE, Lamers WH. Human liver segments: role of cryptic liver lobes and vascular physiology in the development of liver veins and left-right asymmetry. Sci Rep 2017; 7:17109. [PMID: 29214994 PMCID: PMC5719430 DOI: 10.1038/s41598-017-16840-1] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/11/2017] [Accepted: 11/16/2017] [Indexed: 12/15/2022] Open
Abstract
Couinaud based his well-known subdivision of the liver into (surgical) segments on the branching order of portal veins and the location of hepatic veins. However, both segment boundaries and number remain controversial due to an incomplete understanding of the role of liver lobes and vascular physiology on hepatic venous development. Human embryonic livers (5-10 weeks of development) were visualized with Amira 3D-reconstruction and Cinema 4D-remodeling software. Starting at 5 weeks, the portal and umbilical veins sprouted portal-vein branches that, at 6.5 weeks, had been pruned to 3 main branches in the right hemi-liver, whereas all (>10) persisted in the left hemi-liver. The asymmetric branching pattern of the umbilical vein resembled that of a "distributing" vessel, whereas the more symmetric branching of the portal trunk resembled a "delivering" vessel. At 6 weeks, 3-4 main hepatic-vein outlets drained into the inferior caval vein, of which that draining the caudate lobe formed the intrahepatic portion of the caval vein. More peripherally, 5-6 major tributaries drained both dorsolateral regions and the left and right ventromedial regions, implying a "crypto-lobar" distribution. Lobar boundaries, even in non-lobated human livers, and functional vascular requirements account for the predictable topography and branching pattern of the liver veins, respectively.
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Affiliation(s)
- Jill P J M Hikspoors
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - Mathijs M J P Peeters
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - Nutmethee Kruepunga
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
- Department of Anatomy, Faculty of Science, Mahidol University, Rama VI Road, Bangkok, 10400, Thailand
| | - Hayelom K Mekonen
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - Greet M C Mommen
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
| | - S Eleonore Köhler
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands
- NUTRIM Research School of Nutrition and Translational Research in Metabolism, Maastricht, The Netherlands
| | - Wouter H Lamers
- Department of Anatomy & Embryology, Maastricht University, Maastricht, The Netherlands.
- Tytgat Institute for Liver and Intestinal research, Academic Medical Center, Amsterdam, The Netherlands.
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18
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Fasel JHD. Human liver territories: Think beyond the 8-segments scheme. Clin Anat 2017; 30:974-977. [PMID: 28791739 DOI: 10.1002/ca.22974] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2017] [Accepted: 08/04/2017] [Indexed: 12/13/2022]
Abstract
Worldwide, compartmentalization of the human liver into portal venous territories today follows the eight-segments scheme credited to Couinaud. However, there are increasing reports of anatomical, radiological and surgical observations that contradict this concept. This paper presents a viewpoint that enhances understanding of these inconsistencies and can serve as a basis for customized liver interventions. Clin. Anat. 30:974-977, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jean H D Fasel
- Departments of Cell Physiology, Metabolism, and Surgery, Clinical Anatomy Research Group, University Medical Centre and Hospitals, Geneva, Switzerland
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19
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Zhang J, Lin W, Chi Y, Zheng N, Xu Q, Zhang G, Yu S, Li C, Wang B, Sui H. The error analysis of Lobular and segmental division of right liver by volume measurement. Clin Anat 2017; 30:585-590. [PMID: 28493297 DOI: 10.1002/ca.22872] [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: 02/19/2017] [Accepted: 02/27/2017] [Indexed: 11/11/2022]
Abstract
The aim of this study is to explore the inconsistencies between right liver volume as measured by imaging and the actual anatomical appearance of the right lobe. Five healthy donated livers were studied. The liver slices were obtained with hepatic segments multicolor-infused through the portal vein. In the slices, the lobes were divided by two methods: radiological landmarks and real anatomical boundaries. The areas of the right anterior lobe (RAL) and right posterior lobe (RPL) on each slice were measured using Photoshop CS5 and AutoCAD, and the volumes of the two lobes were calculated. There was no statistically significant difference between the volumes of the RAL or RPL as measured by the radiological landmarks (RL) and anatomical boundaries (AB) methods. However, the curves of the square error value of the RAL and RPL measured using CT showed that the three lowest points were at the cranial, intermediate, and caudal levels. The U- or V-shaped curves of the square error rate of the RAL and RPL revealed that the lowest value is at the intermediate level and the highest at the cranial and caudal levels. On CT images, less accurate landmarks were used to divide the RAL and RPL at the cranial and caudal layers. The measured volumes of hepatic segments VIII and VI would be less than their true values, and the measured volumes of hepatic segments VII and V would be greater than their true values, according to radiological landmarks. Clin. Anat. 30:585-590, 2017. © 2017 Wiley Periodicals, Inc.
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Affiliation(s)
- Jianfei Zhang
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | | | - Yanyan Chi
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Nan Zheng
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Qiang Xu
- Huanghai Hospital, Dalian, 116021, China
| | | | - Shengbo Yu
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Chan Li
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Bin Wang
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
| | - Hongjin Sui
- Department of Anatomy, Dalian Medical University, Dalian, 116044, China
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20
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Superselective intra-arterial hepatic injection of indocyanine green (ICG) for fluorescence image-guided segmental positive staining: experimental proof of the concept. Surg Endosc 2016; 31:1451-1460. [PMID: 27495341 DOI: 10.1007/s00464-016-5136-y] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/08/2016] [Accepted: 07/16/2016] [Indexed: 12/16/2022]
Abstract
BACKGROUND Intraoperative liver segmentation can be obtained by means of percutaneous intra-portal injection of a fluorophore and illumination with a near-infrared light source. However, the percutaneous approach is challenging in the minimally invasive setting. We aimed to evaluate the feasibility of fluorescence liver segmentation by superselective intra-hepatic arterial injection of indocyanine green (ICG). MATERIALS AND METHODS Eight pigs (mean weight: 26.01 ± 5.21 kg) were involved. Procedures were performed in a hybrid experimental operative suite equipped with the Artis Zeego®, multiaxis robotic angiography system. A pneumoperitoneum was established and four laparoscopic ports were introduced. The celiac trunk was catheterized, and a microcatheter was advanced into different segmental hepatic artery branches. A near-infrared laparoscope (D-Light P, Karl Storz) was used to detect the fluorescent signal. To assess the correspondence between arterial-based fluorescence demarcation and liver volume, metallic markers were placed along the fluorescent border, followed by a 3D CT-scanning, after injecting intra-arterial radiological contrast (n = 3). To assess the correspondence between arterial and portal supplies, percutaneous intra-portal angiography and intra-arterial angiography were performed simultaneously (n = 1). RESULTS Bright fluorescence signal enhancing the demarcation of target segments was obtained from 0.1 mg/mL, in matter of seconds. Correspondence between the volume of hepatic segments and arterial territories was confirmed by CT angiography. Higher background fluorescence noise was found after positive staining by intra-portal ICG injection, due to parenchymal accumulation and porto-systemic shunting. CONCLUSIONS Intra-hepatic arterial ICG injection, rapidly highlights hepatic target segment borders, with a better signal-to-background ratio as compared to portal vein injection, in the experimental setting.
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21
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Schwen LO, Schenk A, Kreutz C, Timmer J, Bartolomé Rodríguez MM, Kuepfer L, Preusser T. Representative Sinusoids for Hepatic Four-Scale Pharmacokinetics Simulations. PLoS One 2015. [PMID: 26222615 PMCID: PMC4519332 DOI: 10.1371/journal.pone.0133653] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/13/2022] Open
Abstract
The mammalian liver plays a key role for metabolism and detoxification of xenobiotics in the body. The corresponding biochemical processes are typically subject to spatial variations at different length scales. Zonal enzyme expression along sinusoids leads to zonated metabolization already in the healthy state. Pathological states of the liver may involve liver cells affected in a zonated manner or heterogeneously across the whole organ. This spatial heterogeneity, however, cannot be described by most computational models which usually consider the liver as a homogeneous, well-stirred organ. The goal of this article is to present a methodology to extend whole-body pharmacokinetics models by a detailed liver model, combining different modeling approaches from the literature. This approach results in an integrated four-scale model, from single cells via sinusoids and the organ to the whole organism, capable of mechanistically representing metabolization inhomogeneity in livers at different spatial scales. Moreover, the model shows circulatory mixing effects due to a delayed recirculation through the surrounding organism. To show that this approach is generally applicable for different physiological processes, we show three applications as proofs of concept, covering a range of species, compounds, and diseased states: clearance of midazolam in steatotic human livers, clearance of caffeine in mouse livers regenerating from necrosis, and a parameter study on the impact of different cell entities on insulin uptake in mouse livers. The examples illustrate how variations only discernible at the local scale influence substance distribution in the plasma at the whole-body level. In particular, our results show that simultaneously considering variations at all relevant spatial scales may be necessary to understand their impact on observations at the organism scale.
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Affiliation(s)
| | - Arne Schenk
- Computational Systems Biology, Bayer Technology Services, Leverkusen, Germany
- Aachen Institute for Advanced Study in Computational Engineering Sciences, RWTH Aachen University, Aachen, Germany
| | - Clemens Kreutz
- Freiburg Center for Data Analysis and Modeling (FDM), Institute of Physics, University of Freiburg, Freiburg, Germany
| | - Jens Timmer
- Freiburg Center for Data Analysis and Modeling (FDM), Institute of Physics, University of Freiburg, Freiburg, Germany
- BIOSS Centre for Biological Signalling Studies, University of Freiburg, Freiburg, Germany
| | | | - Lars Kuepfer
- Computational Systems Biology, Bayer Technology Services, Leverkusen, Germany
- Institute of Applied Microbiology, RWTH Aachen University, Aachen, Germany
| | - Tobias Preusser
- Fraunhofer MEVIS, Bremen, Germany
- Jacobs University, Bremen, Germany
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22
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Macchi V, Porzionato A, Morra A, Zanon GF, De Caro R. Pattern of branching of the left portal vein: an anatomo-radiological study. Surg Radiol Anat 2015; 37:463-71. [DOI: 10.1007/s00276-015-1440-9] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/26/2014] [Accepted: 01/26/2015] [Indexed: 12/15/2022]
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23
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Schwen LO, Wei W, Gremse F, Ehling J, Wang L, Dahmen U, Preusser T. Algorithmically generated rodent hepatic vascular trees in arbitrary detail. J Theor Biol 2014; 365:289-300. [PMID: 25451523 DOI: 10.1016/j.jtbi.2014.10.026] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/03/2014] [Revised: 10/16/2014] [Accepted: 10/22/2014] [Indexed: 12/13/2022]
Abstract
Physiologically realistic geometric models of the vasculature in the liver are indispensable for modelling hepatic blood flow, the main connection between the liver and the organism. Current in vivo imaging techniques do not provide sufficiently detailed vascular trees for many simulation applications, so it is necessary to use algorithmic refinement methods. The method of Constrained Constructive Optimization (CCO) (Schreiner et al., 2006) is well suited for this purpose. Its results after calibration have been previously compared to experimentally acquired human vascular trees (Schwen and Preusser, 2012). The goal of this paper is to extend this calibration to the case of rodents (mice and rats), the most commonly used animal models in liver research. Based on in vivo and ex vivo micro-CT scans of rodent livers and their vasculature, we performed an analysis of various geometric features of the vascular trees. Starting from pruned versions of the original vascular trees, we applied the CCO procedure and compared these algorithmic results to the original vascular trees using a suitable similarity measure. The calibration of the postprocessing improved the algorithmic results compared to those obtained using standard CCO. In terms of angular features, the average similarity increased from 0.27 to 0.61, improving the total similarity from 0.28 to 0.40. Finally, we applied the calibrated algorithm to refine measured vascular trees to the (higher) level of detail desired for specific applications. Having successfully adapted the CCO algorithm to the rodent model organism, the resulting individual-specific refined hepatic vascular trees can now be used for advanced modeling involving, e.g., detailed blood flow simulations.
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Affiliation(s)
- Lars Ole Schwen
- Fraunhofer MEVIS, Universitätsallee 29, 28359 Bremen, Germany.
| | - Weiwei Wei
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Drackendorfer Str. 1, 07747 Jena, Germany.
| | - Felix Gremse
- Experimental Molecular Imaging, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Josef Ehling
- Experimental Molecular Imaging, RWTH Aachen University, Pauwelsstrasse 30, 52074 Aachen, Germany.
| | - Lei Wang
- Fraunhofer MEVIS, Universitätsallee 29, 28359 Bremen, Germany.
| | - Uta Dahmen
- Department of General, Visceral and Vascular Surgery, University Hospital Jena, Drackendorfer Str. 1, 07747 Jena, Germany.
| | - Tobias Preusser
- Fraunhofer MEVIS, Universitätsallee 29, 28359 Bremen, Germany; School of Engineering and Science, Jacobs University, Campus Ring 1, 28759 Bremen, Germany.
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24
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Majno P, Mentha G, Toso C, Morel P, Peitgen HO, Fasel JHD. Anatomy of the liver: an outline with three levels of complexity--a further step towards tailored territorial liver resections. J Hepatol 2014; 60:654-62. [PMID: 24211738 DOI: 10.1016/j.jhep.2013.10.026] [Citation(s) in RCA: 45] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/30/2013] [Revised: 09/27/2013] [Accepted: 10/25/2013] [Indexed: 12/22/2022]
Abstract
The vascular anatomy of the liver can be described at three different levels of complexity according to the use that the description has to serve. The first--conventional--level corresponds to the traditional 8-segments scheme of Couinaud and serves as a common language between clinicians from different specialties to describe the location of focal hepatic lesions. The second--surgical--level, to be applied to anatomical liver resections and transplantations, takes into account the real branching of the major portal pedicles and of the hepatic veins. Radiological and surgical techniques exist nowadays to make full use of this anatomy, but this requires accepting that the Couinaud scheme is a simplification, and looking at the vascular architecture with an unprejudiced eye. The third--academic--level of complexity concerns the anatomist, and the need to offer a systematization that resolves the apparent contradictions between anatomical literature, radiological imaging, and surgical practice. Based on the real number of second-order portal branches that, although variable averages 20, we submit a system called the "1-2-20 concept", and suggest that it fits best the number of actual--as opposed to idealized--anatomical liver segments.
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Affiliation(s)
- Pietro Majno
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland.
| | - Gilles Mentha
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Christian Toso
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Philippe Morel
- Hepatobiliary Center, Digestive Surgery and Transplantation Units, Department of Surgery, University Hospitals of Geneva, Switzerland
| | - Heinz O Peitgen
- Fraunhofer Institute for Medical Image Computing, Bremen, Germany
| | - Jean H D Fasel
- Anatomy Sector, Department of Cellular Physiology and Metabolism, Faculty of Medicine, University of Geneva, Switzerland
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