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Lelievre O, Fuks D, Tzedakis S. Laparoscopic right posterior liver sectionectomy extended to the right hepatic vein (with video). J Visc Surg 2023; 160:474-476. [PMID: 37858429 DOI: 10.1016/j.jviscsurg.2023.09.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2023]
Affiliation(s)
- Oceane Lelievre
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; University of Paris-Centre, Paris, France
| | - David Fuks
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; University of Paris-Centre, Paris, France
| | - Stylianos Tzedakis
- Department of Digestive, Pancreatic, Hepato-biliary and Endocrine Surgery, Cochin Hospital, Assistance publique-Hôpitaux de Paris (AP-HP), Paris, France; University of Paris-Centre, Paris, France.
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Lin J, Fang C, Yang J. Laparoscopic modular extended right posterior sectionectomy for hepatocellular carcinoma guided by projection plane extension from the right hepatic vein. J Gastrointest Surg 2023. [PMID: 36932306 DOI: 10.1007/s11605-023-05647-3] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/18/2023] [Accepted: 03/02/2023] [Indexed: 03/19/2023]
Abstract
BACKGROUND Extended right posterior sectionectomy (ERPS) preserves more liver parenchyma than right hepatectomy when hepatocellular carcinoma (HCC) is in the right posterior section (RPS) and part of the right anterior section (RAS), but the difficulty lies in the precise determination of the cutting plane, especially under laparoscopy.[Torzilli et al. in Annals of surgery. 247:603-611, 2008] If the right hepatic vein (RHV) is not invaded by the tumor, it can help to divide the ventral and dorsal plane (VP, DP) as surgical landmark.[Makuuchi in International Journal of Surgery. 11:S47-S49, 2013] (Fig. 1) This study presented a laparoscopic modular ERPS (LMERPS) guided by projection plane extension from the RHV. Fig. 1 Projection plane extending from the right hepatic vein. a & b: The VP was bounded by the RHV and its projection; c & d: The DP was bounded by the RHV, IVC, and DL of the RPS and RAS. RHV, right hepatic vein; VP, ventral plane; DP, dorsal plane; IVC, inferior vena cava; DL, demarcation line; RPS, right posterior section; RAS, right anterior section METHODS: A 56-year-old man was seen with HCC in the (RPS) and segment 8 following two laparotomies. After releasing intraperitoneal adhesions, the short hepatic veins were severed to expose the inferior vena cava (IVC). The right posterior Glission pedicle (RPGP) was clamped to control RPS inflow and allow determination of the demarcation line (DL) between the RPS and RAS using ICG fluorescence staining.[Chen et al. in Annals of surgical oncology. 29:2034-2040, 2022] Intraoperative ultrasound identified the RHV projection to satisfy the requirements of oncologic treatment. The VP and DP were incised along the DL and RHV projection. The RHV was exposed fully on the cutting plane and the tumor was completely removed finally. RESULTS The operation was completed in 265 min, with a blood loss of 50 ml. The diagnosis was HCC with a negative resection margin. The patient was discharged on postoperative day 8 without any complications. CONCLUSION LMERPS guided by a projection plane extending from the RHV is feasible and effective.
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Ome Y, Seyama Y, Doi M. Laparoscopic anatomic resection of segment 7 of the liver using the intrahepatic Glissonean approach from the dorsal side (with video). J Hepatobiliary Pancreat Sci 2019; 27:E3-E6. [PMID: 31562675 DOI: 10.1002/jhbp.679] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/08/2022]
Abstract
Laparoscopic anatomic resection of S7 is challenging. Ome and colleagues described an intrahepatic approach to the S7 Glissonean pedicles from the dorsal side without dissection around the hepatic hilum, allowing safe exposure of the right hepatic vein in the same view. This approach is safe and offers advantages for later hepatectomy.
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Affiliation(s)
- Yusuke Ome
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Yasuji Seyama
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
| | - Manami Doi
- Division of Hepato-Biliary-Pancreatic Surgery, Department of Surgery, Tokyo Metropolitan Cancer and Infectious Diseases Center Komagome Hospital, 3-18-22 Honkomagome, Bunkyo-ku, Tokyo, 113-8677, Japan
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Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Aramaki T, Uesaka K. The Pitfalls of Left Trisectionectomy or Central Bisectionectomy for Biliary Cancer: Anatomical Classification Based on the Ventral Branches of Segment VI Portal Vein Relative to the Right Hepatic Vein. J Gastrointest Surg 2017; 21:1453-1462. [PMID: 28667434 DOI: 10.1007/s11605-017-3486-y] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/26/2017] [Accepted: 06/23/2017] [Indexed: 01/31/2023]
Abstract
BACKGROUNDS Some patients have P6a running on the ventral side (Ventral-P6a), relative to the right hepatic vein (RHV). STUDY DESIGN Forty-one patients who underwent left trisectionectomy or central bisectionectomy for biliary cancer were enrolled. We compared the anatomical features using 3D images and surgical outcomes between patients with Ventral-P6a (n = 17) and those with P6a running on the dorsal side relative to the RHV (Dorsal-P6a; n = 25). Moreover, the liver volume by hand-tracing 2D axial images was compared to the volume calculated using the 3D images. RESULTS The frequency of complete exposure of RHV on the transection plane was less in Ventral-P6a (12 vs. 76%; p < 0.001), and the frequency of supraportal type of right posterior hepatic artery (RPHA, 29 vs. 4%, p = 0.020), the presence of inferior RHV (47 vs. 12%, p = 0.011), and the angle between the transection plane of segment VI and VII (S6-S7angle, 29.0° vs. 4.9°; p < 0.001) were greater in Ventral-P6a than in Dorsal-P6a. In Dorsal-P6a, the volume of posterior section calculated using 2D images was greater than that calculated using 3D images (404 vs. 370 mL; p = 0.004). The incidence of daily diuretic administration in Dorsal-P6a was greater than in Ventral-P6a (88 vs. 54%, p = 0.035). CONCLUSION AND RELEVANCE In Ventral-P6a, the complete exposure of RHV was rare in left trisectionectomy or central bisectionectomy. Surgeons should preoperatively recognize the course of RPHA, the presence of inferior RHV, and the S6-S7angle. In Dorsal-P6a, the volume of posterior section, which tended to be overestimated using 2D images, was smaller than that in Ventral-P6a.
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Affiliation(s)
- Yusuke Yamamoto
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan.
| | - Teiichi Sugiura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Yukiyasu Okamura
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Takaaki Ito
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Ryo Ashida
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
| | - Takeshi Aramaki
- Division of Radiology, Shizuoka Cancer Center, Shizuoka, Japan
| | - Katsuhiko Uesaka
- Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, 1007, Shimo-Nagakubo, Sunto-Nagaizumi, Shizuoka, 4118777, Japan
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Hwang S, Ha TY, Ahn CS, Moon DB, Kim KH, Song GW, Jung DH, Park GC, Lee SG. Standardized surgical techniques for adult living donor liver transplantation using a modified right lobe graft: a video presentation from bench to reperfusion. Korean J Hepatobiliary Pancreat Surg 2016; 20:97-101. [PMID: 27621745 PMCID: PMC5018955 DOI: 10.14701/kjhbps.2016.20.3.97] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/21/2016] [Revised: 05/30/2016] [Accepted: 06/05/2016] [Indexed: 12/11/2022]
Abstract
After having experienced more than 2,000 cases of adult living donor liver transplantation (LDLT), we established the concepts of right liver graft standardization. Right liver graft standardization intends to provide hemodynamics-based and regeneration-compliant reconstruction of vascular inflow and outflow. Right liver graft standardization consists of the following components: Right hepatic vein reconstruction includes a combination of caudal-side deep incision and patch venoplasty of the graft right hepatic vein to remove the acute angle between the graft right hepatic vein and the inferior vena cava; middle hepatic vein reconstruction includes interposition of a uniform-shaped conduit with large-sized homologous or prosthetic grafts; if the inferior right hepatic vein is present, its reconstruction includes funneling and unification venoplasty for multiple short hepatic veins; if donor portal vein anomaly is present, its reconstruction includes conjoined unification venoplasty for two or more portal vein orifices. This video clip that shows the surgical technique from bench to reperfusion was a case presentation of adult LDLT using a modified right liver graft from the patient's son. Our intention behind proposing the concept of right liver graft standardization is that it can be universally applicable and may guarantee nearly the same outcomes regardless of the surgeon's experience. We believe that this reconstruction model would be primarily applied to a majority of adult LDLT cases.
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Affiliation(s)
- Shin Hwang
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Tae-Yong Ha
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Chul-Soo Ahn
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Deok-Bog Moon
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki-Hun Kim
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gi-Won Song
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dong-Hwan Jung
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Gil-Chun Park
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Sung-Gyu Lee
- Division of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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Daher CH, Gomes AC, Kobayashi S, Cerri GG, Chammas MC. Ultrasonographic study and Doppler flow velocimetry of maternal kidneys and liver in low-risk pregnancy. Radiol Bras 2015; 48:135-42. [PMID: 26185338 PMCID: PMC4492564 DOI: 10.1590/0100-3984.2013.1822] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2013] [Accepted: 10/14/2014] [Indexed: 11/21/2022] Open
Abstract
OBJECTIVE Longitudinal study with B-mode ultrasonography and Doppler ultrasonography of maternal kidneys and liver in low-risk pregnancy, to establish and quantify normality parameters, correlating them with physiological changes. MATERIALS AND METHODS Twenty-five pregnant women were assessed and selected to participate in the study, each of them undergoing four examinations at the first, second, third trimesters and postpartum. RESULTS Findings during pregnancy were the following: increased renal volume, pyelocaliceal dilatation with incidence of 45.4% in the right kidney, and 9% in the left kidney; nephrolithiasis, 18.1% in the right kidney, 13.6% in the left kidney. With pyelocaliceal dilatation, mean values for resistivity index were: 0.68 for renal arteries; 0.66 for segmental arteries; 0.64 for interlobar arteries; 0.64 for arcuate arteries. Without pyelocaliceal dilatation, 0.67 for renal arteries; 0.64 for segmental arteries; 0.63 for interlobar arteries; and 0.61 for arcuate arteries. Portal vein flow velocities presented higher values in pregnancy, with mean value for maximum velocity of 28.9 cm/s, and 22.6 cm/s postpartum. The waveform pattern of the right hepatic vein presented changes persisting in the postpartum period in 31.8% of the patients. Cholelithiasis was observed in 18.1% of the patients. CONCLUSION Alterations in renal volume, pyelocaliceal dilatation, nephrolithiasis, cholelithiasis, changes in portal vein flow velocity, alterations in waveform pattern of the right hepatic vein, proved to be significant.
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Affiliation(s)
- Cibele Helena Daher
- MD, Researcher at Instituto de Radiologia do Hospital das
Clínicas da Faculdade de Medicina da Universidade de São Paulo
(InRad/HC-FMUSP), São Paulo, SP, Brazil
| | - Andrea Cavalanti Gomes
- Physician Assistants at Unit of Ultrasonography, Instituto de Radiologia
do Hospital das Clínicas da Faculdade de Medicina da Universidade de São
Paulo (In- Rad/HC-FMUSP), São Paulo, SP, Brazil
| | - Sergio Kobayashi
- Physician Assistants at Unit of Ultrasonography, Instituto de Radiologia
do Hospital das Clínicas da Faculdade de Medicina da Universidade de São
Paulo (In- Rad/HC-FMUSP), São Paulo, SP, Brazil
| | - Giovanni Guido Cerri
- Full Professor, Division of Radiology and Imaging Diagnosis, Faculdade
de Medicina da Universidade de São Paulo (FMUSP), São Paulo, SP,
Brazil
| | - Maria Cristina Chammas
- Director, Unit of Ultrasonography, Instituto de Radiologia do Hospital
das Clínicas da Faculdade de Medicina da Universidade de São Paulo
(InRad/HC-FMUSP), São Paulo, SP, Brazil
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Tomishige H, Morise Z, Kawabe N, Nagata H, Ohshima H, Kawase J, Arakawa S, Yoshida R, Isetani M. Caudal approach to pure laparoscopic posterior sectionectomy under the laparoscopy-specific view. World J Gastrointest Surg 2013; 5:173-177. [PMID: 23977419 PMCID: PMC3750128 DOI: 10.4240/wjgs.v5.i6.173] [Citation(s) in RCA: 48] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [What about the content of this article? (0)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/11/2013] [Revised: 03/27/2013] [Accepted: 05/10/2013] [Indexed: 02/06/2023] Open
Abstract
AIM: To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.
METHODS: Points of the procedure are: (1) Patients are put in left lateral position and posterior sector is not mobilized; (2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection; (3) Dissection of inferior vena cava (IVC) anterior wall behind the liver is started from caudal. Simultaneously, liver transection is performed to search right hepatic vein (RHV) from caudal; (4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial, exposing the surfaces of IVC and RHV. Since the remnant liver sinks down, the cutting surface is well-opend; and (5) After the completion of transection, dissection of the resected liver from retroperitoneum is easily performed using the gravity. This approach was performed for a 63 years old woman with liver metastasis close to RHV.
RESULTS: RHV exposure is required for R0 resection of the lesion. Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space, the use of specific characteristics of laparoscopic hepatectomy, such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning, made the complete RHV exposure during the liver transection easy to perform. The operation time was 341 min and operative blood loss was
1356 mL. Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.
CONCLUSION: The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.
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