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Tverdov IV, Akhaladze DG. [Transplantation technologies in pediatric liver resections]. Khirurgiia (Mosk) 2023:74-80. [PMID: 36583497 DOI: 10.17116/hirurgia202301174] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/31/2022]
Abstract
Liver resections with transplantation technologies have been recognized as safe procedures for the last decades. These procedures may be the only curative option or alternative to liver transplantation in some cases. Moreover, these surgeries can also provide parenchyma-sparing liver resection. Nevertheless, higher postoperative morbidity and mortality compared to traditional hepatectomy require careful research of indications for liver resections with transplantation technologies, the role of vascular liver exclusion, methods of vascular reconstructions with or without anticoagulation. These challenges are more important for pediatric surgery due to few literature data on this issue. This review is devoted to liver resections with transplantation technologies.
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Affiliation(s)
- I V Tverdov
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
| | - D G Akhaladze
- Dmitry Rogachev National Medical Research Center of Pediatric Hematology, Oncology and Immunology, Moscow, Russia
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Dziodzio T, Martin F, Gül-Klein S, Globke B, Ritschl PV, Jara M, Hillebrandt KH, Nösser M, Koulaxouzidis G, Fehrenbach U, Gratopp A, Henning S, Bufler P, Schöning W, Schmelzle M, Pratschke J, Witzel C, Öllinger R. Hepatic artery reconstruction using an operating microscope in pediatric liver transplantation-Is it worth the effort? Pediatr Transplant 2022; 26:e14188. [PMID: 34719848 DOI: 10.1111/petr.14188] [Citation(s) in RCA: 5] [Impact Index Per Article: 2.5] [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: 07/27/2021] [Revised: 10/19/2021] [Accepted: 10/23/2021] [Indexed: 12/11/2022]
Abstract
INTRODUCTION In pediatric liver transplantation (pLT), hepatic artery thrombosis (HAT) is associated with inferior transplant outcome. Hepatic artery reconstruction (HAR) using an operating microscope (OM) is considered to reduce the incidence of HAT. METHODS HAR using an OM was compared to a historic cohort using surgical loupes (SL) in pLT performed between 2009 and 2020. Primary endpoint was the occurrence of HAT. Secondary endpoints were 1-year patient and graft survival determined by Kaplan-Meier analysis and complications. Multivariate analysis was used to identify independent risk factors for HAT and adverse events. RESULTS A total of 79 pLTs were performed [30 (38.0%) living donations; 49 (62.0%) postmortem donations] divided into 23 (29.1%) segment 2/3, 32 (40.5%) left lobe, 4 (5.1%) extended right lobe, and 20 (25.3%) full-size grafts. One-year patient and graft survival were both 95.2% in the OM group versus 86.2% and 77.8% in the SL group (p = .276 and p = .077). HAT rate was 0% in the OM group versus 24.1% in the SL group (p = .013). One-year patient and graft survival were 64.3% and 35.7% in patient with HAT, compared to 93.9% and 92.8% in patients with no HAT (both p < .001). Multivariate analysis revealed HAR with SL (p = .022) and deceased donor liver transplantation (DDLT) (p = .014) as independent risk factors for HAT. The occurrence of HAT was independently associated with the need for retransplantation (p < .001) and biliary leakage (p = .045). CONCLUSION In pLT, the use of an OM is significantly associated to reduce HAT rate, biliary complications, and graft loss and outweighs the disadvantages of delayed arterial perfusion and prolonged warm ischemia time (WIT).
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Affiliation(s)
- Tomasz Dziodzio
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | - Friederike Martin
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Safak Gül-Klein
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Brigitta Globke
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | - Paul Viktor Ritschl
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | - Maximilian Jara
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Karl-Herbert Hillebrandt
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany.,BIH Charité (Digital) Clinician Scientist Program, Berlin Institute of Health (BIH), Berlin, Germany
| | - Maximilian Nösser
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Georgios Koulaxouzidis
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Uli Fehrenbach
- Department of Radiology, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Alexander Gratopp
- Division of Pulmonology, Immunology and Critical Care Medicine, Department of Pediatrics, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Stephan Henning
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Philipp Bufler
- Department of Pediatric Gastroenterology, Nephrology and Metabolic Diseases, Charité- Universitätsmedizin Berlin, Berlin, Germany
| | - Wenzel Schöning
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Moritz Schmelzle
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Johann Pratschke
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Christian Witzel
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
| | - Robert Öllinger
- Department of Surgery - Campus Charité Mitte and Campus Virchow-Klinikum, Charité - Universitätsmedizin Berlin, Berlin, Germany
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Brasoveanu V, Romanescu D, Diaconu C, Iliescu L, Stiru O, Brezean I, Belu E, Savu C, Savu C, Bratu O, Gorecki G, Pop L, Balescu I, Bacalbasa N. Hepatic artery reconstruction after extended resection for borderline resectable pancreatic head cancer: A case report. Exp Ther Med 2020; 21:87. [PMID: 33363598 DOI: 10.3892/etm.2020.9518] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/31/2020] [Accepted: 09/30/2020] [Indexed: 11/05/2022] Open
Abstract
Pancreatic head cancer is frequently associated with invasion of the surrounding vascular structures, such cases being considered for a long period of time as unresectable. Improvement of the vascular surgery techniques allowed association of extended vascular resections and reconstructions, increasing in this way the percentage of patients benefiting from radical surgery. We present the case of a 47-year-old male patient with no significant medical history diagnosed with a large pancreatic head tumor invading the common and proper hepatic artery as well as the portal vein. The venous reconstruction was performed using a synthetic prosthesis while the left hepatic artery was sutured to the left gastric artery; meanwhile the right hepatic artery was reconstructed using the splenic artery. In conclusion, extended hepatic artery resection followed by arterial reconstruction in association with portal vein resection and prosthetic replacement might be needed in cases presenting large pancreatic head tumors with vascular invasion.
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Affiliation(s)
- Vladislav Brasoveanu
- Department of Surgery, 'Dan Setlacec' Center of Gastrointestinal Diseases and Liver Transplantation, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Surgery, 'Sanador' Medical Center, 011038 Bucharest, Romania
| | - Dragos Romanescu
- Department of Internal Medicine, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania
| | - Camelia Diaconu
- Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, Clinical Emergency Hospital of Bucharest, 105402 Bucharest, Romania
| | - Laura Iliescu
- Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Internal Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Ovidiu Stiru
- Department of Cardiovascular Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Cardiovascular Surgery, 'Prof. Dr. C.C. Iliescu' Emergency Institute for Cardiovascular Diseases, 022322 Bucharest, Romania
| | - Iulian Brezean
- Department of Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Surgery, 'Dr. I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
| | - Emil Belu
- Department of Oncology, 'Prof. Dr. Al. Trestioreanu' Institute of Oncology, 022328 Bucharest, Romania
| | - Carmen Savu
- Department of Anesthesiology, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania
| | - Cornel Savu
- Department of Thoracic Surgery, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Thoracic Surgery, 'Marius Nasta' Institute of Pneumonology, 050159 Bucharest, Romania
| | - Ovidiu Bratu
- Department of Urology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Urology, Emergency Central Military Hospital, Academy of Romanian Scientists, 010825 Bucharest, Romania
| | - Gabriel Gorecki
- Department of Anaesthesia and Intensive Care, 'Ilfov' County Emergency Hospital, 022104 Bucharest, Romania
| | - Lucian Pop
- Department of Obstetrics and Gynecology, 'Alessandrescu‑Rusescu' National Institute of Mother and Child Health, Fetal Medicine Excellence Research Center, 020395 Bucharest, Romania
| | - Irina Balescu
- Department of Surgery, 'Ponderas' Academic Hospital, 021188 Bucharest, Romania
| | - Nicolae Bacalbasa
- Department of Obstetrics and Gynecology, 'Carol Davila' University of Medicine and Pharmacy, 020021 Bucharest, Romania.,Department of Visceral Surgery, Center of Excellence in Translational Medicine, 'Fundeni' Clinical Institute, 022328 Bucharest, Romania.,Department of Obstetrics and Gynecology, 'Dr. I. Cantacuzino' Clinical Hospital, 030167 Bucharest, Romania
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Kakizaki Y, Miyagi S, Hara Y, Fujio A, Miyazawa K, Maida K, Kashiwadate T, Tokodai K, Nakanishi C, Kamei T, Unno M. The extra-anatomical jump graft reconstruction of the right hepatic artery after resection of a biliary tract malignancy with a common hepatic artery aneurysm: a case report. Clin Case Rep 2017; 5:1841-1846. [PMID: 29152283 PMCID: PMC5676259 DOI: 10.1002/ccr3.1200] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [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: 05/22/2017] [Revised: 06/23/2017] [Accepted: 08/07/2017] [Indexed: 12/27/2022] Open
Abstract
Performing resection of a biliary tract malignancy with a hepatic artery aneurysm is very challenging. Resection of the extrahepatic bile duct and extra‐anatomical reconstruction can be successfully performed using free radial artery autografts from the aorta to the right hepatic artery. Hepatic artery thrombosis can be prevented with intimal preservation.
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Affiliation(s)
- Yuta Kakizaki
- Department of Surgery Tohoku University Sendai Japan
| | | | - Yasuyuki Hara
- Department of Surgery Tohoku University Sendai Japan
| | - Atsushi Fujio
- Department of Surgery Tohoku University Sendai Japan
| | - Koji Miyazawa
- Department of Surgery Tohoku University Sendai Japan
| | - Kai Maida
- Department of Surgery Tohoku University Sendai Japan
| | | | | | | | - Takashi Kamei
- Department of Surgery Tohoku University Sendai Japan
| | - Michiaki Unno
- Department of Surgery Tohoku University Sendai Japan
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Uchiyama H, Shirabe K, Araki K, Sugimachi K, Morita K, Takenaka K, Maehara Y. Left hepatectomy with simultaneous hepatic artery and portal vein reconstructions in the operation for cholangiocarcinoma: the surgical techniques comprised of step-by-step established procedures. Transl Gastroenterol Hepatol 2017; 2:34. [PMID: 28529988 DOI: 10.21037/tgh.2017.03.16] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.7] [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: 02/25/2017] [Accepted: 03/15/2017] [Indexed: 11/06/2022] Open
Abstract
Hepatectomy needing simultaneous reconstruction of the hepatic artery and the portal vein in the operation for cholangiocarcinoma is a challenging procedure. We experienced three cases of left hepatectomy with simultaneous reconstructions of the right hepatic artery (RHA) and the right portal vein (RPV) in all of which the surgical procedures were performed in the same manner. At the initial step of the procedure, we confirmed that the RHA and the RPV at the porta hepatis as well as the proper hepatic artery and the main portal vein (MPV) proximal to the cancer involvement could be controlled by tapes, which meant the cancer could be resected by means of vascular reconstructions. All the vascular reconstructions were performed under loupe magnification. The mean periods of portal and arterial ischemic time of the remnant liver were 14 min. 32 sec. and 35 min. 58 sec., respectively. The mean operative time and the intraoperative blood loss were 627 min. and 804 mL, respectively. No serious postoperative complication occurred. By performing step-by-step well-established procedures, this complicated and challenging operation could be safely completed.
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Affiliation(s)
- Hideaki Uchiyama
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
| | - Ken Shirabe
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | - Kenichiro Araki
- Department of Hepatobiliary and Pancreatic Surgery, Gunma University Hospital, Maebashi, Gunma, Japan
| | | | - Kazutoyo Morita
- Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Kenji Takenaka
- Department of Surgery, Fukuoka City Hospital, Fukuoka, Japan
| | - Yoshihiko Maehara
- Department of Surgery and Science, Graduate School of Medical Sciences, Kyushu University, Fukuoka, Japan
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Lee CF, Lu JCY, Zidan A, Lee CS, Wu TH, Chan KM, Lee WC. Microscope-assisted hepatic artery reconstruction in adult living donor liver transplantation-A review of 325 consecutive cases in a single center. Clin Transplant 2017; 31. [PMID: 27888549 DOI: 10.1111/ctr.12879] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 11/08/2016] [Indexed: 12/15/2022]
Abstract
BACKGROUND Despite the technical and medical improvements in the recent years, hepatic artery thrombosis (HAT) remains a devastating complication after living donor liver transplantation (LDLT). We described our surgical techniques and monitoring protocols for hepatic artery reconstruction. We reported one of the lowest incidence rates of HAT in the literature. METHODS Between 2008 and 2015, a total of 325 LDLTs performed at our institute were retrospectively analyzed. Under microscope assistance, all hepatic artery anastomosis were performed in a risk-free and back-wall first manner. We collected donors' and recipients' demographics, operative procedures, and outcome. RESULTS A total of 325 adult LDLTs were enrolled in the study. Of these, 297(91.4%) were right liver graft. The mean diameter of the hepatic arteries of the graft was 1.9 ± 0.3 mm. A single HA anastomosis was performed in 310 patients (95.4%). The 1-, 3-, and 5-year overall patient survival rates were 84.8%, 76.8%, and 75.2%, respectively. Only one (0.3%) episode of HAT was encountered in our series. The patient was treated successfully with nonsurgical management. CONCLUSION Our study showed that the occurrence of HAT is avoidable. Identifying risk factors associated with HAT, meticulous surgical techniques, and careful routine flow monitoring are mandatory to avoid disastrous complications.
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Affiliation(s)
- Chen-Fang Lee
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Johnny Chuieng-Yi Lu
- Division of Reconstructive Microsurgery, Department of Plastic and Reconstructive Surgery, Chang Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Ahmed Zidan
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan.,Assiut University Hospital, Assiut, Egypt
| | - Ching-Song Lee
- Department of Gastroenterology, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Tsung-Han Wu
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Kun-Ming Chan
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
| | - Wei-Chen Lee
- Department of Liver and Transplantation Surgery, Chang-Gung Memorial Hospital at Linkou, Taoyuan, Taiwan
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