1,399 results on '"Laparoscopic hepatectomy"'
Search Results
302. Laparoscopic hepatectomy for hepatic angiomyolipoma with preoperative diagnosis of other malignancy: a report of 2 cases
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Tatsuya Orimo, Yoh Asahi, Shingo Shimada, Akinobu Taketomi, Toshiya Kamiyama, Kazuya Hamada, Chihiro Ishizuka, Akihisa Nagatsu, Emi Takakuwa, Yuzuru Sakamoto, Tomoko Mitsuhashi, and Hirofumi Kamachi
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medicine.medical_specialty ,Liver tumor ,Hepatic Angiomyolipoma ,business.industry ,medicine.medical_treatment ,lcsh:Surgery ,Case Report ,Autoimmune hepatitis ,lcsh:RD1-811 ,medicine.disease ,Malignancy ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Laparoscopic hepatectomy ,medicine ,030211 gastroenterology & hepatology ,Hepatic angiomyolipoma ,Hepatectomy ,business ,Pathological ,Calcification - Abstract
Background Hepatic angiomyolipoma (HAML) is a rare liver tumor, and hepatectomy is the only effective treatment. Due to the difficulty of correct diagnosis of HAML before surgery by image studies, more than 36.6% of reported HAMLs are misdiagnosed as other malignant liver tumors before surgery. As there are only few reported cases in which HAMLs were removed using laparoscopic hepatectomy, the effectiveness of laparoscopic hepatectomy for such HAMLs in which are diagnosed as other malignant liver tumor before surgery has not been reported. Case presentation Case 1: a 58-year-old female with a history of treatment for autoimmune hepatitis was preoperatively diagnosed with hepatocellular carcinoma (size: 20 mm) in segment 7 (S7) of the liver. The tumor was removed by laparoscopic partial resection and was diagnosed as a HAML through a pathological examination. The patient’s postoperative course was good, and she was recurrence-free at 37 months after the hepatectomy. Case 2: a 29-year-old female with a history of surgery for a right mature cystic teratoma was referred to our department to receive treatment for a growing 20-mm liver tumor with some calcification, which arose in S3 of the liver. A metastatic liver tumor derived from the mature cystic teratoma was suspected, and laparoscopic left lateral sectionectomy was performed. The liver tumor was diagnosed as a HAML after a pathological examination. The patient’s postoperative course was unremarkable, and more than 54 months have passed since the hepatectomy without any recurrence. Conclusions Two cases in which HAMLs were preoperatively diagnosed as other malignant liver tumor were successfully removed by laparoscopic hepatectomy with a correct postoperative diagnosis. Laparoscopic hepatectomy for the present 2 cases of HAML seemed to be effective for providing a correct diagnosis after the curative removement of liver tumor with a smaller invasion compared to open hepatectomy, and for denying risk of dissemination of the malignant tumor by needle biopsy that had to be considered before ruling out malignant tumor.
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- 2021
303. Laparoscopic hepatectomy versus open hepatectomy for hepatocellular carcinoma: A propensity case-matched analysis of the long-term survival
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Yuk-Pang Yeung, Kai-Chi Cheng, Fiona Ka-Man Chan, and Kit-Man Ho
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Laparoscopic surgery ,medicine.medical_specialty ,Survival ,business.industry ,Hepatocellular carcinoma ,medicine.medical_treatment ,Laparoscopic hepatectomy ,Perioperative ,medicine.disease ,Long-term outcome ,Surgery ,Propensity score matching ,medicine ,Resection margin ,General Materials Science ,Original Article ,Hepatectomy ,Complication ,business - Abstract
Backgrounds/aims Despite the widespread popularity of laparoscopic surgery, laparoscopic liver resection (LLR) remains in evolution. This study aimed to compare the long-term outcomes for patients undergoing laparoscopic versus open hepatectomy for hepatocellular carcinoma (HCC) ≤7 cm. Methods Patients diagnosed with HCC treated by hepatectomy from October 2000 to May 2019 were included. Excluding tumors larger than 7 cm, 1:2 propensity score matching was performed between laparoscopic and open hepatectomies. The perioperative outcomes, 5-year overall survival (OS) and disease-free survival (DFS) of the two groups were compared. Results Forty-five patients who underwent LLR were matched to 90 open hepatectomy (OH) during the same period. LLR group had shorter median hospital stay (5 days vs. 9 days, p=0.00) but required longer operative time (326.0 minutes vs. 272.5 minutes, p=0.018) than the OH group. The 5-year overall survival was better in the LLR group (84.9% vs. 61.1%; p=0.036), though there was no significant difference in the 5-year disease free survival (20.0% vs. 22.2%, p=0.613). The rate of R0 resection was comparable between the 2 groups with a slightly better margin distance in the LLR (5 mm vs. 3 mm, p=0.043). Conclusions Laparoscopic liver resection is safe and feasible for cirrhotic patients with HCC size up to 7 cm. It has better short-term outcomes and comparable perioperative blood loss and complication rates. The resection margin is not jeopardized and the 5-year overall and disease-free survivals are comparable with the open group.
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- 2021
304. The Current State of Minimally Invasive Living Donor Hepatectomy
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Carpenter, Dustin, Chaudhry, Sulemon, and Samstein, Benjamin
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- 2020
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305. Laparoscopic hepatectomy reduces postoperative complications and hospital stay in overweight and obese patients
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Marielle M.E. Coolsen, Ronald M. van Dam, Ulf P. Neumann, Andreas Kroh, Daniel Heise, Jan Bednarsch, Roman Eickhoff, Florian Ulmer, Sandra Schipper, Sven Arke Lang, MUMC+: MA Heelkunde (9), Surgery, and RS: NUTRIM - R2 - Liver and digestive health
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medicine.medical_specialty ,obesity ,Hepatic resection ,Cost ,IMPACT ,Laparoscopic hepatectomy ,body-mass index ,HEPATIC RESECTION ,morbidity ,030230 surgery ,Overweight ,laparoscopic hepatectomy ,postoperative outcome ,outcomes ,SURGICAL COMPLICATIONS ,technical feasibility ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Postoperative outcome ,Retrospective Cohort Study ,cancer ,overweight ,business.industry ,nutritional and metabolic diseases ,Cancer ,medicine.disease ,Obesity ,Surgery ,LIVER RESECTION ,030211 gastroenterology & hepatology ,medicine.symptom ,business ,Body mass index ,Hospital stay - Abstract
BACKGROUNDLaparoscopic liver surgery is currently considered the standard of care for various liver malignancies. However, studies focusing on perioperative outcome after laparoscopic hepatectomy (LH) in overweight patients are still sparse and its benefit compared to open hepatectomy (OH) is a matter of debate.AIMTo analyze postoperative outcomes in overweight [body mass index (BMI) over 25 kg/m(2)] and obese (BMI over 30 kg/m(2)) patients undergoing LH and compare postoperative outcome with patients undergoing OH.METHODSPerioperative data of 68 overweight (BMI over 25 kg/m(2)) including a subcohort of obese (BMI over 30 kg/m(2)) patients (n = 27) who underwent LH at our institution between 2015 and 2019 were retrospectively analyzed regarding surgical outcome and compared to an equal number of patients undergoing OH.RESULTSThe mean BMI was 29.8 +/- 4.9 kg/m(2) in the LH group and 29.7 +/- 3.6 kg/m(2) in the OH group with major resections performed in 20.6% (LH) and 26.5% (OH) of cases, respectively. Operative time (194 +/- 88 min vs 275 +/- 131 min; P < 0.001) as well as intensive care (0.8 +/- 0.7 d vs 1.1 +/- 0.8 d; P = 0.031) and hospital stay (7.3 +/- 3.6 d vs 15.7 +/- 13.5 d; P < 0.001) were significant shorter in the LH group. Also, overall complications (20.6% vs 45.6%; P = 0.005) and major complications (1.5% vs 14.7%, P = 0.002) were observed less frequently after LH. An additional investigation analyzing the subgroup of obese patients who underwent LH (n = 27) and OH (n = 29) showed a shorter operative time (194 +/- 81 min vs 260 +/- 137 min; P = 0.009) and a reduced length of hospitalization (7.7 +/- 4.3 d vs 17.2 +/- 17 d; P < 0.001) but no difference in postoperative complications or overall cost.CONCLUSIONLH is safe and cost-effective in overweight and obese patients. Furthermore, LH is significantly associated with fewer postoperative complications and reduced hospital stay compared to OH in these patients.
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- 2021
306. Current role of intraoperative ultrasonography in hepatectomy
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Tatsuhiko Kakisaka, Toshiya Kamiyama, and Tatsuya Orimo
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medicine.medical_specialty ,medicine.medical_treatment ,Laparoscopic hepatectomy ,Clinical Decision-Making ,Intraoperative ultrasonography ,Hepatic Veins ,Liver transplantation ,Sensitivity and Specificity ,Intraoperative Period ,Imaging, Three-Dimensional ,Blood loss ,Hepatectomy ,Humans ,Medicine ,Ultrasonography ,medicine.diagnostic_test ,Blood flow volume ,Portal Vein ,business.industry ,Liver Neoplasms ,Magnetic resonance imaging ,General Medicine ,Liver Transplantation ,Liver ,Surgery, Computer-Assisted ,Laparoscopy ,Surgery ,Radiology ,Liver function ,Safety ,business - Abstract
Hepatectomy had a high mortality rate in the previous decade because of inadequate techniques, intraoperative blood loss, liver function reserve misdiagnoses, and accompanying postoperative complications. However, the development of several modalities, including intraoperative ultrasonography (IOUS), has made hepatectomy safer. IOUS can provide real-time information regarding the tumor position and vascular anatomy of the portal and hepatic veins. Systematic subsegmentectomy, which leads to improved patient outcomes, can be performed by IOUS in open and laparoscopic hepatectomy. Although three-dimensional (3D) computed tomography and gadoxetic acid-enhanced magnetic resonance imaging have been widely used, IOUS and contrast-enhanced IOUS are important modalities for risk analyses and making decisions regarding resectability and operative procedures because of the vital anatomical information provided and high sensitivity for liver tumors, including "disappearing" liver metastases. Intraoperative color Doppler ultrasonography can be used to delineate the vascular anatomy and evaluate the blood flow volume and velocity in hepatectomy patients and recipients of deceased- and living-donor liver transplantation after vessel reconstruction and liver positioning. For liver surgeons, IOUS is an essential technique to perform highly curative hepatectomy safely, although recent advances have also been made in virtual modalities, such as real-time virtual sonography with 3D visualization.
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- 2021
307. Laparoscopic repeat liver resection for recurrent hepatocellular carcinoma.
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Goh, Brian K. P., Teo, Jin‐Yao, Chan, Chung‐Yip, Lee, Ser‐Yee, Cheow, Peng‐Chung, and Chung, Alexander Y. F.
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LIVER cancer , *CANCER relapse , *SURGICAL excision , *LAPAROSCOPIC surgery , *PREVENTION ,PREVENTION of surgical complications - Abstract
Background Repeat liver resection is effective for recurrent hepatocellular carcinoma ( rHCC). This study aimed to determine the outcomes of laparoscopic repeat liver resection ( LRLR) for rHCC. Methods Eight consecutive patients who underwent LRLR for rHCC were retrospectively reviewed. Results Six patients had previous open and two had laparoscopic liver resection (LLR). There was one (12.5%) open conversion for bleeding and one (12.5%) post-operative morbidity. The median tumour size was 24 mm (range: 8-50 mm). LRLR was performed for rHCC in the ipsilateral lobe as compared to the index surgery in 4/8 (50%) patients. Five of eight (62.5%) patients had rHCC in the difficult posterosuperior segments. Six patients had previous open LR, and two had previous LLR. One patient (patient 4) had two prior open LR for rHCC, and LRLR was performed for the second recurrence. The median duration from the first surgery to LRLR was 29 months (range: 6-109 months). The median post-operative stay was 3.5 days. All eight patients had R0 resections, and at a median follow-up of 7.5 months, all patients were disease-free. Conclusion LRLR for rHCC is feasible and safe. This can be performed even for patients with previous open liver resections, cirrhosis, lesions in the posterosuperior segments and prior LR of the ipsilateral lobe. LRLR for rHCC is feasible and safe in highly selected patients. [ABSTRACT FROM AUTHOR]
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- 2017
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308. Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas.
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Zhang, Wanguang, Wang, Jian, Li, Changhai, Zhang, Zhanguo, Dirie, Najib, Dong, Hanhua, Xiang, Shuai, Zhang, Wei, Zhang, Zhiwei, Zhang, Bixiang, Chen, Xiaoping, and Dirie, Najib Isse
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LIVER tumors , *TUMOR treatment , *HEMANGIOMAS , *INFERIOR vena cava surgery , *HEPATECTOMY , *LAPAROSCOPIC surgery , *CELL enucleation , *HEMORRHAGE prevention , *THERAPEUTICS , *SURGICAL blood loss , *COMPARATIVE studies , *SURGICAL hemostasis , *LAPAROSCOPY , *RESEARCH methodology , *MEDICAL cooperation , *RESEARCH , *RESEARCH funding , *PILOT projects , *EVALUATION research , *TREATMENT effectiveness , *RETROSPECTIVE studies , *PREVENTION - Abstract
Background: This study aimed to determine the feasibility of the extracapsular enucleation method for giant liver hemangiomas by infrahepatic inferior vena cava (IVC) clamping and the Pringle maneuver to control intraoperative bleeding under laparoscopic hepatectomy.Methods: From January 2012 to January 2016, 36 patients underwent laparoscopic extracapsular enucleation of giant liver hemangiomas. Patients were divided into two groups: infrahepatic IVC clamping + Pringle maneuvers group (IVCP group, n = 15) and the Pringle maneuvers group (Pringle group, n = 21). Operative parameters, postoperative laboratory tests, and morbidity and mortality were analyzed.Results: The mean size of liver hemangiomas was 13.3 cm (range 10-25 cm). Infrahepatic IVC clamping + the Pringle maneuvers with laparoscopic extracapsular enucleation significantly reduced intraoperative blood loss (586.7 vs 315.3 mL, p < 0.001) and transfusion rates (23.8 vs 6.7%, p = 0.001), compared with the Pringle maneuver alone. The gallbladder was retained in both groups. The mean arterial pressure (MAP) in Pringle group remained virtually stable before and after clamping of hepatic portal, while it was significantly decreased after IVC clamping in IVCP group than that pre-clamping (p < 0.001). The heart rate of all patients was significantly increased after clamping when compared to pre-clamping heart rates (p < 0.001). Once vascular occlusion was released, MAP returned to normal levels within a few minutes. There were no significant differences in postoperative complications between two groups. The vascular occlusion techniques in both groups had no serious effect on postoperative of hepatic and renal function.Conclusions: Extracapsular enucleation with infrahepatic IVC clamping + the Pringle maneuver is a safe and effective surgical treatment to control bleeding for giant liver hemangiomas in laparoscopic hepatectomy. [ABSTRACT FROM AUTHOR]- Published
- 2017
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309. Recurrence of Hepatocellular Carcinoma After Laparoscopic Hepatectomy: Risk Factors and Treatment Strategies.
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Xu, Xiaodong, Chen, Jiahui, Wang, Feiran, Ni, Qinggan, Naimat, Ullah, and Chen, Zhong
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DISEASE relapse , *CANCER risk factors , *LIVER cancer , *HEPATECTOMY , *LAPAROSCOPIC surgery , *CANCER relapse , *HEPATOCELLULAR carcinoma , *LAPAROSCOPY , *LIVER tumors , *PROGNOSIS , *SURGICAL complications , *SURGICAL blood loss - Abstract
Purpose: To investigate the risk factors for recurrence and treatment strategies after patients with hepatocellular carcinoma (HCC) undergo total laparoscopic hepatectomy (LH).Methods: The study included 109 patients who underwent LH (laparoscopy resection [LR] group, n = 50) or open hepatectomy [OH] (open resection [OR] group, n = 59) for HCC in our hospital between March 2011 and June 2016. Perioperative outcomes, disease recurrence, survival, and risk factors for recurrence were analyzed.Results: Patient characteristics did not significantly differ between groups. The 1- and 3-year survival rates were 90.7% and 78.1%, respectively, for the LR group and 83.1% and 74.4%, respectively, for the OR group (P = .71). The 1- and 3-year disease-free survival rates were 89.6% and 51.4%, respectively, for the LR group and 84.7% and 59.6%, respectively, for the OR group (P = .935). Tumor size, differentiation, vascular invasion, surgical bleeding, and surgical resection margin were risk factors for tumor recurrence after LH.Conclusion: LH for HCC did not increase the risk of recurrence compared with OH. Tumor size, differentiation, vascular invasion, surgical bleeding, and surgical resection margin were risk factors for tumor recurrence. Reducing bleeding during surgery and ensuring sufficient surgical margins were the most important measures to reduce postoperative recurrence of HCC. [ABSTRACT FROM AUTHOR]- Published
- 2017
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310. Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center.
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Li, Wenda, Zhou, Xue, Huang, Zejian, Zhang, Kelin, Luo, Xuan, Zhong, Jinyi, and Chen, Yajin
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HEPATECTOMY , *LAPAROSCOPY , *LIVER cancer , *SURVIVAL analysis (Biometry) - Abstract
Aim Laparoscopic hepatectomy (LH), microwave ablation (MWA), and open hepatectomy (OH) are three widely used methods to treat small hepatocellular carcinoma (HCC). However, few studies have compared the short- and long-term outcomes of these three treatments. The aim of this study was to investigate their effectiveness. Methods The data were reviewed from 280 patients with HCCs measuring ≤3 cm (Barcelona Clinic Liver Cancer stage 0 or A) who received LH ( n = 133), OH ( n = 87), or MWA ( n = 60) in our research center from 2005 to 2010. Short-term outcomes included intraoperative blood loss, operation time, and length of hospital stay. The disease-free survival and overall survival rates were analyzed as long-term outcomes. Results The patients in the MWA and LH groups showed better short-term outcomes compared with those in the OH group. There were no significant differences in overall survival rates among the three treatments. The LH group showed significantly lower recurrence rates than the MWA group ( P = 0.0146). Conclusions Laparoscopic hepatectomy may be a better option for patients with small HCC located on the liver surface and left lateral lobe. The short-term outcome of MWA is promising, although the high risk of local recurrence after the operation should be considered when planning treatment. [ABSTRACT FROM AUTHOR]
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- 2017
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311. Effective stepwise training and procedure standardization for young surgeons to perform laparoscopic left hepatectomy.
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Yamada, Shinichiro, Shimada, Mitsuo, Imura, Satoru, Morine, Yuji, Ikemoto, Tetsuya, Saito, Yu, Takasu, Chie, Yoshikawa, Masato, Teraoku, Hiroki, Yoshimoto, Toshiaki, and Takata, Atsushi
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HEPATECTOMY , *EDUCATION of surgeons , *MENTORING in medicine , *MEDICAL imaging systems , *THREE-dimensional imaging , *CLINICAL competence , *LAPAROSCOPY , *MENTORING , *SURGEONS , *OPERATIVE surgery , *WEIGHTS & measures , *CERTIFICATION , *SURGICAL blood loss ,LAPAROSCOPIC surgery complications - Abstract
Background: Laparoscopic hepatectomy remains one of the most difficult procedures for young surgeons to perform. We recently developed a new training method and standardization procedure for teaching young surgeons to perform laparoscopic left hepatectomy (Lap-LHx). The aim of this study was to assess the effectiveness of our method.Methods: In 2004, we standardized a laparoscopic procedure for Lap-LHx, using a laparoscopy-assisted method as a stepping stone. The laparoscopic training method comprised the following three steps: (1) training in fundamental procedures using a dry box and checking by mentors; (2) detailed preoperative simulation using Vincent three-dimensional software for each patient; and (3) self-assessment including understanding of relevant anatomy and completion grade for each procedure using a check sheet and feedback by both mentors and a professor. Twenty-three Lap-LHx procedures performed during the study period were divided into two groups: those performed by young non-board-certified surgeons (n = 9) and those performed by senior board-certified surgeons (n = 14).Results: The blood loss and operative time were similar in the young surgeon (194 g and 336 min, respectively) and senior surgeon groups (208 g and 322 min, respectively).Conclusion: Our standardized Lap-LHx procedure and stepwise training to perform it enable young surgeons to perform Lap-LHx as confidently and safely as more experienced surgeons. [ABSTRACT FROM AUTHOR]- Published
- 2017
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312. Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors.
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Ichida, Hirofumi, Ishizawa, Takeaki, Tanaka, Masayuki, Terasawa, Muga, Watanabe, Genki, Takeda, Yoshinori, Matsuki, Ryota, Matsumura, Masaru, Hata, Taigo, Mise, Yoshinori, Inoue, Yosuke, Takahashi, Yu, and Saiura, Akio
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HEPATECTOMY , *LAPAROSCOPIC surgery , *LIVER tumors , *TUMOR treatment , *ARTIFICIAL pneumoperitoneum , *ABDOMEN , *DIAPHRAGM (Anatomy) , *ENDOSCOPES , *LAPAROSCOPY , *SURGICAL blood loss ,TUMOR surgery - Abstract
Background: The aim of this study was to demonstrate the detailed surgical techniques of laparoscopic hepatectomy using intercostal transthoracic trocars for subcapsular tumors located in segment VII or VIII.Methods: Intercostal transthoracic trocars were used in patients undergoing laparoscopic hepatectomy for tumors located in segment VII or VIII. Following establishment of pneumoperitoneum and placement of abdominal trocars, balloon-tipped trocars were inserted into the abdominal cavity from the intercostal space and through the pleural space and diaphragm. Upon placement of the intercostal trocars, the lung edge was confirmed by ultrasonography and laparoscopic examination. Following minimal mobilization of the right liver, hemispherical wedge resection of segment VII or VIII was performed using the intercostal trocars as a camera port or for the forceps of the surgeon's left hand. After the hepatectomy, the holes in the diaphragm were sutured closed.Results: Among the 79 patients who underwent laparoscopic hepatectomy, intercostal trocars were used in 14 patients for resection of tumors located in segment VII (4 nodules) or VIII (10 nodules). The median (range) operation time and amount of blood loss for hepatectomy were 225 (109-477) min and 60 (20-310) mL, respectively. No postoperative complications associated with hepatectomy or the use of intercostal trocars occurred.Conclusions: Use of intercostal transthoracic trocars is safe and effective not only for complicated laparoscopic hepatectomy but also for hemispherical wedge resections of subcapsular hepatic tumors located in segment VII or VIII. [ABSTRACT FROM AUTHOR]- Published
- 2017
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313. Clinical impact of laparoscopic hepatectomy: technical and oncological viewpoints.
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Komatsu, Shohei, Brustia, Raffaele, Goumard, Claire, Sepulveda, Ailton, Perdigao, Fabiano, Soubrane, Olivier, and Scatton, Olivier
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HEPATECTOMY , *LIVER surgery , *LIVER cancer , *LIVER metastasis , *ONCOLOGIC surgery , *ADENOMA , *HEPATOCELLULAR carcinoma , *LAPAROSCOPY , *LIVER tumors , *METASTASIS , *CANCER treatment , *CHOLANGIOCARCINOMA , *TREATMENT effectiveness ,BILE duct tumors - Abstract
The objective of this study was to assess the clinical impact of laparoscopic hepatectomy from technical and oncological viewpoints through the consecutive 5-year experience of an expert team. The subjects consisted of 491 consecutive hepatectomies performed over the course of 5 years. A total of 190 hepatectomies (38.6 %) were performed laparoscopically, and the remaining 301 (61.4 %) were open hepatectomies. Chronological trends of operative procedures and their indications were evaluated, and patients with hepatocellular carcinoma (HCC) were analyzed from an oncological viewpoint. The proportion of laparoscopic hepatectomies performed increased significantly during the study period (from 17.6 to 49.5 %). According to chronological trends, right hepatectomy was standardized using consecutive steps after minor hepatectomy, left lateral sectionectomy, and left hepatectomy were standardized. The proportion of laparoscopic hepatectomies performed for HCC increased from 21.4 to 71.0 %. No significant difference was observed in the proportion of major hepatectomies performed for HCC between the open and laparoscopy groups (50.6 vs. 48.6 %, p = 0.8053), whereas that of anatomical segmentectomy for HCC was significantly lower in the laparoscopy group (28.7 vs. 11.1 %, p = 0.0064). All laparoscopic anatomical segmentectomies were of segments 5 and 6, and there was no segmentectomy of posterosuperior lesions. The present study shows the consecutive technical developmental processes for minor hepatectomy, left lateral sectionectomy, left hepatectomy, and right hepatectomy without compromising oncological principles. Laparoscopic anatomical segmentectomy for posterosuperior lesions may be the most technically demanding procedure, requiring individualized standardization. [ABSTRACT FROM AUTHOR]
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- 2017
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314. Usefulness of a CT-guided hookwire marking in laparoscopic partial hepatectomy for hepatocellular carcinoma invisible on ultrasonography.
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Monden, Kazuteru, Sadamori, Hiroshi, Hioki, Masayoshi, Nakano, Kanyu, Asami, Shinya, Ohno, Satoshi, Sasaki, Kyo, Ueki, Toru, Yabushita, Kazuhisa, Uka, Mayu, Hyodo, Tsuyoshi, Sakaguchi, Kousaku, and Takakura, Norihisa
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LIVER cancer , *COMPUTED tomography , *HEPATECTOMY , *LAPAROSCOPIC surgery , *OPERATIVE ultrasonography , *LIVER punctures , *SURGICAL site - Abstract
Introduction The intra-operative detection of hepatocellular carcinoma (HCC) by ultrasonography is indispensable for laparoscopic partial hepatectomy. However, it is occasionally difficult to localize an HCC on an ultrasound in chronic liver disease. Two cases of partial hepatectomy using hookwire marking under CT guidance are presented. Materials and Surgical Technique The location of the HCC was identified by CT scan, and the puncture site was determined. A hookwire system, made of a stainless steel hook, was used to localize the HCC. The hookwire was placed percutaneously close to the HCC, and then the patient was taken to the operating room as soon as possible. After identification of the hookwire marker, the cutting line was determined on the liver surface to ensure a sufficient surgical margin in laparoscopic partial hepatectomy. Discussion Two cases underwent these procedures with easy intra-operative marking of the resection area. This technique facilitates safe laparoscopic partial hepatectomy for an HCC that is invisible on ultrasound. [ABSTRACT FROM AUTHOR]
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- 2017
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315. Liver mobilization and liver hanging for totally laparoscopic right hepatectomy: an easy way to do it.
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Rotellar, Fernando, Pardo, Fernando, Martí-Cruchaga, Pablo, Zozaya, Gabriel, Valentí, Victor, Bellver, Manuel, Lopez-Olaondo, Luis, and Hidalgo, Francisco
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LAPAROSCOPIC surgery , *HEPATECTOMY , *LIVER transplantation , *LIVER cancer , *LAPAROSCOPY - Abstract
Purpose: The purpose of this study is to describe a technical modification that facilitates right liver mobilization in laparoscopic right hepatectomy (LRH). Methods: In the supine position, an inflatable device is placed under the patient's right chest. For right hemiliver mobilization, the table is placed in 30° anti-Trendelenburg and full-left tilt. Balloon inflation offers an additional 30° left inclination that places the patient in an almost left lateral position. Foot and lateral supports are placed to prevent patient slippage during changes in the patient positioning. Results: From December 2013 to October 2015, this technique has been used in 10 consecutive LRH. The indications for these procedures were as follows: four donor hepatectomies for living donor liver transplant, three hepatocellular carcinomas and one peripheral cholangiocarcinoma in cirrhotic patients, one hepatocellular carcinoma in a non-cirrhotic patient, and one case of colorectal cancer metastases. In this period, it has also been used to facilitate mobilization and resection in the posterior segments of the liver in seven patients. In every case, right hemiliver mobilization was easily performed in a maximum time of 15 min and placement of a tape or plastic tube for liver hanging was prepared. We have not observed any complication directly attributable to the technique herein described (i.e. right brachialgia; arms, back or left flank pain) in the early or late postoperative follow-up. Conclusions: The additional left inclination obtained with the inflation of a balloon under the right chest facilitates right hemiliver mobilization. Its use may help in the performance and adoption of LRH. [ABSTRACT FROM AUTHOR]
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- 2017
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316. Comprehensive guide to laparoscope-assisted graft harvesting in live donors for living-donor liver transplantation: perspective of laparoscopic vision.
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Tomohide Hori, Toshimi Kaido, Taku Iida, Shintaro Yagi, and Shinji Uemoto
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LIVER transplantation , *LAPAROSCOPES , *LAPAROSCOPIC surgery - Abstract
Background: A living donor (LD) for liver transplantation (LT) is the best target for minimally invasive surgery. Laparoscope-assisted surgery (LAS) for LDs has gradually evolved. A donor safety rate of 100% should be guaranteed. Methods: We began performing LAS for LDs in June 2012. The aim of this report is to describe the surgical procedures of LAS in detail, discuss various tips and pitfalls, and address the potential for a smooth transition to more advanced LAS. Results: Preoperative planning based on three-dimensional image analysis is a powerful tool for successful surgery. The combination of liver retraction/countertraction and the pressure produced by pneumoperitoneum widens the dissectible/cuttable layer, increasing the safety of LAS. A flexible laparoscope provides excellent magnified vision in both the horizontal view along the inferior vena cava, under adequate liver retraction, and in the lateral view, to harvest left-sided grafts in critical procedures. Intentional omission of painful incisions is beneficial for LDs. Hepatectomy using a smaller midline incision is safe if a hanging maneuver is used. Safe transition from LAS to a hybrid technique involving a combination of pure laparoscopic surgery and subsequent open surgery seems possible. Conclusion: LDLT surgeons have a very broad intellectual and technical frontier. [ABSTRACT FROM AUTHOR]
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- 2017
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317. Effects of targeted mild hypercapnia versus normocapnia on cerebral oxygen saturation in patients undergoing laparoscopic hepatectomy under low central venous pressure: a prospective, randomized controlled study.
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Lv H, Xiong C, Wu B, Lan Z, Xu D, Duan D, Huang X, Guo J, and Yu S
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- Humans, Central Venous Pressure, Hepatectomy, Prospective Studies, Oxygen Saturation, Oxygen, Postoperative Complications, Hypercapnia, Laparoscopy
- Abstract
Background: Laparoscopic hepatectomy under low central venous pressure (LCVP) is associated with intraoperative organ hypoperfusion, including cerebral hypoperfusion. We hypothesized that a ventilation strategy designed to achieve targeted mild hypercapnia (TMH) (end-tidal carbon dioxide partial pressure [PetCO
2 ] of 45 ± 5 mmHg) rather than targeted normocapnia (TN) (PetCO2 of 30 ± 5 mmHg) would increase regional cerebral oxygen saturation (rSO2 ) during laparoscopic hepatectomy under LCVP., Methods: Eighty patients undergoing laparoscopic hepatectomy under LCVP were randomly divided into the TMH group (n = 40) and the TN group (n = 40). Mechanical ventilation was adjusted to maintain the PetCO2 within the relevant range. Cerebral oxygenation was monitored continuously using the FORE-SIGHT system before anesthetic induction until the patient left the operating room. Patient and surgical characteristics, rSO2 , intraoperative hemodynamic parameters (CVP, mean artery blood pressure [MAP], and heart rate), PetCO2 , intraoperative blood gas analysis results, and postoperative complications were recorded., Results: No significant differences were observed in CVP, MAP, and heart rate between the two groups during surgery. The rSO2 was significantly lower in the TN group on both the left and right sides during the intraoperative period (P < 0.05), while the TMH group had a stable rSO2 . In the TN group, the mean rSO2 decreased most during liver parenchymal transection when compared with the baseline value (P < 0.05). The mean (standard deviation) percentage change in rSO2 from baseline to parenchymal transection was - 7.5% (4.8%) on the left and - 7.1% (4.6%) on the right. The two groups had a similar incidence of postoperative complications (P > 0.05)., Conclusion: Our findings demonstrate that rSO2 is better maintained during laparoscopic hepatectomy under LCVP when patients are ventilated to a PetCO2 of 45 ± 5 mmHg (TMH) than a PetCO2 of 30 ± 5 mmHg (TN)., Trial Registration: ChiCTR2100051130(14/9/2021)., (© 2023. The Author(s).)- Published
- 2023
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318. Laparoscopic Extended Left Lateral Sectionectomy for Hepatocellular Carcinoma in a Patient with Right-Sided Ligamentum Teres: A Case Report and Literature Review.
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Adachi Y, Takahashi H, Yamamoto T, Hagiwara M, Imai K, and Yokoo H
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Right-sided ligamentum teres (RSLT) is a rare anatomic variant in which the fetal umbilical vein connects to the right portal vein. Patients with RSLT frequently have hepatic vasculature and bile duct anomalies, which increase the risk of complications with hepatectomy. Most patients with RSLT undergo open hepatectomy. Herein, we describe a patient with RSLT and hepatocellular carcinoma who underwent laparoscopic hepatectomy. The patient was a 69-year-old man with hepatocellular carcinoma located in the left liver based on computed tomography (CT) and magnetic resonance imaging. Imaging also demonstrated RSLT. Three-dimensional CT analysis revealed independent right lateral type anomalies of the portal vein and bile duct. A laparoscopic extended left lateral sectionectomy was performed after careful surgical planning. Ultrasonography was used frequently during surgery to avoid damaging the right hepatic vasculature. The left lateral and partial left median sections were removed as planned. The patient's postoperative recovery was uneventful. Avoiding injury to the right hepatic vasculature is essential when performing left lobectomy, including left lateral sectionectomy, in patients with RSLT. Laparoscopic hepatectomy can be performed safely in patients with RSLT, provided that careful surgical planning is conducted using preoperative three-dimensional CT analysis and intraoperative ultrasonography.
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- 2023
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319. Primary animal experiment to test the feasibility of a novel Y-Z magnetic hepatic portal blocking band.
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Zhang MM, Li CG, Xu SQ, Mao JQ, Ren YX, Zhang YH, Ma J, Shi AH, Lyu Y, and Yan XP
- Abstract
Background: Hepatic portal blood flow occlusion is a common technique for reducing hepatic hemorrhage during hepatectomy. We designed a novel Y-Z magnetic hepatic portal blocking band (Y-Z MHPBB) based on the principle of magnetic compression technique., Aim: To introduce the Y-Z MHPBB device and verify the feasibility of this device for hepatic portal blood flow occlusion in dogs., Methods: Ten beagles were randomly divided into the experimental group and control group. The operation time, intraoperative blood loss, the number of portal blood flow occlusions, the total time spent on adjusting the blocking band, and the average time spent on adjusting the blocking band were recorded. The surgeons evaluated the feasibility and flexibility of the two portal occlusion devices., Results: Laparoscopic hepatectomy was successfully performed in both the experimental group and control group. There was no statistical difference between the two groups in the operation time, intraoperative blood loss, and the number of hepatic portal blood flow occlusions. With respect to the total time spent on adjusting the blocking band and the average time spent on adjusting the blocking band, the experimental group showed significantly better outcomes than the control group, with a statistical difference ( P < 0.05). The operators found that the Y-Z MHPBB was superior to the modified T-tube in terms of operational flexibility., Conclusion: The Y-Z MHPBB seems to be an ingenious design, accurate blood flow occlusion effect, and good flexibility; and it can be used for hepatic portal blood flow occlusion during laparoscopic hepatectomy., Competing Interests: Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2023
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320. Laparoscopic Hepatectomy versus Open Hepatectomy After Conversion Therapy Using Transarterial Chemoembolization or Hepatic Arterial Infusion Chemotherapy for Patients with Initially Unresectable Hepatocellular Carcinoma.
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Yang Z, Hu Z, Fu Y, Hu D, Zhou Z, Chen M, Pan Y, and Zhang Y
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Background: Laparoscopic hepatectomy (LH) is more advantageous than open hepatectomy (OH) for hepatocellular carcinoma (HCC). However, surgical methods of conversion resection for patients with HCC have not been compared. We aimed to compare LH with OH for HCC after conversion therapy., Methods: We retrospectively reviewed the data of 334 patients who underwent conversion resection between January 2016 and December 2020 at Sun Yat-sen University, China. Propensity score matching (PSM) of patients in a ratio of 1:2 was conducted, and 62 patients and 121 patients who underwent LH and OH, respectively, were matched., Results: The LH and OH groups differed at baseline in terms of ALT ( P =0.008), AFP ( P =0.042), largest tumor size ( P =0.028), macrovascular invasion ( P =0.006), BCLC stages ( P =0.021), and CNLC stages ( P =0.048). The incidences of postoperative complications before and after PSM were lower in the LH group than in the OH group ( P =0.007 and 0.003, respectively). There were no significant differences in the overall survival (OS) and recurrence-free survival (RFS) between the two groups ( P =0.79 and 0.8, respectively). According to the multivariable Cox regression analyses, the largest tumor size ( P <0.0001) and tumor number ( P =0.004) were significant and independent prognostic factors of OS., Conclusion: In our study, we found that LH is technically feasible and safe in patients after conversion therapy. Compared with OH, LH showed similar OS and RFS and was associated with fewer postoperative complications., Competing Interests: The authors declare that they have no conflicts of interest in this work., (© 2023 Yang et al.)
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- 2023
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321. Hepatic inflammatory myofibroblastic tumor: A case report.
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Tong M, Zhang BC, Jia FY, Wang J, and Liu JH
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Background: Hepatic inflammatory myofibroblastic tumor (HIMT) is a rare type of hepatic tumor. It is always misdiagnosed and mistreated because it is primarily found with no obvious specific manifestation, and its imaging findings are diverse., Case Summary: Here, we report a case of HIMT that was initially diagnosed as liver malignancy but was confirmed as HIMT by histopathology after hepatectomy. Mostly, HIMTs are infiltrated with plasma cells and stain positively for anaplastic lymphoma kinase on immunohistochemistry as well as for some other kinases., Conclusion: HIMT can be treated with single nonsteroidal anti-inflammatory drugs and without surgery when it is diagnosed accurately. Because the etiology of HIMT is unknown and the diagnosis is difficult, the pathogenesis and clinical process need to be further studied., Competing Interests: Conflict-of-interest statement: The authors declare having no conflicts of interest., (©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.)
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- 2023
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322. The influence of the Pringle maneuver in laparoscopic hepatectomy: continuous monitor of hemodynamic change can predict the perioperatively physiological reservation.
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Chen YC, Lee MH, Hsueh SN, Liu CL, Hui CK, and Soong RS
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Importance: This is the first study to investigate the correlation between intra-operative hemodynamic changes and postoperative physiological status., Design Settings and Participants: Patients receiving laparoscopic hepatectomy were routinely monitored using FloTract for goal-directed fluid management. The Pringle maneuver was routinely performed during parenchymal dissection and the hemodynamic changes were prospectively recorded. We retrospectively analyzed the continuous hemodynamic data from FloTrac to compare with postoperative physiological outcomes., Exposure: The Pringle maneuver during laparoscopic hepatectomy., Results: Stroke volume variation that did not recover from the relief of the Pringle maneuver during the last application of Pringle maneuver predicted elevated postoperative MELD-Na scores., Conclusions and Relevance: The complexity of the hemodynamic data recorded by the FloTrac system during the Pringle Maneuver in laparoscopic hepatectomy can be effectively analyzed using the growth mixture modeling (GMM) method. The results can potentially predict the risk of short-term liver function deterioration., Competing Interests: The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest., (Copyright © 2023 Chen, Lee, Hsueh, Liu, Hui and Soong.)
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- 2023
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323. The difficulty grade of laparoscopic hepatectomy for hepatocellular carcinoma correlates with long-term outcomes.
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Lv X, Zhang L, Yu X, and Yu H
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- Humans, Hepatectomy, Retrospective Studies, Length of Stay, Postoperative Complications epidemiology, Postoperative Complications surgery, Treatment Outcome, Carcinoma, Hepatocellular surgery, Liver Neoplasms surgery, Laparoscopy
- Abstract
The tremendous development of laparoscopic hepatectomy helps to relieve the difficulties encountered during open hepatectomy. Therefore, a difficulty scoring system was produced to assess the difficulty grade of laparoscopic hepatectomy. The aim of this study was to explore whether the IWATE-DSS is comparable to the long-term outcomes of LH for hepatocellular carcinoma. Clinical data from all consecutive patients who underwent laparoscopic hepatectomy for hepatocellular carcinoma at the Sir Run Run Shaw Hospital, Hangzhou, were prospectively collected and reviewed. The difficulty level of the operations was graded using the IWATE-DSS. The perioperative and postoperative outcomes of laparoscopic hepatectomy were compared at each difficulty level. A total of 300 patients underwent laparoscopic hepatectomy for HCC during the study period. The perioperative and postoperative outcomes were significantly different between the groups according to the IWATE-DSS. There were significant differences in both the intraoperative (bleeding control p = 0.000; surgical time p = 0.000; estimated blood loss p = 0.033) and postoperative variables (postoperative hospital stay p = 0.005) among these four groups. The 5-year disease-free survival decreased significantly along with the LH difficulty score (p = 0.000). The 5-year overall survival also decreased significantly along with the LH difficulty score (p = 0.000). IWATE-DSS was significantly correlated with short- and long-term outcomes in patients who underwent laparoscopic hepatectomy for HCC., (© 2023. The Author(s).)
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- 2023
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324. Usefulness of cranio-dorsal approach for laparoscopic left lateral sectionectomy.
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Kawasaki Y, Yamasaki Y, Idichi T, Oi H, Kurahara H, Mataki Y, Ueno S, and Ohtsuka T
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- Humans, Hepatectomy methods, Length of Stay, Operative Time, Retrospective Studies, Treatment Outcome, Laparoscopy methods, Liver Neoplasms surgery
- Abstract
Most surgeons perform laparoscopic left lateral sectionectomy (Lap LLS) using the caudo-peripheral approach (C-P approach). However, recently, a cranio-dorsal approach (C-D approach) has been applied to various types of hepatectomy owing to its advantage of preventing split injury. No studies yet have compared the perioperative outcomes of Lap LLS using each approach. Therefore, this study aimed to determine whether the C-D approach is useful for Lap LLS by comparing its perioperative outcomes with the C-P approach. Data of patients who underwent Lap LLS in our institution between 2010 and 2022 for liver tumors were retrospectively collected. We compared the perioperative outcomes of Lap LLS using a conventional C-P approach, which transects hepatic parenchyma in the caudo-peripheral direction and a C-D approach, which transects hepatic parenchyma in the cranio-caudal direction. All surgeries were performed only by board-certified expert surgeons to minimize technical bias. Furthermore, the perioperative procedures employed at our institution remained unchanged throughout the study period. A total of 36 patients were included in the study (C-P approach, n = 25; C-D approach, n = 11). The C-D approach showed a significantly shorter operation time than the C-P approach (median, 225 min vs. 262 min, p = 0.04). In addition, the C-D approach showed significantly lower blood loss than the C-P approach (median, 20 mL vs. 100 mL, p < 0.01). Other parameters, such as morbidity and hospital stay, were comparable between groups. The C-D approach could offer better surgical outcomes than the conventional C-P approach., (© 2023. Italian Society of Surgery (SIC).)
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- 2023
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325. The pharmacokinetics and safety of lidocaine in liver cancer patients undergoing hepatic resection.
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He C, Jin Y, Zhang Y, Zhang M, Di X, Fu L, Qi X, Liu R, Zheng L, Wang Z, Li J, and Tu F
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- Humans, China, Chromatography, Liquid, Lidocaine adverse effects, Liver Neoplasms surgery
- Abstract
Purpose: The purpose of this study was to explore the pharmacokinetics (PK) characteristics and safety of continuous lidocaine infusion during hepatectomy in liver cancer patients., Methods: This study included thirty-five patients undergoing laparoscopic hepatectomy from January 2021 to December 2021. Patients received a short infusion of 1% lidocaine at a dose of 1.5 mg/kg based on ideal body weight, followed by a continuous infusion of 1 mg/kg/h during the operation. The plasma concentrations of lidocaine and its active metabolites were measured using validated ultra-performance liquid chromatography-tandem mass spectrometry. Safety was evaluated by monitoring and recording all adverse events (AEs)., Results: The concentrations of lidocaine were within the safe range, except one patient's concentration of lidocaine which reached the toxic range (> 5 μg/mL). The mean half-life (T
1/2 ), the mean time to maximum observed concentration (Tmax ), and the mean maximum observed concentration (Cmax ) of lidocaine were 3.96 h, 2.85 h, and 2030 ng/mL, respectively; the mean T1/2 , Tmax , and Cmax (n = 32) of MEGX were 6.59 h, 5.05 h, and 333.28 ng/mL, respectively; and the mean T1/2 , Tmax , and Cmax of GX (n = 18) were 25.98 h, 7.33 h, and 75.81 ng/mL. Although eight subjects with AEs were reported, there were no serious AEs or deaths. No patients had serious postoperative complications. No deaths occurred within 30 days after the operation., Conclusions: Under the administration regimen of this study, intravenous infusion of lidocaine is safe and tolerable for liver cancer patients with laparoscopic hepatectomy. Fine safety and PK characteristics support the application of lidocaine in such patients and further clinical research., Trial Registration: China Clinical Trial Registration Center (ChiCTR2100042730), Registered 27 January 2021., (© 2023. The Author(s), under exclusive licence to Springer-Verlag GmbH Germany, part of Springer Nature.)- Published
- 2023
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326. Detection of Colorectal Liver Metastases Using Near-Infrared Fluorescence Imaging During Hepatectomy: Prospective Single Centre UK Study.
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Patel I, Bartlett D, Dasari BV, Chatzizacharias N, Isaac J, Marudanayagam R, Mirza DF, Roberts JK, and Sutcliffe RP
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- Humans, Hepatectomy methods, Prospective Studies, Indocyanine Green, Optical Imaging methods, United Kingdom, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery, Colorectal Neoplasms diagnostic imaging, Colorectal Neoplasms surgery, Colorectal Neoplasms pathology
- Abstract
Introduction: Small superficial colorectal liver metastases (CLM) may be difficult to localise intraoperatively, especially during minimally invasive hepatectomy due to reduced tactile feedback and limitations of ultrasound (US). Near-infrared (NIRF) fluorescence imaging is an emerging technology that permits detection of liver tumours after systemic injection of indocyanine green (ICG). Our aim was to report our experience using NIRF to detect CLM., Patients and Methods: Patients with small, superficial resectable CLM received a 10-mg IV bolus of ICG the day before hepatectomy. All patients underwent preoperative liver-specific MRI. CLM were localised intraoperatively using a combination of white light/ultrasound (WL-US) and NIRF. Sensitivity and specificity of NIRF were compared with WL-US., Results: Between March 2019 and July 2021, NIRF was utilised in 15 patients who underwent hepatectomy (laparoscopic 13, open 2). Thirty-two lesions were detected by MRI (including 3 disappearing CLM), of which 2 were ICG-negative and not resected (1 haemangioma, 1 disappearing CLM). Of 30 resected lesions, the median tumour diameter was 11 mm (range 2-25), median distance from liver surface was 4.5 mm (range 0-20) and all were confirmed CLM on histology (R0 resection rate 71%). Twenty-three of thirty (77%) and twenty-seven of thirty (90%) resected CLM were detected by WL-US and NIRF, respectively. Of 7/30 (23%) resected CLM that were WL-US negative, 5 were ICG-positive. Two resected 'disappearing' CLM were ICG-positive, one of which contained viable cancer cells. Overall, NIRF influenced the operative strategy in 6 patients (43%)., Conclusion: Near-infrared fluorescence imaging allows detection of small, superficial colorectal liver metastases that are missed by conventional techniques and warrants further study., (© 2022. Crown.)
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- 2023
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327. Double cone-unit laparoscopic hepatic resection for tumors adjacent to the hepatic vein.
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Yasuda J, Furukawa K, Yanagaki M, Igarashi Y, Tanji Y, Haruki K, Onda S, and Ikegami T
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- Humans, Hepatectomy methods, Hepatic Veins surgery, Laparoscopy methods, Liver Neoplasms diagnostic imaging, Liver Neoplasms surgery, Portal Vein surgery
- Abstract
Background: In tumor adjacent to the hepatic vein, it is important to treat two tertiary Glissonean pedicles that straddle to the hepatic vein in order to remove the tumor with a negative margin. The anatomical resection of the smallest unit may be considered to be the resection of the double cone-unit (DCU) in small tumor adjacent to the vein., Patients and Methods: 127 patients who had undergone laparoscopic hepatectomy at the Jikei Medical University Hospital from 2020 through 2021. In 5 cases, Laparoscopic DCU resection was performed. If the CT image shows a hepatic vein near the tumor and the tumor is relatively small, less than 50 mm in size, DCU resection should be considered. After approaching the target Glissonean pedicles, the Bulldog Clamps were used to testing clamp it. After clamping it, the ICG was injected from peripheral veins. A few minutes later, the tumor-bearing portal territory could be identified as negative regions of fluorescence in the near infrared imaging system. The target hepatic vein, which runs between the two territories, was dissected where it transitions from the first to the second territory., Results: The median operative time in these 5 patients was 279 min, and the median volume of blood loss was 290 g. The average tumor size was 33 mm and the average surgical margin was 4.5 mm., Conclusion: In small tumor adjacent to the hepatic vein, the anatomical hepatectomy of the smallest unit may be the Double Cone-Unit resection., Competing Interests: Declaration of competing interest The authors declare that they have no conflict of interest., (Copyright © 2023. Published by Elsevier Ltd.)
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- 2023
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328. Impact of tumor size on the difficulty of laparoscopic left lateral sectionectomies.
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Aizza G, Russolillo N, Ferrero A, Syn NL, Cipriani F, Aghayan D, Marino MV, Memeo R, Mazzaferro V, Chiow AKH, Sucandy I, Ivanecz A, Vivarelli M, Di Benedetto F, Choi SH, Lee JH, Park JO, Gastaca M, Fondevila C, Efanov M, Rotellar F, Choi GH, Robles-Campos R, Wang X, Sutcliffe RP, Pratschke J, Tang CN, Chong CC, D'Hondt M, Yong CC, Ruzzenente A, Herman P, Kingham TP, Scatton O, Liu R, Levi Sandri GB, Soubrane O, Mejia A, Lopez-Ben S, Monden K, Wakabayashi G, Cherqui D, Troisi RI, Yin M, Giuliante F, Geller D, Sugioka A, Edwin B, Cheung TT, Long TCD, Hilal MA, Fuks D, Chen KH, Aldrighetti L, Han HS, and Goh BKP
- Subjects
- Humans, Postoperative Complications surgery, Length of Stay, Hepatectomy methods, Operative Time, Retrospective Studies, Liver Neoplasms surgery, Laparoscopy methods
- Abstract
Background: Tumor size (TS) represents a critical parameter in the risk assessment of laparoscopic liver resections (LLR). Moreover, TS has been rarely related to the extent of liver resection. The aim of this study was to study the relationship between tumor size and difficulty of laparoscopic left lateral sectionectomy (L-LLS)., Methods: The impact of TS cutoffs was investigated by stratifying tumor size at each 10 mm-interval. The optimal cutoffs were chosen taking into consideration the number of endpoints which show a statistically significant split around the cut-points of interest and the magnitude of relative risk after correction for multiple risk factors., Results: A total of 1910 L-LLS were included. Overall, open conversion and intraoperative blood transfusion were 3.1 and 3.3%, respectively. The major morbidity rate was 2.7% and 90-days mortality 0.6%. Three optimal TS cutoffs were identified: 40-, 70-, and 100-mm. All the selected cutoffs showed a significant discriminative power for the prediction of open conversion, operative time, blood transfusion and need of Pringle maneuver. Moreover, 70- and 100-mm cutoffs were both discriminative for estimated blood loss and major complications. A stepwise increase in rates of open conversion rate (Z = 3.90, P < .001), operative time (Z = 3.84, P < .001), blood loss (Z = 6.50, P < .001), intraoperative blood transfusion rate (Z = 5.15, P < .001), Pringle maneuver use (Z = 6.48, P < .001), major morbidity(Z = 2.17, P = .030) and 30-days readmission (Z = 1.99, P = .047) was registered as the size increased., Conclusion: L-LLS for tumors of increasing size was associated with poorer intraoperative and early postoperative outcomes suggesting increasing difficulty of the procedure. We determined three optimal TS cutoffs (40-, 70- and 100-mm) to accurately stratify surgical difficulty after L-LLS., (© 2022 Japanese Society of Hepato-Biliary-Pancreatic Surgery.)
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- 2023
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329. Usefulness of a Transumbilical Incision for Organ Removal in Laparoscopic Hepatectomy
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Tomotake Koizumi, Tatsuya Yamazaki, Tomoki Hakozaki, Yuta Enami, Koji Nogaki, Kazuhiro Matsuda, Kodai Tomioka, Masahiko Murakami, Yusuke Wada, Akira Fujimori, Tomokazu Kusano, Hideki Shibata, Yoshihiko Tashiro, Kazuhiko Saito, Takahito Hirai, and Takeshi Aoki
- Subjects
Adult ,Male ,Cancer Research ,medicine.medical_specialty ,Hernia ,Incisional hernia ,medicine.medical_treatment ,Laparoscopic hepatectomy ,Risk Factors ,medicine ,Hepatectomy ,Humans ,Surgical Wound Infection ,Risk factor ,Aged ,Aged, 80 and over ,Univariate analysis ,Umbilicus ,business.industry ,Liver Neoplasms ,General Medicine ,Middle Aged ,medicine.disease ,Surgery ,Liver ,Oncology ,Female ,Laparoscopy ,business ,Complication ,Body mass index - Abstract
Background/aim To evaluate the complication rates and risk factors associated with transumbilical wounds and investigate the usefulness of an incision for organ removal in laparoscopic hepatectomy (Lap-H). Patients and methods We enrolled 42 patients who underwent Lap-H excluding a small partial resection in our hospital between 2013 and 2018. The occurrences of superficial surgical site infection (SSI) and transumbilical port-site incisional hernia were recorded. Results SSI was not observed, and hernia occurred in 3 patients (7.14%). Univariate analysis revealed that body mass index (BMI) (p=0.004) was significantly associated with the risk of hernia formation. Conclusion High BMI is a risk factor for hernia formation in patients undergoing Lap-H with transumbilical incision; hence, wound closure should be performed carefully. The construction of the transumbilical wound for organ removal was feasible with rationality, with no need to create a new wound.
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- 2020
330. Solitary hepatic lymphangioma mimicking liver malignancy: A case report and literature review
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Xiaoping Chen, Qian Chen, Lei Zhang, Xin Long, and Qi Cheng
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Adult ,medicine.medical_specialty ,Hepatocellular carcinoma ,business.industry ,Laparoscopic hepatectomy ,Trans-arterial chemoembolization ,General Medicine ,Hepatic lymphangioma ,medicine.disease ,Malignancy ,body regions ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Case report ,Lymphangioma ,medicine ,030211 gastroenterology & hepatology ,Radiology ,Trans arterial chemoembolization ,business - Abstract
BACKGROUND Hepatic lymphangioma, a malformation of the liver lymphatic system, is a rare benign neoplasm and usually coexists with other visceral lymphangiomas. Solitary hepatic lymphangioma is much more rarely seen and could cause a clinical misinterpretation as malignancy. CASE SUMMARY A 50-year-old woman with a liver mass of approximately 3.5 cm was initially diagnosed with hepatocellular carcinoma given the risk factors for liver cancer that she presented with, including Schistosome japonicum infection and jaundice, and also together with imaging results, which showed the mass enhanced quickly in the arterial phase and faded fast in the venous phase. The patient did not have the surgery first but received three rounds of transarterial chemoembolization because of her anxiety and fears for operation. Finally, the patient underwent laparoscopic liver segment 4b resection and cholecystectomy and was discharged from the hospital only 10 d after the operation. The pathological examination indicated the mass as hepatic lymphangioma. The patient has been followed up for 30 mo without recurrence. To raise the awareness of this misdiagnosed case and to better diagnose and treat this rare disease in future, we reviewed the published literature of solitary hepatic lymphangioma for its clinical symptoms, imaging presentation, operative techniques, histology features and prognosis. CONCLUSION Solitary hepatic lymphangioma mimicking malignancy makes diagnosis difficult. Complete surgical resection is the first choice to treat solitary hepatic lymphangioma.
- Published
- 2020
331. The Postoperative Analgesic Effect of Ultrasound-Guided Bilateral Transversus Abdominis Plane Combined with Rectus Sheath Blocks in Laparoscopic Hepatectomy: A Randomized Controlled Study
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Ping Yu, Zhongguo Zhou, Junchao Wang, Chaopeng Ou, Renchun Lai, and Xiaoyun Lu
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Therapeutics and Clinical Risk Management ,Visual analogue scale ,Nausea ,rectus sheath block ,Remifentanil ,laparoscopic hepatectomy ,030204 cardiovascular system & hematology ,transversus abdominis plane block ,03 medical and health sciences ,0302 clinical medicine ,Transversus Abdominis Plane Block ,medicine ,Pharmacology (medical) ,030212 general & internal medicine ,General Pharmacology, Toxicology and Pharmaceutics ,Original Research ,Chemical Health and Safety ,ultrasound ,Ropivacaine ,business.industry ,analgesia ,General Medicine ,Rectus sheath ,medicine.anatomical_structure ,Anesthesia ,Vomiting ,medicine.symptom ,business ,Safety Research ,Oxycodone ,medicine.drug - Abstract
Xiaoyun Lu1,2 *,* Ping Yu1,2 *,* Chaopeng Ou1,2 *,* Junchao Wang,1,2 Zhongguo Zhou,1,3 Renchun Lai1,2 1Collaborative Innovation Center for Cancer Medicine, State Key Laboratory of Oncology in South China, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China; 2Department of Anesthesiology, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China; 3Department of Liver Surgery, Sun Yat-Sen University Cancer Center, Guangzhou, Guangdong, People’s Republic of China*These authors contributed equally to this work.Correspondence: Zhongguo Zhou; Renchun Lai Email zhouzhg@sysucc.org.cn; lairench@sysucc.org.cnBackground: Our aim was to investigate the postoperative analgesic effect of ultrasound (US)-guided bilateral transversus abdominis plane (TAP) blocks combined with rectus sheath blocks (RSBs) in laparoscopic hepatectomy.Patients and Methods: A total of 126 patients were allocated into two groups for analysis. Group 1 (n = 63) did not receive any local anesthetics. Group 2 (n = 63) received US-guided bilateral TAP blocks and RSBs using 20 mL 0.25% ropivacaine in each block. Postoperative pain scores, the dose of intraoperative remifentanil, 24 h consumption of oxycodone, adverse events such as postoperative dizziness, nausea and vomiting, and the length of postoperative hospital stay were recorded.Results: In the postanesthesia care unit, patients in group 2 had significantly lower pain visual analog scale (VAS) scores at rest than those in group 1 (P < 0.001). The VAS scores both at rest and during movement were significantly lower in group 2 than in group 1 at 2, 4 and 6 h postoperatively (all P < 0.001). There was no difference in VAS scores between the two groups at rest 24 h postoperatively (P = 0.477). However, the VAS score during movement at 24 h in group 2 was significantly lower than that in group 1 (P < 0.001). No significant differences in the incidence of adverse events or the dose of intraoperative remifentanil were observed between the two groups (all P > 0.05). Patients in group 2 had a significantly lower 24 h consumption of oxycodone than patients in group 1 (P < 0.001). The mean length of postoperative hospital stay of group 2 was shorter than that of group 1 (P = 0.032).Conclusion: US-guided bilateral TAP blocks combined with RSBs provide effective postoperative analgesia for laparoscopic hepatectomy, and they could shorten the postoperative hospital stay without increasing the incidence of adverse events from opioids.Keywords: laparoscopic hepatectomy, analgesia, transversus abdominis plane block, rectus sheath block, ultrasound
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- 2020
332. Efficacy and safety of laparoscopic hepatectomy for hepatocellular carcinoma comorbid with cirrhosis
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Hideko Ohama, Kazuhide Higuchi, Tetsuji Terazawa, Yusuke Tsuchimoto, Yoshihiro Inoue, Akira Asai, Shinya Fukunishi, Kazuhisa Uchiyama, Keisuke Yokohama, and Junji Okuda
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Laparoscopic surgery ,medicine.medical_specialty ,Original Paper ,Cirrhosis ,business.industry ,Pleural effusion ,medicine.medical_treatment ,Mortality rate ,liver cirrhosis ,Gastroenterology ,hepatocellular carcinoma ,laparoscopic hepatectomy ,medicine.disease ,Exact test ,Hepatocellular carcinoma ,Internal medicine ,Medicine ,Hepatectomy ,Complication ,business - Abstract
Introduction Laparoscopic hepatectomy (LH) is very difficult to perform in patients with cirrhosis because of the haemorrhagic and fibrotic nature of the liver, although there are various advantages to laparoscopic surgery. Aim To investigate the surgical outcomes, and efficacy and safety of LH versus open hepatectomy (OH) for hepatocellular carcinoma (HCC) resection. Material and methods A total of 112 patients with cirrhosis, who underwent hepatectomy, were analysed retrospectively. We investigated the safety and efficacy of LH for HCC with cirrhosis. Student's t and χ2 tests, Mann-Whitney's U test, Wilcoxon's signed-rank test, and Fisher's exact test were used in the statistical analysis. Results Seventy-one patients underwent LH, and 41 underwent OH. The conversion rate from LH to OH was 12.7%. After propensity score matching, the estimated blood loss was significantly lower in the LH group than in the OH group (25 vs. 310 ml; p < 0.001), and there was a significant difference between the groups in the operative time (p = 0.091). The LH group had complication rates of 3.6% and 0% for refractory ascites and pleural effusion, respectively, while those were 17.9% and 10.7%, respectively, in the OH group (p = 0.019 and p = 0.005, respectively). The LH group had no mortality, whereas the OH group had a mortality rate of 10.7% (p = 0.038). The postoperative length of stay was significantly longer in the LH group than in the OH group (9 days vs. 14 days) (p = 0.002). Conclusions LH can be performed safely for HCC with cirrhosis. More favourable results are achieved with LH than with OH in terms of surgical outcomes.
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- 2020
333. Radiofrequency ablation versus laparoscopic hepatectomy for treatment of hepatocellular carcinoma: a systematic review and meta-analysis
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Peng Wen, Chunshan Luo, Jiang Ying, Tan Shisheng, and Jin Shan
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medicine.medical_specialty ,China ,Blood transfusion ,Carcinoma, Hepatocellular ,Radiofrequency ablation ,medicine.medical_treatment ,review ,lcsh:Surgery ,Cochrane Library ,laparoscopic hepatectomy ,lcsh:RC254-282 ,law.invention ,03 medical and health sciences ,0302 clinical medicine ,Randomized controlled trial ,law ,medicine ,Hepatectomy ,Humans ,business.industry ,Incidence (epidemiology) ,Liver Neoplasms ,hepatocellular carcinoma ,lcsh:RD1-811 ,medicine.disease ,Prognosis ,lcsh:Neoplasms. Tumors. Oncology. Including cancer and carcinogens ,Confidence interval ,Surgery ,meta-analysis ,Treatment Outcome ,Oncology ,030220 oncology & carcinogenesis ,Meta-analysis ,Hepatocellular carcinoma ,Catheter Ablation ,030211 gastroenterology & hepatology ,Laparoscopy ,radiofrequency ablation ,Neoplasm Recurrence, Local ,business - Abstract
Background Several randomized controlled trials (RCTs) compared the effects of laparoscopic hepatectomy (LH) and radiofrequency ablation (RFA) for the treatment of hepatocellular carcinoma (HCC), but the results have remained inconsistent. Hence, a meta-analysis and a systematic review of these treatment modalities are necessary to evaluate their efficacy and safety for HCC treatment. Methods From the inception of this meta-analysis and review until August 31, 2019, we searched Medline, PubMed, EMBASE, Cochrane Library, China National Knowledge Infrastructure, Wanfang Database, and China Biomedical Literature Database for RCTs involving LH and RFA treatments of patients with HCC. The studies were screened and the data from these articles were extracted independently by two authors. Summary odd ratios (OR) or mean differences (MD) with 95% confidence intervals (CI) were calculated for each outcome with a fixed- or random-effect model. The outcomes for effectiveness evaluations included duration of surgery, estimated bleeding volume, incidence of blood transfusion during surgery, duration of hospital stay, and the outcome for safety included the incidence of cancer recurrence. Results Seven RCTs with a total of 615 patients were identified, 312 and 303 of which underwent RFA and LH treatments, respectively. The duration of surgery (MD = −99.04; 95% CI: −131.26–−66.82), estimated bleeding volume (MD = −241.97; 95% CI: −386.93–−97.02), incidence of blood transfusion during surgery (OR = 0.08; 95% CI: 0.02–0.37), and duration of hospital stay (MD = −3.4; 95% CI: −5.22–−1.57) in RFA treatment were significantly lower than those of LH treatment. However, the incidence of cancer recurrence was significantly higher for RFA treatment compared with LH treatment (OR = 2.68; 95% CI: 1.72–4.18). Conclusions LH treatment is preferred over RFA treatment with a better radical effect, but RFA treatment is more beneficial with smaller trauma, development of less complications, and shorter operating time when compared with HCC treatment.
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- 2020
334. The Safety and Efficacy of Ultrasound-Guided Bilateral Dual Transversus Abdominis Plane (BD-TAP) Block in ERAS Program of Laparoscopic Hepatectomy: A Prospective, Randomized, Controlled, Blinded, Clinical Study
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Tieshuai Liu, Xin Yu, Jun Zhang, Yue Fei, and Haiyan Zhou
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0301 basic medicine ,Male ,Visual analogue scale ,Nausea ,Pharmaceutical Science ,laparoscopic hepatectomy ,Sufentanil ,03 medical and health sciences ,0302 clinical medicine ,Double-Blind Method ,Drug Discovery ,neurotoxicity ,medicine ,Hepatectomy ,Humans ,Prospective Studies ,Anesthetics, Local ,Ultrasonography, Interventional ,Abdominal Muscles ,Pharmacology ,ropivacaine ,Pain, Postoperative ,Drug Design, Development and Therapy ,BD-TAP block ,Ropivacaine ,business.industry ,Nerve Block ,Perioperative ,Middle Aged ,Regimen ,030104 developmental biology ,Clinical Trial Report ,030220 oncology & carcinogenesis ,Anesthesia ,Vomiting ,Female ,Laparoscopy ,Liver function ,Patient Safety ,medicine.symptom ,business ,medicine.drug - Abstract
Jun Zhang, Tieshuai Liu, Haiyan Zhou, Yue Fei, Xin Yu Department of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, Hangzhou, Zhejiang, People’s Republic of ChinaCorrespondence: Xin YuDepartment of Anesthesiology, Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, 3 Qingchun Road East, Jianggan District, Hangzhou 310016, Zhejiang, People’s Republic of ChinaTel +86 13588708514Fax +86 0571-86006662Email xinxin_yu@zju.edu.cnPurpose: Postoperative pain management for patients undergoing hepatic resection is still a challenge due to the risk of perioperative liver dysfunction. The transversus abdominis plane (TAP) block is a promising regional analgesic technique. However, the correct guidelines regarding the dose and regimen of local anesthetics in patients undergoing hepatic resection have yet to be established completely. This study aimed to evaluate the safety and efficacy of ultrasound-guided BD-TAP block with a large dose of ropivacaine in laparoscopic hepatectomy.Patients and Methods: This prospective, blinded, randomized, controlled study was conducted with 50 patients who were scheduled for selective laparoscopic hepatectomy. Patients who received a BD-TAP block (3 mg/kg of ropivacaine diluted to 60 mL) with general anesthesia were categorized into the BD-TAP block group (n = 25), and those who received general anesthesia were categorized into the control group (n = 25). The primary outcomes were consumption of sufentanil within 48 hours post-operation and plasma ropivacaine concentration. The secondary outcomes were the severity of pain (at rest and upon coughing), nausea and/or vomiting, and quality of recovery.Results: Compared with the control group, the patients in BD-TAP block group had a significant reduction of postoperative sufentanil consumption at 2 hours (P = 0.019), 24 hours (P = 0.001), and 48 hours (P = 0.001), and the visual analog scale (VAS) scores on coughing were significantly lower at postoperative 2 hours (P = 0.004). There were no statistically significant differences in postoperative nausea and/or vomiting, flatus, catheter removal, off-bed activity, liver function, or postoperative hospital stay. The mean peak total ropivacaine concentration was 1,067.85 ng/mL, which occurred 1 hour after administering the block, and mean free ropivacaine concentration was 52.32 ng/mL. The highest individual peak plasma concentration was 2,360.90 ng/mL at 45 min postinjection, and the free ropivacaine concentration was 139.29 ng/mL.Conclusion: Ultrasound-guided BD-TAP block provides effective postoperative analgesia after laparoscopic hepatectomy. This study also confirms that ultrasound-guided BD-TAP blocks with 3 mg/kg ropivacaine during laparoscopic hepatectomy almost never results in the plasma ropivacaine concentrations associated with neurotoxicity.Keywords: ropivacaine, laparoscopic hepatectomy, BD-TAP block, neurotoxicity
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- 2020
335. Minimally Invasive Hepatectomy in North America: Laparoscopic Versus Robotic
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Henry A. Pitt, Kwan N. Lau, Alexander M. Fagenson, and Elizabeth M. Gleeson
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medicine.medical_specialty ,business.industry ,Laparoscopic hepatectomy ,Open surgery ,medicine.medical_treatment ,Gastroenterology ,030230 surgery ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,030220 oncology & carcinogenesis ,Cohort ,Propensity score matching ,medicine ,Robotic hepatectomy ,Operative time ,Hepatectomy ,Outcomes research ,business - Abstract
Minimally invasive hepatectomy has been shown to be associated with improved outcomes when compared with open surgery. However, data comparing laparoscopic and robotic hepatectomy is lacking and limited to single-center studies. Patients undergoing major (≥ 3 segments) or partial (≤ 2 segments) hepatectomy were identified in the 2014–2017 ACS-NSQIP hepatectomy targeted database. Patients undergoing laparoscopic and robotic approaches were compared, and propensity score matching was utilized to adjust for bias. Of 3152 minimally invasive hepatectomies (MIHs), 86% (N = 2706) were partial and 14% (N = 446) were major. The laparoscopic approach was utilized in 92% of patients (N = 2905) and 8% were performed robotically (N = 247). The percentage of MIHs increased over time (p
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- 2020
336. Successful outcome of massive carbon dioxide embolism during laparoscopic hepatectomy
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Jie Zhao, Tieshuai Liu, Yue Fei, Minjun Liu, and Jun Zhang
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medicine.medical_specialty ,Pleural effusion ,business.industry ,Laparoscopic hepatectomy ,CO2 embolism ,lcsh:Surgery ,lcsh:RD1-811 ,Muscular power ,medicine.disease ,Paradoxical CO2 embolism ,Surgery ,03 medical and health sciences ,0302 clinical medicine ,Embolism ,Postoperative treatment ,030220 oncology & carcinogenesis ,Pulmonary oedema ,medicine ,030211 gastroenterology & hepatology ,Hypoalbuminemia ,Left upper extremity ,business ,Severe complication - Abstract
Carbon dioxide embolism is a rare but severe complication of laparoscopic hepatectomy. We reported a case of massive carbon dioxide embolism that developed into a rare paradoxical gas embolism during laparoscopic hepatectomy and resulted in reduced muscular power of the left upper extremity, severe pleural effusion and hypoalbuminemia after surgery. Fortunately, the patient fully recovered with positive prevention and postoperative treatment. This case report highlights that the surgeon and anaesthesiologist must be aware of the risks and the importance for prompt treatment when massive carbon dioxide embolism occurs.
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- 2020
337. Clinical Value of Serum LHPP-associated miR-765 in the Prognosis of Laparoscopic or Open Hepatectomy for Hepatocellular Carcinoma
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Dunxue Yang, Wei Li, Xiuda Peng, Liyan He, Jin Liu, Xianrong Liu, Peng Zhang, Xianzhou Lu, Jingting Yan, and Guang Li
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medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Laparoscopic hepatectomy ,laparoscopic hepatectomy ,Gastroenterology ,03 medical and health sciences ,0302 clinical medicine ,Internal medicine ,microRNA ,medicine ,Hepatectomy ,Humans ,Anilides ,Grading (tumors) ,Survival analysis ,Aged ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Original Articles ,hepatocellular carcinoma ,Middle Aged ,Prognosis ,medicine.disease ,open hepatectomy ,Survival Rate ,MicroRNAs ,Pyrimidines ,Apoptosis ,Lymphatic Metastasis ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Clinical value ,Laparoscopy ,030211 gastroenterology & hepatology ,Surgery ,business - Abstract
Purpose: The current study aims to investigate the effect of tumor suppressor LHPP-associated microRNA (miR)-765 on the prognosis of laparoscopic hepatectomy (LH) or open hepatectomy (OH) for hepatocellular carcinoma (HCC). Materials and Methods: A total of 160 patients with HCC were enrolled and randomly divided into the LH or OH group. According to the operation time, these patients were followed up for 12 months, and the number of deaths and the corresponding death time during the follow-up period were counted. Results: The authors found that the LHPP gene levels in HCC tissues were lower than that in adjacent normal tissues, whereas miR-765 was overexpressed in HCC tissue. Overexpression of miR-765 promoted the epithelial-mesenchymal transition and proliferation and inhibited apoptosis of HCC through directly downregulating LHPP expression. Serum miR-765 expression level was significantly associated with lymph node metastasis and histologic grading. Survival analysis showed that the overall survival rate in 12 months after the operation was significantly lower in the OH-high miR-765 group (P
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- 2020
338. Impact on operative outcomes of laparoscopic simultaneous resection of colorectal cancer and synchronous liver metastases
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Shoji Kawakatsu, Masashi Ueno, Akio Saiura, Yousuke Inoue, Yoshiya Fujimoto, Atsushi Oba, Takeaki Ishizawa, Yu Takahashi, Yoshihiro Mise, and Hiromichi Ito
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Laparoscopic surgery ,medicine.medical_specialty ,Colorectal cancer ,medicine.medical_treatment ,Laparoscopic hepatectomy ,Simultaneous resection ,030230 surgery ,Neoplasms, Multiple Primary ,03 medical and health sciences ,0302 clinical medicine ,medicine ,Hepatectomy ,Humans ,Colectomy ,Retrospective Studies ,business.industry ,Liver Neoplasms ,General Medicine ,Length of Stay ,medicine.disease ,Primary tumor ,Surgery ,Treatment Outcome ,030220 oncology & carcinogenesis ,Colonic Neoplasms ,Evaluated data ,Laparoscopy ,Colorectal Neoplasms ,business ,Wedge resection (lung) - Abstract
Introduction The efficacy of laparoscopic simultaneous resection of primary colorectal cancer and synchronous colorectal liver metastases (SCRLM) remains unclear. Methods We retrospectively evaluated data from 258 patients who had undergone simultaneous curative resection of the primary tumor and SCRLM from 2006 to 2017. We compared surgical outcomes between open, hybrid (laparoscopic colorectal resection and open hepatectomy), and pure laparoscopic approaches. Surgical outcomes were also evaluated between the open hepatectomy (OH) group (ie, open/hybrid surgery) and the laparoscopic hepatectomy (LH) group (ie, pure laparoscopic surgery) in 141 patients later in the study period (2013-2017), when the clinical indications for laparoscopic hepatectomy were restricted to simple wedge resection and/or left lateral sectionectomy in our center. Results The pure laparoscopic approach was associated with significantly less intraoperative blood loss and a significantly shorter postoperative hospital stay than the open and hybrid approaches. Late in the study period, operative outcomes in the LH group (n = 37) were more favorable than for the OH group (n = 104) in terms of intraoperative blood loss and postoperative hospital stay. In patients with rectal cancer, however, earlier postoperative recovery in the LH group did not differ significantly from the OH group. Conclusion Laparoscopic simultaneous resection of SCRLM with the primary tumor by simple hepatectomy is safe and may enhance patients' postoperative recovery, especially in patients with colon cancer.
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- 2020
339. Radiofrequency ablation versus laparoscopic hepatectomy for hepatocellular carcinoma: A real world single center study
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Zhongguo Zhou, Minshan Chen, Li Xu, Yaojun Zhang, Jian Cong Chen, Min jiang Yi, Jin Bin Chen, Yangxun Pan, and Qian Long
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Adult ,Male ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,Radiofrequency ablation ,Laparoscopic hepatectomy ,Urology ,Single Center ,law.invention ,Young Adult ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,law ,medicine ,Hepatectomy ,Humans ,Major complication ,Stage (cooking) ,Aged ,Retrospective Studies ,Ultrasonography ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Rate control ,General Medicine ,Middle Aged ,medicine.disease ,Treatment Outcome ,surgical procedures, operative ,Surgery, Computer-Assisted ,Oncology ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Propensity score matching ,Catheter Ablation ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,Surgery ,business ,therapeutics - Abstract
Both radiofrequency ablation (RFA) and laparoscopic hepatectomy (LH) are minimally invasive approach for hepatocellular carcinoma (HCC) at early stage. This study aimed to compare the efficacy of RFA and LH for treating HCC with a large cohort.From March 2014 to July 2016, 477 patients who underwent RFA (n = 314) or LH (n = 163) for HCC tumors meeting the criteria were included. Overall survival (OS) and recurrence-free survival (RFS) were compared. Propensity score matching (PSM) was performed to balance for the factors that may affect the choice of treatment.Collectively, the 1-, 2- and 3-year OS rates were significantly greater after LH than RFA, as well the corresponding RFS rates, before and after PSM by 2:1. However, the RFA group had fewer major complications (P=0.004), shorter postoperative stays (P=0.023) and lower hospital charges (P0.001) than the LH group. In the subgroup analysis, RFA demonstrated comparable RFS in treating less than 3 cm tumor (P=0.22) located in noncentral bisection (SII, SIII, SVI, SVII) and tumor between 3 cm and 5 cm (P=0.07) located in central bisections (SIV, SV, SVIII). The female, HBV infection, and RFA are factors of worse OS, and the latter two factors also indicated higher RFS.Though, LH possessed superior intrahepatic control rate than RFA in most condition of tumor smaller than 5 cm, the RFA could be an optimal approach achieved comparable outcomes in patients with centrally located HCC, with fewer major complications, shorter postoperative stays and lower hospital charges.
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- 2020
340. Identifying Cystic Vein Perfusion Area Employing Indocyanine Green Fluorescence Imaging during Laparoscopic Extended Cholecystectomy for Clinical T2 Gallbladder Cancer
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Hiroyuki Nitta, Yasushi Hasegawa, Akira Sasaki, Takeshi Takahara, Hirokatsu Katagiri, Megumi Kobayashi, Akira Umemura, Shoji Kanno, and Taro Ando
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medicine.medical_specialty ,medicine.medical_treatment ,Single Case ,Extended cholecystectomy ,03 medical and health sciences ,chemistry.chemical_compound ,0302 clinical medicine ,medicine.artery ,medicine ,lcsh:RC799-869 ,Gallbladder cancer ,Vein ,Cystic vein ,business.industry ,Gallbladder ,Gastroenterology ,Hepatoduodenal ligament ,medicine.disease ,medicine.anatomical_structure ,chemistry ,030220 oncology & carcinogenesis ,Laparoscopic hepatectomy ,lcsh:Diseases of the digestive system. Gastroenterology ,030211 gastroenterology & hepatology ,Cholecystectomy ,Lymphadenectomy ,Gallbladder bed resection ,Radiology ,Indocyanine green fluorescence ,business ,Indocyanine green - Abstract
We present an original surgical technique for identifying the perfusion area of the cystic vein with indocyanine green (ICG) fluorescence imaging and laparoscopic extended cholecystectomy with lymphadenectomy for a 56-year-old woman with diagnosis of clinical T2 gallbladder cancer (GBC). First, we encircled Calot’s triangle using the Glissonean approach from the ventral side of the gallbladder plate and then taped the hilar Glissonean pedicles; these were temporally clamped, and ICG was injected into the vein. The perfusion area of the cystic vein was scrutinized, specifically the stained area of the hepatic parenchyma was marked, and extended cholecystectomy was performed along the resection line. Subsequently, we performed lymphadenectomy of the hepatoduodenal ligament to complete the operation. A postoperative histopathological examination revealed moderately differentiated adenocarcinoma with pathological T1bN0M0. Although extended cholecystectomy is currently recommended for clinical T2 GBC, there is no consensus on the definition of the gallbladder bed, and the ideal extent of hepatic resection has, therefore, not yet been determined. In addition, gallbladder bed resection with 2–3 cm of surgical margin is an empirical procedure that lacks scientific verification. Regarding anatomical features, the cystic vein sometimes drains directly into the anterior branch of the portal vein, penetrating the gallbladder plate and Laennec’s capsule of the anterior Glissonean pedicle. To address this background, we have developed a technique to identify the perfusion area of the cystic vein to determine the extent of hepatic parenchyma that should be resected during laparoscopic extended cholecystectomy for clinical T2 GBC.
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- 2020
341. The 'Tenting Sign of the Hepatic Vein' Is Important for Laparoscopic Anatomical Hepatectomy Along the Major Hepatic Vein
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Kosuke Hikita, Yosuke Ozawa, Naokazu Chiba, Shigeyuki Kawachi, Toshimichi Kobayashi, Masashi Nakagawa, Yuta Abe, Rina Tsutsui, Koichi Tomita, Toru Sano, Itsuki Koganezawa, and Kei Yokozuka
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medicine.medical_treatment ,Laparoscopic hepatectomy ,Operative Time ,Dissection (medical) ,Hepatic Veins ,03 medical and health sciences ,0302 clinical medicine ,Hepatectomy ,Humans ,Medicine ,Vein ,business.industry ,Anatomical hepatectomy ,Liver Neoplasms ,Gastroenterology ,Anatomy ,medicine.disease ,Trunk ,medicine.anatomical_structure ,Liver ,030220 oncology & carcinogenesis ,cardiovascular system ,Laparoscopy ,030211 gastroenterology & hepatology ,Surgery ,business ,Liver parenchyma ,Sign (mathematics) - Abstract
Laparoscopic hepatectomy has rapidly evolved and has become a viable alternative to open hepatectomy. However, the dissection of liver parenchyma via the laparoscopic caudal approach (parenchymal transection from the caudal to cranial direction under a laparoscopic caudal view) has several limitations. To avoid these limitations in anatomical hepatectomy along the hepatic vein with the caudal approach, it is important to recognize the “tenting sign of the hepatic vein,” which helps to identify the running of the main trunk of the hepatic vein. In the bifurcation of the hepatic vein, there is a possibility of splitting of the hepatic vein branch or disorientation between the main trunk and branch. Therefore, it is vital that when the branch is pulled, the main trunk of the hepatic vein appears to be toward the direction of the branch. As a result, the main trunk appears in the direction from the original route to the pseudo route. In the caudal approach, this phenomenon is called “tenting sign of the hepatic vein.” Therefore, liver dissection should be performed in the contralateral and cranial sides of the main trunk, with the “tenting sign of the hepatic vein” in mind. This report describes specific cases of the “tenting sign of the hepatic vein.” The “tenting sign of the hepatic vein” from the caudal approach is essential knowledge for safe and reliable anatomical laparoscopic hepatectomy and can lead to expansion of indications in the future.
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- 2020
342. Laparoscopic versus Open Hepatectomy for Hepatocellular Carcinoma in Elderly Patients: A Single-Institutional Propensity Score Matching Comparison
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Ho-Seong Han, Soyeon Ahn, Yoo Seok Yoon, Jai Young Cho, YoungRok Choi, and Wethit Dumronggittigule
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Male ,Reoperation ,medicine.medical_specialty ,Carcinoma, Hepatocellular ,medicine.medical_treatment ,Laparoscopic hepatectomy ,Blood Loss, Surgical ,Gastroenterology ,Disease-Free Survival ,03 medical and health sciences ,Postoperative Complications ,0302 clinical medicine ,Internal medicine ,medicine ,Hepatectomy ,Humans ,Intraoperative Complications ,Propensity Score ,Aged ,Retrospective Studies ,business.industry ,Incidence (epidemiology) ,Liver Neoplasms ,Perioperative ,Length of Stay ,medicine.disease ,Survival Rate ,Treatment Outcome ,030220 oncology & carcinogenesis ,Hepatocellular carcinoma ,Propensity score matching ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,Surgery ,Liver cancer ,Complication ,business ,Liver Failure - Abstract
Background: The incidence of hepatocellular carcinoma (HCC) in elderly patients is increasing worldwide. Although open hepatectomy (OH) yields acceptable outcomes, high morbidity rate is concerned. Laparoscopic hepatectomy (LH) has evolved to improve perioperative outcomes. However, comparative study between both techniques for elderly patients with HCC is scarce. Objective: This study aimed to compare outcomes between LH and OH specifically. Methods: HCC patients aged ≥70 years after hepatectomy (2003–2018) were included. The propensity score matching (PSM) and comparative analyses between groups were performed. Results: After PSM, there were 41 patients in each group with similar demographics, radiographic tumor characteristics, cirrhotic status, and extent of resection. The LH group had a shorter hospital stay (7 vs. 11 days, p = 0.002) compared with the OH group. The completeness of resection and complication rates were not statistically different between groups. The 5-year overall survival and recurrence-free survival rates were 86.7 and 43.4% in the LH group and 62.2 and 30.8% in the OH group (p = 0.221 and 0.500). Conclusion: Our study confirmed the operative and oncological safety of LH in elderly HCC patients with improved perioperative outcomes compared with OH.
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- 2020
343. Utility of the Iwate difficulty scoring system for laparoscopic right posterior sectionectomy: do surgical outcomes differ for tumors in segments VI and VII?
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Choi S. H., Chen K. -H., Syn N. L., Cipriani F., Cheung T. -T., Chiow A. K. H., Choi G. -H., Siow T. -F., Sucandy I., Marino M. V., Gastaca M., Chong C. C., Lee J. H., Ivanecz A., Mazzaferro V., Lopez-Ben S., Fondevila C., Rotellar F., Campos R. R., Efanov M., Kingham T. P., Sutcliffe R. P., Troisi R. I., Pratschke J., Wang X., D'Hondt M., Yong C. C., Levi Sandri G. B., Tang C. N., Ruzzenente A., Cherqui D., Ferrero A., Wakabayashi G., Scatton O., Aghayan D., Edwin B., Coelho F. F., Giuliante F., Liu R., Sijberden J., Abu Hilal M., Sugioka A., Long T. C. D., Fuks D., Aldrighetti L., Han H. -S., Goh B. K. P., Kang I., Jang J. Y., Chan C. -Y., D'Silva M., Schotte H., De Meyere C., Lai E., Krenzien F., Schmelzle M., Kadam P., Montalti R., Giglio M., Liu Q., Lee K. -F., Salimgereeva D., Alikhanov R., Lee L. -S., Prieto M., Lim C., Nghia P. P., Kojima M., Kato Y., Forchino F., Herman P., Kruger J. A. P., Saleh M., Pascual F., Dalla Valle B., Lopez-Lopez V., Casellas-Robert M., Giustizieri U., Citterio D., Mishima K., Fretland A. A., Ghotbi J., Ettorre G. M., Colasanti M., Guzman Y., Ardito F., Vani S., Wang H. -P., Choi, S. H., Chen, K. -H., Syn, N. L., Cipriani, F., Cheung, T. -T., Chiow, A. K. H., Choi, G. -H., Siow, T. -F., Sucandy, I., Marino, M. V., Gastaca, M., Chong, C. C., Lee, J. H., Ivanecz, A., Mazzaferro, V., Lopez-Ben, S., Fondevila, C., Rotellar, F., Campos, R. R., Efanov, M., Kingham, T. P., Sutcliffe, R. P., Troisi, R. I., Pratschke, J., Wang, X., D'Hondt, M., Yong, C. C., Levi Sandri, G. B., Tang, C. N., Ruzzenente, A., Cherqui, D., Ferrero, A., Wakabayashi, G., Scatton, O., Aghayan, D., Edwin, B., Coelho, F. F., Giuliante, F., Liu, R., Sijberden, J., Abu Hilal, M., Sugioka, A., Long, T. C. D., Fuks, D., Aldrighetti, L., Han, H. -S., Goh, B. K. P., Kang, I., Jang, J. Y., Chan, C. -Y., D'Silva, M., Schotte, H., De Meyere, C., Lai, E., Krenzien, F., Schmelzle, M., Kadam, P., Montalti, R., Giglio, M., Liu, Q., Lee, K. -F., Salimgereeva, D., Alikhanov, R., Lee, L. -S., Prieto, M., Lim, C., Nghia, P. P., Kojima, M., Kato, Y., Forchino, F., Herman, P., Kruger, J. A. P., Saleh, M., Pascual, F., Dalla Valle, B., Lopez-Lopez, V., Casellas-Robert, M., Giustizieri, U., Citterio, D., Mishima, K., Fretland, A. A., Ghotbi, J., Ettorre, G. M., Colasanti, M., Guzman, Y., Ardito, F., Vani, S., Wang, H. -P., Choi, Sung Hoon, Chen, Kuo-Hsin, Syn, Nicholas L, Cipriani, Federica, Cheung, Tan-To, Chiow, Adrian K H, Choi, Gi-Hong, Siow, Tiing-Foong, Sucandy, Iswanto, Marino, Marco V, Gastaca, Mikel, Chong, Charing C, Lee, Jae Hoon, Ivanecz, Arpad, Mazzaferro, Vincenzo, Lopez-Ben, Santiago, Fondevila, Constantino, Rotellar, Fernando, Campos, Ricardo Roble, Efanov, Mikhail, Kingham, T Peter, Sutcliffe, Robert P, Troisi, Roberto I, Pratschke, Johann, Wang, Xiaoying, D'Hondt, Mathieu, Yong, Chee Chien, Levi Sandri, Giovanni Battista, Tang, Chung Ngai, Ruzzenente, Andrea, Cherqui, Daniel, Ferrero, Alessandro, Wakabayashi, Go, Scatton, Olivier, Aghayan, Davit, Edwin, Bjørn, Coelho, Fabricio Ferreira, Giuliante, Felice, Liu, Rong, Sijberden, Jasper, Abu Hilal, Mohammad, Sugioka, Atsushi, Long, Tran Cong Duy, Fuks, David, Aldrighetti, Luca, Han, Ho-Seong, and Goh, Brian K P
- Subjects
Carcinoma, Hepatocellular ,Laparoscopic liver ,Settore MED/18 - CHIRURGIA GENERALE ,Operative Time ,Liver Neoplasms ,Carcinoma ,Hepatocellular ,Difficulty score ,Length of Stay ,Iwate ,Laparoscopic hepatectomy ,Right posterior sectionectomy ,Treatment Outcome ,Postoperative Complications ,Humans ,Hepatectomy ,Surgery ,Laparoscopy ,Retrospective Studies - Abstract
Introduction: The Iwate Score (IS) have not been well-validated for specific procedures, especially for right posterior sectionectomy (RPS). In this study, the utility of the IS was determined for laparoscopic (L)RPS and the effect of tumor location on surgical outcomes was investigated. Methods: Post-hoc analysis of 647 L-RPS performed in 40 international centers of which 596L-RPS cases met the inclusion criteria. Baseline characteristics and perioperative outcomes of patients stratified based on the Iwate score were compared to determine whether a correlation with surgical difficulty existed. A 1:1 Mahalanobis distance matching was utilized to investigate the effect of tumor location on L-RPS outcomes. Results: The patients were stratified into 3 levels of difficulty (31 intermediate, 143 advanced, and 422 expert) based on the IS. When using a stepwise increase of the IS excluding the tumor location score, only Pringle’s maneuver was more frequently used in the higher surgical difficulty level (35.5%, 54.6%, and 65.2%, intermediate, advanced, and expert levels, respectively, Z = 3.34, p = 0.001). Other perioperative results were not associated with a statistical gradation toward higher difficulty level. 80 of 85 patients with a segment VI lesion and 511 patients with a segment VII lesion were matched 1:1. There were no significant differences in the perioperative outcomes of the two groups including open conversion, operating time, blood loss, intraoperative blood transfusion, postoperative stay, major morbidity, and mortality. Conclusion: Among patients undergoing L-RPS, the IS did not significantly correlate with most outcome measures associated with intraoperative difficulty and postoperative outcomes. Similarly, tumor location had no effect on L-RPS outcomes.
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- 2022
344. The Relationship Between the Number of Ports and Surgical Outcomes in Laparoscopic Hepatectomy
- Author
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Masashi Yamamoto, Keitaro Tanaka, Yusuke Tsuchimoto, Masahiro Goto, Shinya Fukunishi, Toshifumi Yamaguchi, Kazuya Kitada, Shinsuke Masubuchi, Junji Okuda, Kazuhisa Uchiyama, Masatsugu Ishii, Tetsuji Terazawa, Hiroki Hamamoto, Koji Komeda, Akira Asai, Atsushi Tomioka, Syuji Kagota, Wataru Osumi, Yoshihiro Inoue, Akira Imoto, Keisuke Yokohama, Hideko Ohama, Kensuke Fujii, Takeshi Ogura, Kazuhide Higuchi, and Fumitoshi Hirokawa
- Subjects
Adult ,Male ,medicine.medical_specialty ,Visual analogue scale ,Laparoscopic hepatectomy ,Operative Time ,030230 surgery ,Analgesic agents ,03 medical and health sciences ,symbols.namesake ,Postoperative Complications ,0302 clinical medicine ,Hepatectomy ,Humans ,Medicine ,Fisher's exact test ,Aged ,Retrospective Studies ,Aged, 80 and over ,business.industry ,Liver Neoplasms ,Significant difference ,Length of Stay ,Middle Aged ,Surgery ,Treatment Outcome ,Invasive surgery ,Mann–Whitney U test ,symbols ,Female ,Laparoscopy ,030211 gastroenterology & hepatology ,business ,Umbilical region - Abstract
Introduction Reduced port surgery (RPS) has been garnering interest as a novel minimally invasive surgery lately. Aim The authors examined the relationship between the number of ports and surgical outcomes after laparoscopic hepatectomy (LH). Materials and methods Between January 2012 and April 2019, 209 patients who underwent laparoscopic partial resection and lateral sectionectomy were retrospectively analyzed with respect to operative variables and surgical outcomes. Patients were divided into 5 groups by the number of ports used. Student's t test, the χ test, the likelihood-ratio test, Fisher exact test, or Mann-Whitney U test were used to analyze the data. Results Operative duration was significantly longer in patients with a larger number of ports than in those with a smaller number of ports. Chronological pain scores according to the visual analog scale (VAS) on postoperative days 1, 2, 4, and 7 were not associated with the number of ports and wound length in the umbilical region. The frequency of using additional analgesic agents was not significantly different between the groups. VAS scores and the number of additional analgesic agents used were smaller in patients in whom non-steroidal anti-inflammatory drugs were regularly administered postoperatively than in those in whom the drug was not regularly administered postoperatively. LH had a 3.4% complication rate (Clavien-Dindo classification >IIIA); however, this was not significantly different between the groups. Conclusions No significant difference in postoperative pain was observed between RPS and conventional methods, although operative durations were shorter with RPS. However, RPS for LH may be associated with excellent cosmetic results compared with conventional methods.
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- 2019
345. Iatrogenic diaphragmatic hernia and intestinal obstruction following laparoscopic hepatectomy: A case report
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Rıfat Peksöz, Ercan Korkut, and Nurhak Aksungur
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medicine.medical_specialty ,business.industry ,Laparoscopic hepatectomy ,diaphragmatic hernia ,lcsh:R ,lcsh:Medicine ,intestinal obstruction ,medicine.disease ,Surgery ,hepatectomy ,diaphragmatic injury ,Medicine ,Diaphragmatic hernia ,business - Abstract
Diaphragmatic hernias may be either congenital or acquired. Acquired diaphragmatic hernias generally develop in association with blunt or penetrating thoraco-abdominal injuries. Iatrogenic diaphragmatic hernias are rare in the literature. Traumatic diaphragmatic ruptures are diagnosed during the imaging tests performed due to accompanying organ injuries or during surgery. However, acquired diaphragmatic hernias developing in the late postoperative period are uncommon, and the difficulties in diagnosis may result in increased mortality and morbidity. The use of electrocautery and other electric devices during the release of hepatic ligaments is thought to result in diaphragmatic hernias in the late period of diaphragmatic injuries that are missed during surgery. We describe the diagnosis and the therapeutic course of a case undergoing laparoscopic right hepatectomy due to hepatic alveolar echinococcosis and taken for emergency surgery with diagnoses of diaphragmatic hernia and intestinal obstruction approximately 20 months subsequently in the light of the current literature.
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- 2019
346. Laparoscopic Hepatectomy via Remote Mentoring From Jamaica to Trinidad
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Shamir O Cawich, Lindberg Simpson, and Andrew Josephs
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General Surgery ,liver surgeon ,liver parenchymal transection ,General Engineering ,Emergency Medicine ,advanced laparoscopy ,Healthcare Technology ,laparoscopic hepatectomy ,partial hepatectomy - Abstract
Laparoscopic hepatectomy brings many physiologic advantages over open hepatectomy and adheres to all oncologic principles. It is currently considered the standard of care. However, these are technically difficult operations to perform. Consequently, the expertise may not be universally available for all patients to benefit from laparoscopic hepatectomy. We report a unique situation where remote mentoring was used to guide bariatric surgeons in Jamaica to complete a laparoscopic hepatectomy.
- Published
- 2021
347. Enhanced Recovery After Surgery in Patients With Hepatocellular Carcinoma Undergoing Laparoscopic Hepatectomy
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Lu Wang, Ning Zhang, Longrong Wang, Miao Wang, Yiming Zhao, Jiamin Zhou, Xigan He, and Anrong Mao
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medicine.medical_specialty ,medicine.diagnostic_test ,RD1-811 ,business.industry ,medicine.medical_treatment ,Laparoscopic hepatectomy ,laparoscopy ,Perioperative ,hepatocellular carcinoma ,medicine.disease ,Surgery ,hepatectomy ,enhanced recovery after surgery ,liver function ,Hepatocellular carcinoma ,Propensity score matching ,medicine ,Liver function ,Hepatectomy ,Laparoscopy ,business ,Enhanced recovery after surgery ,Original Research - Abstract
Objective: To compare the effectiveness and safety of enhanced recovery after surgery (ERAS) in patients with hepatocellular carcinoma (HCC) undergoing laparoscopic hepatectomy.Methods: From September 2016 to June 2019, 282 patients were enrolled, and ERAS was implemented since March 2018. All indicators related to surgery, liver function, and postoperative outcomes were included in the analysis. Propensity score matching (PSM) identified 174 patients for further comparison.Results: After PSM, the clinicopathological baselines were well-matched. The group showed significantly less intraoperative blood loss (100.00 [100.00–200.00] vs. 200.00 [100.00–300.00] ml, P = 0.001), fewer days before abdominal drainage tube removal (4.00 [3.00–4.00] days vs. 4.00 [3.00–5.00] days, P = 0.023), shorter hospital stay after surgery (6.00 [5.00–6.00] days vs. 6.00 [6.00–7.00] days, P < 0.001), and reduced postoperative morbidity (18.39 vs. 34.48%, P = 0.026). The proportion of patients with a pain score ≥ 4 was significantly lower in the ERAS group within the first 2 days after surgery (1.15 vs. 13.79% and 8.05 vs. 26.44%, P = 0.002 and P = 0.001, respectively). Pringle maneuver was performed more frequently in the ERAS group (70.11 vs. 18.39%, P < 0.001), and a significantly higher postoperative alanine aminotransferase level was also observed (183.40 [122.85–253.70] vs. 136.20 [82.93–263.40] U/l, P = 0.026). The 2-year recurrence-free survival was similar between the two groups (72 vs. 71%, P = 0.946).Conclusions: ERAS programs are feasible and safe and do not influence mid-term recurrence in HCC patients undergoing laparoscopic hepatectomy.
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- 2021
348. Laparoscopic extended left hepatectomy with middle hepatic vein reconstruction for intrahepatic cholangiocarcinoma with a video vignette.
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Chang, Yin-Jen, Siow, Tiing-Foong, Lin, Tzu-Chao, and Chen, Kuo-Hsin
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- 2022
- Full Text
- View/download PDF
349. Hepatectomía laparoscópica de quiste hidatídico
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I Domínguez-Rosado, J Cisneros-Correa, and K A González-Espinoza
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medicine.medical_specialty ,business.industry ,Laparoscopic hepatectomy ,Gastroenterology ,Medicine ,Hydatid cyst ,business ,Surgery - Published
- 2021
350. Left Intercostal Approach for Laparoscopic Isolated Total Caudate Lobectomy (with Video)
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Furukawa, Kenei, Onda, Shinji, and Ikegami, Toru
- Published
- 2022
- Full Text
- View/download PDF
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