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Hepatic vein guided hepatectomy

Katharina Joechle, Eduardo A Vega, Masayuki Okuno, Eve Simoneau, Satoshi Ogiso, Timothy E Newhook, David L Ramirez, A Alex Holmes, Jose M Soliz, Yun Shin Chun, Ching-Wei D Tzeng, Jeffrey E Lee, Jean-Nicolas Vauthey, Claudius Conrad
BACKGROUND: When performing a right hepatectomy, the middle hepatic vein (MHV) should guide the parenchymal transection. MHV hotspots for bleeding can be anticipated when applying the previously developed MHV Roadmap to a minimally invasive approach.1 This video demonstrates application of the MHV Roadmap to perform a safe laparoscopic right hepatectomy. PATIENT: A 44-year-old woman with a solitary and large breast cancer liver metastasis in the right liver was considered for a laparoscopic right hepatectomy following an excellent response to neoadjuvant chemotherapy...
November 21, 2018: Annals of Surgical Oncology
Satoshi Ogiso, Masayuki Okuno, Junichi Shindoh, Yoshihiro Sakamoto, Takashi Mizuno, Kenichiro Araki, Claire Goumard, Takeo Nomi, Takamichi Ishii, Shinji Uemoto, Yun Shin Chun, Ching-Wei D Tzeng, Jeffrey E Lee, Jean-Nicolas Vauthey, Claudius Conrad
BACKGROUND: While the middle hepatic vein (MHV) guides parenchymal transection during right hepatectomy, its most proximal tributaries can be difficult to identify, and injury to its tributaries can be a source of major bleeding. METHOD: Following simulation modeling of right hepatectomy, reconstructed MHV data was pooled from 40 patients. MHV-tributaries and MHV-relationship to the portal pedicle were mapped out to facilitate their identification from the beginning of parenchymal transection...
September 25, 2018: HPB: the Official Journal of the International Hepato Pancreato Biliary Association
Ji Hoon Kim
Anatomical landmarks are commonly utilized in surgical practice to help surgeons to maintain an anatomical orientation. The ligamentum venosum (LV) is an anatomical landmark that is utilized during left hepatectomy via both the open and the laparoscopic approaches. We describe the usefulness of the LV as an anatomical landmark in performing a safe laparoscopic left hepatectomy. The key characteristic of our technique is that the LV is divided at the end of the surgery. Our technique involves identification and dissection of the LV, but we do not divide it during liver mobilization...
August 2018: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Mariano E Giménez, Eduardo J Houghton, C Federico Davrieux, Edgardo Serra, Patrick Pessaux, Mariano Palermo, Pablo A Acquafresca, Caetano Finger, Bernard Dallemagne, Jacques Marescaux
BACKGROUND: When a major hepatic resection is necessary, sometimes the future liver remnant is not enough to maintain sufficient liver function and patients are more likely to develop liver failure after surgery. AIM: To test the hypothesis that performing a percutaneous radiofrecuency liver partition plus percutaneous portal vein embolization (PRALPPS) for stage hepatectomy in pigs is feasible. METHODS: Four pigs (Sus scrofa domesticus) both sexes with weights between 25 to 35 kg underwent percutaneous portal vein embolization with coils of the left portal vein...
March 1, 2018: Arquivos Brasileiros de Cirurgia Digestiva: ABCD, Brazilian Archives of Digestive Surgery
X J Zhou, Q Dong, C Z Zhu, X Chen, B Wei, Y H Duan, J Zhao, X W Hao, H Zhang, P Nie, B Hu, W J Xu, R W Shen, Z H Chen, K R Dong, Y Z Bai, Q Shu, W J Luo, F Gao, N Xia, Q Y Yu
Objective: To study the segment of liver according to the large amount of three-dimensional(3D) reconstructive images of normal human livers and the vascular system, and to recognize the basic functional liver unit based on the anatomic features of the intrahepatic portal veins. Methods: The enhanced CT primitive DICOM files of 1 260 normal human livers from different age groups who treated from October 2013 to February 2017 provided by 16 hospitals were analyzed using the computer-aided surgery system.The 3D liver and liver vascular system were reconstructed, and the digital liver 3D model was established...
January 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Ji Hoon Kim
BACKGROUND: The laparoscopic caudal approach is very different from the open ventral approach, specifically with respect to the surgical view, which is completely different and is the underlying reason for why laparoscopic hepatectomy is technically challenging. We have introduced a new laparoscopy-specific ventral approach in laparoscopic hemihepatectomy. METHODS: The liver was transected from the ventral side to the dorsal side, via a flexible laparoscope, as in open liver resection...
August 2017: Journal of Surgical Oncology
Yoshikuni Kawaguchi, Vimalraj Velayutham, David Fuks, Frederic Mal, Norihiro Kokudo, Brice Gayet
BACKGROUND: The lack of a complete hepatic overview and tactile feedback during laparoscopic hepatectomy may result in near misses or fatal intraoperative complications despite the advantage of a magnified laparoscopic view. The aim of the study is to describe operative techniques and guiding principles with which to address near misses unique to laparoscopic hepatectomy and evaluate the intraoperative complication rate overtime. METHODS: Data of 408 consecutive patients who underwent laparoscopic hepatectomy were reviewed...
February 2017: Surgery
Cheng-Zuo Xiao, Wei Wei, Zhi-Xing Guo, Shu-Hong Li, Yong-Fa Zhang, Jia-Hong Wang, Ming Shi, Rong-Ping Guo
The present study aimed to identify the risk factors influencing the survival of patients with hepatocellular carcinoma (HCC) affected by portal vein tumor thrombus (PVTT), following hepatic resection, and to establish a prognostic model. Between March 2001 and May 2008, 234 cases of HCC with PVTT that underwent hepatic resection were randomly divided into experimental or validation groups. The association between the clinicopathological factors and disease-free survival (DFS) and overall survival (OS) was analyzed, and the significant factors involved were used to establish a prognostic model, which was then validated...
November 2015: Oncology Letters
Peng-Fei Wang, Chong-Hui Li, Ai-Qun Zhang, Shou-Wang Cai, Jia-Hong Dong
BACKGROUND: The aim of this study was to evaluate the safety, feasibility, and efficacy of a new segmental hepatectomy (SH) approach using intraoperative ultrasound (IOUS) guided infusion of a reversible thermosensitive gel into the portal vein branch in pigs; MATERIALS AND METHODS: Poloxamer 407 aqueous solution (20%, W/V) was mixed with indocyanine green (P407-ICG) in this study to make it green, and it remained liquid at room temperature and turned into a firm gel upon reaching body temperature...
2015: Journal of Investigative Surgery: the Official Journal of the Academy of Surgical Research
Nan Xiang, Chihua Fang
OBJECTIVE: To study the value of hepatic segment resection combined with rigid choledochoscope by the three-dimensional (3D) visualization technology in the diagnosis and treatment of complex hepatolithiasis. METHODS: Enhance computed tomography (CT) data of 46 patients with complex hepatolithiasis who were admitted to the Zhujiang Hospital of the Southern Medical University from July 2010 to June 2014 were collected.All of the CT data were imported into the medical image three-dimensional visualization system (MI-3DVS) for 3D reconstruction and individual 3D types...
May 2015: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Chihua Fang, Zhaoshan Fang, Yingfang Fan, Jianyi Li, Fei Xiang, Haisu Tao
OBJECTIVE: To study the value of three-dimensional (3D) visualization, 3D printing and 3D laparoscopy (3-3D techniques) in the diagnosis and surgical treatment of hepatic tumors. METHODS: From November 2013 to January 2015, 22 patients with hepatic tumors admitted in our department underwent abdominal thin-slice CT scanning. The CT images were imported into Medical Image three Dimensional Visualization System (MI-3DVS) for 3D reconstruction. Standard Template Library (STL) files were exported for 3D printing...
May 2015: Nan Fang Yi Ke da Xue Xue Bao, Journal of Southern Medical University
Cai Shou-wang, Yang Shi-zhong, Lv Wen-ping, Chen Geng, Gu Wan-qing, Duan Wei-dong, Wang Wei-yi, Huang Zhi-qiang, Dong Jia-hong
BACKGROUND: The boundary of the target hepatic segment within the liver parenchyma cannot be marked by the use of a conventional anatomic hepatectomy approach. This study describes a novel methylene blue staining technique for guiding the anatomic resection of hepatocellular carcinoma (HCC). METHODS: Between February 2009 and February 2012, anatomic hepatectomy was performed in 106 patients with HCC via a novel, sustained methylene blue staining technique. Sustained staining was achieved by injecting methylene blue into the distal aspect of the portal vein after exposing Glisson's sheath...
July 2015: Surgery
A Abdelraouf, H Hamdy, A M El Erian, M Elsebae, S Taha, H E Elshafey, S Ismail, M Hassany
Surgical hepatic resection has been considered as the first-line treatment which is most effective and radical treatment for HCC, however, HCC is usually associated with poor liver function owing to chronic hepatitis or liver cirrhosis. Techniques that can eradicate the tumor and also preserve liver function are needed. Moreover, hepatic resection, in the presence of cirrhosis, raises special problem of high risk as hemorrhage and liver failure, thus, good clinical results can only be achieved by minimizing operative blood loss, time of the intervention as well as the hepatic reserve...
August 2014: Journal of the Egyptian Society of Parasitology
Guido Torzilli, Fabio Procopio, Matteo Cimino, Matteo Donadon, Daniele Del Fabbro, Guido Costa, Carlos A Garcia-Etienne
BACKGROUND: Two-stage hepatectomies generally are selected for patients with multiple bilobar colorectal liver metastases (CLMs) involving the hepatic veins (HV) at the caval confluence to reduce the risk of postoperative hepatic failure due to insufficient remnant liver.1 (,) 2 The use of IOUS based on well-established criteria offers alternative technical solutions to the staged resections.3 (,) 4 This report describes a sophisticated IOUS-guided parenchyma-sparing procedure. METHODS: A 57-year-old woman with multiple CLMs underwent surgery...
May 2015: Annals of Surgical Oncology
L Sand, S Lundin, M Rizell, J Wiklund, O Stenqvist, E Houltz
BACKGROUND: To reduce blood loss during liver surgery, a low central venous pressure (CVP) is recommended. Nitroglycerine (NG) with its rapid onset and offset can be used to reduce CVP. In this study, the effect of NG on portal and hepatic venous pressures (PVP and HVP) in different body positions was assessed. METHODS: Thirteen patients undergoing liver resection were studied. Cardiac output (CO), mean arterial pressure (MAP) and CVP were measured. PVP and HVP were measured using tip manometer catheters at baseline (BL) in horizontal position; during NG infusion, targeting a MAP of 60 mmHg, with NG infusion and the patient placed in 10 head-down position...
September 2014: Acta Anaesthesiologica Scandinavica
Caitlin W Hicks, Michael A Choti
The use of stapling devices to manage vascular pedicles during hepatic surgery has been a significant advance in the field. However, insertion and application of the stapler in vascular dissection planes can be associated with injury to adjacent structures. We describe a five-step technique using a silicone Penrose drain to aid in the positioning of an endovascular stapling device to obtain vascular control during hepatectomy. The use is described here for hepatic vein management during right hepatectomy. The technique can be also used for other applications when transecting major vessels during major liver surgery...
February 2014: Journal of Gastrointestinal Surgery: Official Journal of the Society for Surgery of the Alimentary Tract
Tiffany C L Wong, Ronnie T P Poon
With the higher incidences of hepatocellular carcinoma (HCC) and cholangiocarcinoma (CCA) in the East compared with the West, Asian centers have made significant contributions to the management of these malignancies. The major risk factor for HCC is hepatitis B infection in Asia in contrast to hepatitis C in Western populations. Barcelona Clinic for Liver Cancer (BCLC) staging that guides the treatment of patients with HCC in the West is considered too conservative by many Asian centers. In Asia, liver resection is widely offered to patients with multifocal, bilobar tumor or tumor invasion to the portal vein...
2013: Digestive Diseases
Kevin K W Chu, See Ching Chan, Sheung Tat Fan, Kenneth S H Chok, Tan To Cheung, William W Sharr, Albert C Y Chan, Chung Mau Lo
BACKGROUND: Hepatectomy is the main curative treatment for hepatocellular carcinoma (HCC), but postoperative long-term survival is poor. Preoperative radiological features of HCC displayed by computed tomography or magnetic resonance imaging could serve as additional prognostic factors. This study aimed to identify preoperative radiological features of HCC that may be of prognostic significance in hepatectomy. METHODS: Ninety-two patients who underwent hepatectomy for HCC were included in this study...
December 15, 2012: Hepatobiliary & Pancreatic Diseases International: HBPD INT
Guido Torzilli, Matteo Cimino, Daniele Del Fabbro, Fabio Procopio, Matteo Donadon, Florin Botea, Carlos Garcia-Etienne, Marco Montorsi
BACKGROUND: Anatomical resection is the gold standard for liver resection in patients with hepatocellular carcinoma (HCC). Bimanual hepatic vessel compression has been already described, although segmental and subsegmental resection of segment 8 (S8) remain challenging by this technique. We demonstrate how to obtain a S8 demarcation by means of ultrasound-guided vessel compression. METHODS: Two patients with HCC with hepatitis C virus-related cirrhosis partially or fully located in S8 without portal thrombosis underwent liver resection...
February 2013: Annals of Surgical Oncology
Guido Torzilli, Fabio Procopio, Matteo Donadon, Daniele Del Fabbro, Matteo Cimino, Carlos A Garcia-Etienne, Marco Montorsi
BACKGROUND: For tumors involving hepatic veins (HV) at hepato-caval confluence (HC), major hepatectomy or vascular reconstruction, are recommended. Detection of communicating veins (CV) between adjacent HVs allows conservative hepatectomies. METHODS: A 61 year-old man was operated for multiple colorectal liver metastases (CLM). The 2 main CLM (14 and 3.5 cm in size) were adjacent, separated by the middle HV (MHV) at HC, and involved segments 1(paracaval portion), 7, and 8, and segments 4-superior(S4sup) and 1(paracaval portion), respectively...
October 2012: Annals of Surgical Oncology
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