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Objective To investigate the safety and feasibility of laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis.Methods Between September 2015 and May 2016,patients with hepatic cystic echinococcosis indicated for surgery were evaluate.Selective hemihepatic inflow inclusion or non-selective hepatic inflow inclusion was adopted to control the bleeding.Laparoscopic multifuctional operative dissector (LPMOD) was applied for liver parenchymal transection.Laparoscopic hepatectomy and cystectomy was applied for hepatic cystic echinococcosis in eight cases,including one case of mesohepatectomy,two cases of right posterior sectionectomy,two cases of right partial hepatectomy,one case of left hepatectomy,one case of left lateral sectionectomy and one case of cystectomy in the left hepatic lobe.Results 8 patients received laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis.Seven cases were performed totally laparoscopically and one case required a conversion.The maximum size of the lesion was 10 cm.Operating time was 150-260 min (mean,200 ± 35);Blood loss was 100-1 000 ml (313 ±290).One patient received intraoperative transfusion.Postoperative hospital stay was 6-9 days (mean,7.6 ± 1.3).One patient developed postoperative pleural effusion that resolved after medical treatment.One patient developed biliary leak in postoperative five days and recovered after drainage for twelve days.No remaining cavity infection,postoperative abdominal bleeding,liver failure occurred.No hospital death occurred.Conclusions Laparoscopic hepatectomy and cystectomy for hepatic cystic echinococcosis is technically safe and feasible.
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Objective To study the safety and feasibility of laparoscopic left lateral sectionectomy using the Glissonian pedicel approach.Methods The root of the round ligament of the liver was exposed and the Glissonian pedicel of the left lateral section was dissected,starting from left and using the lapa roscopic Peng's multifunctional operative dissector (LPMOD).After the Glissonian pedicel of segment Ⅱ and Ⅲ was dissected,clipped and cut,the ischemic boundary showed up.The liver was transected at the boundary of the ischemic liver,and the left hepatic vein and its branches were cut. Resutts The surgery was successtully performed in 8 patients.There was no conversion to open operation.The operative time was 110- 190 (151.0±35.4) min.The time of Glissonian pedicel dissection and liver resection was 70- 135 (101.0±24.1) min.Operative blood loss was 100-300(210.0± 89.4) ml.The ALT increased by 35- 102 (75.4± 26.5) U/L after operation and decreased to a normal level in 2-6 (3.0± 1.7) d.The postoperative hospital stay was 6-10 (8.2± 1.6) d.There was no major complication.Conclusion Laparoscopic left lateral sectionectomy using the Glissonian pedicel approach is safe and feasible.
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Objective To evaluate the feasibility and safety of laparoscopic right hemihepatectomy under selective hemihepatic inflow occlusion.Methods In performing this procedure,first dissect the right hepatic portal,and under selective hemihepatic inflow occlusion,laparoscopie Peng's multifunctional operative dissector (LPMOD) was used to transect the hepatic parenchyma by stepwise curettage and aspiration.Results Procedures were successful in all six patients of benign liver diseases,though a small subcostal auxiliary incision was needed in one case to control the middle hepatic vein branch hemorrhage.Operation time was 300-540 min[mean,( 399 ± 75 ) min].The time of hepatic portal dissect was 30-75 min[mean,(51 ± 16) min].The time of liver parenchyma transection was 60-160 min[mean,( 116 ± 32) min].Intraoperative blood loss was 600-3000 ml[mean,( 1486 ± 809 ) ml].The level of ALT increased to (302-557) U/L[mean,(386 ± 85 ) U/L]after the operation,and back to normal level in 5-11 d[mean,( 7.1 ± 2.0) d].The postoperative hospital stay was 10-18 d[mean,( 12.4 ± 2.6 ) d].No severe complication occurred after the operation.Conclusions Laparoscopic right hemihepatectomy under selective hemihepatic inflow occlusion is safe and feasible.
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Objective To investigate the effect of the Ras-related tumor suppressor gene aplasia Ras homolog member Ⅰ (ARHI) on angiogenesis in hepatocellular carcinoma (HCC).Methods We generated stable cell lines overexpressing ARHI in Hep3B cells,which lack endogenous ARHI.Cell proliferation was assessed by the MTT assay.The effects of ARHI overexpression on tumor growth and angiogenesis were assessed.Because of the key role of mammalian target of rapamycin (mTOR)signaling in HCC progression,we also tested whether ARHI overexpression affected the mTOR pathway.Results Ectopic expression of ARHI significantly diminished cell proliferation in Hep3B cells (P＜0.01).ARHI overexpression significantly retarded Hep3B xenograft growth by 76.4 ％ in vivo,and caused a marked reduction in tumor angiogenesis assessed by CD31-stained microvessel count.Western blot analysis of the xenografts showed that ARHI overexpression substantially reduced the phosphorylation of two mTOR substrates,S6K1 and 4E-BP1,indicative of an inactivation of the mTOR pathway.Accompanying with the mTOR inactivation,the angiogenic factors,hypoxia-inducible factor 1 alpha and vascular endothelial growth factor,were significantly downregulated.Conclusion These data highlighted an important role for ARHI in controlling HCC growth and angiogenesis,therefore offering a possible therapeutic strategy against this malignancy.
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Objective To evaluate the efficacy of laparoscopic Habib 4X (Habib 4X,Angio Dynamics US),a new bipolar radiofrequency (RF) device,in laparoscopic liver resection.Methods Thirty one patients who underwent laparoscopic liver resection using the laparoscopic Habib 4X from Sept 2009 to Apr 2012 were studied retrospectively.Results The laparoscopic Habib 4X was success fully used in 30 patients (malignant,n=18; benign,n=12).The procedures performed included left lateral sectionectomy (n=12),left hemi-hepatectomy (n=1),Ⅴ or Ⅵ segmentectomy (n=9),Ⅴ and Ⅵ bi-segmentectomy (n=2) and wedge exclusion (n=6).The time required for precoagulation and resection was 10～68 min (median 24 min).The mean intraoperative blood loss was 145±75ml (range 8-370 ml).Mild abnormal liver function which returned to normal in 3 to 5 days was detected postoperatively.The mean hospital stay was 7.8±2.6 d (range 3～12 days).There was no patient who developed postoperative bleeding,bile leakage or abdominal abscess.For cancer patients,there was no local recurrence on follow-up.Conclusion Laparoscopic Habib 4X,a device when used in laparoscopic liver resection,resulted in minimal blood loss and quick recovery.It had only mild effect on liver function and it had low morbidity.In addition,it might reduce the risk of local recurrence in malignant tumours.
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Objective To explore the method and clinical effect of laparoscopic anatomical right liver resections. Method The candidates for laparoscopic right hepatic lobectomys were 4 cases including 3 cases of liver hemangioma and 1 case of hepatorrhexis. Results The laparoscopic right hepatic lobectomy we performed saccess bully in all the 4 patients, operation time was (470±42.7)min. The blood loss in operation was ( 1950± 881.3) ml. The postoperative hospital stay was ( 15 ± 2.9) days.There was not complcation. Conclusions Laparoscopic right hepatic libectomy is feasible and safe.For the patients with benign liver disease, it is an operation with less operation wound.
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Objective To evaluate the feasibility of laparoscopic hepatectomy.Methods A total of 27 patients received laparoscopic hepatectomy by using laparoscopic Peng's multifunctional operative dissector(LPMOD).Among the patients,13 underwent anatomic hepatectomy(resection of the Ⅱ and Ⅲ segments in 3,Ⅴ segment in 1,Ⅵ in 7,Ⅴ and Ⅵ in 1,and Ⅴ,Ⅵ,Ⅶ,and Ⅷ segments in 1),and 14 received partial hepatectomy.Results The laparoscopic hepatectomy was accomplished successfully in all the patients without converting to open surgery.The mean operation time was 35-360 min [mean,(178.0?78.4) min];intraoperative blood loss was 35-1200 ml [mean,(451.7?332.6) ml];and the postoperative hospital stay was 2-14 d [mean,(8.4?3.0) d].No severe complication occurred after the operation.The postoperative pathological examinations showed hepatic hemangioma in 15,focal hyperplasia of the liver in 2,hepatocelluar carcinoma complicated with liver cirrhosis in 6,intrahepatic bile duct stone complicated with hyperplasia of the bile duct in 2,liver(hematoma) fibrosis in 1,and hepatic angiomyolipoma in 1.The patients were followed up for 1-26 months [mean,(7.9?7.4) months] by using B-ultrasonography or CT.No recurrence of hemangioma or carcinoma,tumor implantation at the puncture site,or residual stones in the intrahepatic bile duct was found in this series.Conclusion By using LPMOD,laparoscopic hepatectomy is safe and feasible for selected patients.
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0.05).Conclusion Selective hepatic vascular occlusion is superior to complete hepatic vascular occlusion,and is worth being widely used.