Changes and optimization of operator model in laparoscopic anastomic hepatectomy / 中华消化外科杂志

Laparoscopic anatomical resection (LAR) is a highly-demanding and high risky procedure.Traditional single-surgeon technique appears to be frustrating when dealing with intro-operative emergency and ensuring the safety of complicated LAR.The authors' department has applied two-surgeon technique when performing LAR since 2014.In complicated cases of LAR,two skillful surgeons cooperate to perform surgeries.The two surgeons stand at each side of the patient and switch their duties as the surgeon or the assistant during the operation.Experience of the authors' department shows that compared with single-surgeon technique,two-surgeon technique can help better deal with intro-operative accidental events such as hemorrhage and guarantee the safety of LAR,as well as enhance the efficiency and quality of procedures.Two-surgeon technique benefits team building and training young laparoscopic liver surgeons,and help them pass the learning curve more safely and quickly.

Prognosis of anatomical and non-anatomical liver resections for hepatocellular carcinoma / 中华肝胆外科杂志

Objective Surgical resection is the primary form of curative treatment for hepatocellular carcinoma.Recent reports suggested that when compared to non-anatomical resection,anatomical liver resection improved prognosis of HCC patients.Whether anatomical liver resection should be the preferred routine procedure remains controversial.Methods The data of 236 HCC patients who underwent curative hepatectomy at the PLA General Hospital from January 2008 to July 2013 were reviewed.The data included basic information,procedure,tumor related information and follow-up data.Factors influencing overall survival and tumor-free survival rates were analyzed by multivariate analysis.Multivariate analysis and stratification analysis were also used to evaluate the long-term efficacy of the different procedures.Results The 5-year survival rate of anatomical liver resection was 75％,which was significantly better than that of non-anatomical resection (65 ％) (P ＜ 0.05).The tumor-free survival rate was 51％,which was significantly better than that of non-anatomical resection (34％) P ＜ 0.05).Antiviral therapy prolonged survival time and tumor-free survival time of HbsAg-positive patients.Surgical procedure,tumor diameter,tumor staging,antiviral therapy were influencing factors of overall survival.Surgical procedure,tumor staging,antiviral therapy were influencing factors of tumor-free survival.Anatomical resection improved the tumor-free survival for patients with tumor diameters less than 5 cm (P =0.098),improved tumor-free survival for patients with TNM stage T1 and T2 (P =0.059),and significantly improved the overall survival and tumor-free survivals for patients with T3,T4 (P ＜ 0.05).Conclusion Anatomical resection is recommended for treatment of patients with hepatocellular carcinoma.

Application of Anatomical Liver Resection in Treatment of Bilateral Hepatolithiasis / 昆明医科大学学报

Objective To explore the value of anatomical liver resection in the treatment of bilateral intrahepatic biliary lithiasis. Methods We collected the clinical data of 32 patients with bilateral intrahepatic biliary lithiasis who received anatomical liver resection and 25 patients who recevied non-anatomical liver resection from May 2010 to May 2012 in our hospital and Sun Yat-sen Memorial Hospital. We comapred the therapeutic efficacy of these two operative modalities in the diagnosis and treatment of bilateral intrahepatic biliary lithiasis. Results The intraoperative blood loss was 436 ±48.162 mL in patients who received anatomical liver resection, and was significantly less than that in the control group (763 ± 37.645ml) ( 0.05 ), but there 1 patients died of liver failure in the control group. Conclusions Anatomical liver resection is a favorable method to completely remove the lesions under the premise of retaining the residual liver function as much as possible. The rate of remnant biliary lithiasis and recurrence is lower and the recovery is quicker in these patients after anatomical liver resection. Thus, anatomical liver resection is worthy of promotion.

Current Status of Laparoscopic Liver Resection in Korea

Since laparoscopic liver resection was first introduced in 2001, Korean surgeons have chosen a laparoscopic procedure as one of the treatment options for benign or malignant liver disease. We distributed and analyzed a nationwide questionnaire to members of the Korean Laparoscopic Liver Surgery Study Group (KLLSG) in order to evaluate the current status of laparoscopic liver resection in Korea. Questionnaires were sent to 24 centers of KLLSG. The questionnaire consisted of operative procedure, histological diagnosis of liver lesions, indications for resection, causes of conversion to open surgery, and postoperative outcomes. A laparoscopic liver resection was performed in 416 patients from 2001 to 2008. Of 416 patients, 59.6% had malignant tumors, and 40.4% had benign diseases. A total laparoscopic approach was performed in 88.7%. Anatomical laparoscopic liver resection was more commonly performed than non-anatomical resection (59.9% vs 40.1%). The anatomical laparoscopic liver resection procedures consisted of a left lateral sectionectomy (29.3%), left hemihepatectomy (19.2%), right hemihepatectomy (6%), right posterior sectionectomy (4.3%), central bisectionectomy (0.5%), and caudate lobectomy (0.5%). Laparoscopy-related serious complications occurred in 12 (2.8%) patients. The present study findings provide data in terms of indication, type and method of liver resection, and current status of laparoscopic liver resection in Korea.

Anatomical polysegmentectomy with reservation of segments Ⅰ and Ⅳ for the treatment of complicated hepatolithiasis / 中华消化外科杂志

Anatomical hepatic segmentectomy is the treatment of choice for hepatolithiasis. However, in consideration of the volume of residual liver and the liver function, anatomical polysegmentectomy of the bilateral lobes for hepatolithiasis is restricted. Protection of the portal pedicles to the segments preserved and avoidance of ischemia/reperfusion injury to the residual liver parenchyma are critical steps during the operation.A female patient with hepatolithiasis and had a surgical history of choledocholithiasis removal and T-tube drainage received ana tomic polysegmentectomy with segments Ⅰ and Ⅳ preservation at the General Hospital of Kunming Medical College. During the operation, Portal pedicles to the segments Ⅰ , Ⅱ, right lobe,and segments Ⅱ and Ⅲ were isolated prior to liver parenchyma transection. Portal pedicles to segments Ⅰ and Ⅳ were protected under direct visualization. Hepatoduodenal ligament occlusion was not applied during liver parenchyma transaction. Segments Ⅱ- Ⅲ and Ⅴ-Ⅷ were anatomically resected, and segments Ⅰ ,Ⅳ were preserved with satisfactory vascularization. The patient recovered uneventfully and was discharged 14 days after the operation.

Clinical Application of Hepatic Resection Using Glissonean Pedicle Transection Method and Hanging Maneuver

PURPOSE: The liver hanging maneuver (LHM) is a useful technique enabling a safe anterior approach, which is one of the most important innovations in the field of major hepatic resections. This study was conducted to review tumors' profiles after applying this procedure and to evaluate the usefulness of LHM and Glissonean pedicle transaction method (GPTM). METHODS: Medical records of 64 patients who underwent hepatic resection using LHM and GPTM at the Asan Medical Center were reviewed. The classic LHM was conducted according to the Belghiti method. RESULTS: Among 64 patients, 46 patients had hepatocellular carcinoma; 7, intrahpatic cholangiocarcinoma; 4, hilar cholangiocarcinoma; 4, metastatic liver cancer; 3, benign liver tumor. Mean tumor size was 10.6 cm (3~22). Mean liver parenchymal transection time was 20 min (15~30). Right side hepatectomy was performed in 44 patients; left side hepatectomy with or without caudate lobe was performed in 19 patients. Twenty patients (31.3%) required blood transfusion during surgery. There was no in-hospital mortality or major complications. Minor complications developed in 6 patients (9.37%). CONCLUSION: GPTM and LHM are a safe and useful surgical application of various anatomical resections for huge liver tumor and an effective procedure during left hepatectomy with or without caudate lobe.