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Objective:To study the safety and feasibility of laparosocpic left-liver-first anterior radical modular orthotopic right hemihepatectomy (Lap-Larmorh) in treatment of Bismuth-Corlette type Ⅲa hilar cholangiocarcinoma.Methods:From June 2020 to April 2022, 13 patients with Bismuth-Corlette type Ⅲa hilar cholangiocarcinoma underwent Lap-Larmorh at the Department of Hepatobiliary Surgery of the Second Hospital of Hebei Medical University. There were 8 males and 5 females, aged (60.9±8.4) years. The operation time, intraoperative blood loss, complications and postoperative survival were analyzed.Results:Five patients were treated with percutaneous transhepatic cholangial drainage to reduce jaundice before surgery. All 13 patients successfully underwent the Lap-Larmorh and there was no conversion to laparotomy. The operative time was [ M( Q1, Q3)] 390.0 (355.0, 435.0) minutes, and the intraoperative blood loss was [ M( Q1, Q3)] 800.0 (300.0, 1 100.0) ml. Postoperative complications occurred in 4 patients with pleural effusion, and 1 patient had portal vein thrombosis associated with pleural effusion, who was managed successfully using low molecular weight heparin sodium anticoagulation therapy and pleural effusion tapping. The postoperative hospital stay was (12.5±5.5) days, and there was no perioperative death. Intraoperative frozen pathology showed 12 patients with left hepatic duct with negative margins, and 1 patient with moderate dysplasia. Postoperative paraffin pathology showed 12 patients with bile duct adenocarcinoma, 1 patient with bile duct mucinous adenocarcinoma, 2 patients with tumors of high differentiation, 10 patients with moderate differentiation, and 1 patient with poor differentiative. The R 0 resection rate was 100.0% (13/13) and the tumor diameter was (2.9±0.9) cm. Follow-up by telephone or outpatient clinics after operation showed 1 patients to be lost to follow-up. The 1-year survival rate after operation was 66.7% (8/12). Conclusion:For Bismuth-Corlette type Ⅲa hilar cholangiocarcinoma, the new laparoscopic approach of Lap-Larmorh was safe and feasible.
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Objective:To investigate the application value of Laennec approach in laparoscopic anatomical right hemihepatectomy (LARH).Methods:The retrospective and descriptive study was conducted. The clinicopathological data of 2 female patients who underwent LARH via Laennec approach in the First Affiliated Hospital of Kangda College of Nanjing Medical University from May to July 2020 were collected. The two patients were 51 and 57 years old, respectively. Observation indicators: (1) surgical situations; (2) postoperative situations and follow-up. Follow-up using outpatient examination and telephone interview was conducted to detect post-operative survival and tumor recurrence of patients up to December 2020. Count data were repre-sented as absolute numbers.Results:(1) Surgical situations: 2 patients successfully underwent LARH via Laennec approach, without conversion to open surgery. The operation time was 180 minutes and 185 minutes, and the volume of intraoperative blood loss was 200 mL and 400 mL, respectively. No blood transfusion or gastrointestinal decompression was performed in either patient. (2) Postoperative situations and follow-up: 2 patients began to take liquid diet on the first day and out-of-bed activities on the postoperative second to third day. There was no postoperative bile fistula or bleeding, but different degrees of peritoneal and pleural effusion occurred to the 2 patients after operation. One case was improved after right-sided thoracentesis and chest tube drainage due to dyspnea, and the other case was cured after conservative therapy. There was no perioperative death. The duration of postoperative hospital stay of 2 patients was 13 days and 11 days, respectively. Results of pathological examination showed 1 case of hepatic hemangioma and 1 case of primary liver cancer, respectively. The Laennec capsule was observed on the hepatic vein branches of segment Ⅴ, Ⅵ, Ⅶ, Ⅷ, and the gap existed between the Laennec capsule and the hepatic vein. Two patients were followed up for 7 months and 5 months，respectively. They survived during the follow-up，without tumor recurrence.Conclusion:It is safe and feasible to perform LARH by Laennec approach.
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Objective To determine the clinical value of laparoscopic right hepatectomy (LRH) carried out following a standardized technique.Methods The medical records of 15 patients who underwent LRH at the First Affiliated Hospital of Soochow University were retrospectively reviewed.The perioperative indicators which included the operation duration,blood loss,tumor diameter,hospitalization duration and postoperative complications were analyzed.Results There was no conversion to open surgery.The operation duration was (251.1 ± 73.3) min.The resected tumor diameter was (8.5 ± 4.2) cm,the blood loss was (550.8 ± 343.6) ml,and the hospitalization duration was (10.2 ± 3.7) days.There was one patient who developed postoperative bile leakage.There was no other complication and there was no perioperative death.Conclusions The standardized technique of LRH was easy and effective.This technique shortened the operation duration and improved patient safety.
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Objective: To summarize our experience on right hemihepatectomy for treatment of hepatolithiasis. Methods: The clinical data of thirty-nine patients suffering from intrahepatic bile duct stones, who had undergone right hemihepatectomy in our hospital from Jan. 2000 to Dec. 2006, were retrospectively analyzed. The outcomes of operation, complication, and the follow-up findings were analyzed; and the clinical experience was summarized. Results: The 39 patients included 8 males and 31 females, with an age range of 23-65 years old and a mean of (44.2 ± 10.5) years old. All patients had various degrees of hepatobiliary stricture. All cases underwent right hemihepatectomy plus eholedoehotomy and T-tube drainage, including 28 also had cholecystectomy, 1 had additional left lateral hepatectomy, 1 had choledoehocystomy plus hepatojejunostomy, and 1 had demolishment of anastomotie stoma of choledochoduodenostomy. The post-operation complications included pleural effusion (17.9%), subphrenic infection (12.8%), liver failure (7.7%), biliary fistula (5.1%), and infection of incisional wound (5.l%). Two patients (5.1%) died of liver failure during the hospital stay. One was indicated of having intrahepatic cholangiocarcinoma and died of recurrence of cholangiocarcinoma 6 months after operation. Thirty-six patients (92.3%) received long-term follow-up (a median of [42.5±2.5] months) and 34 (94.4%) of them were symptom free. Excellent outcomes were achieved in the 31 patients with isolated right intrahepatic bile duct stones. Conclusion: Right hemihepatectomy is effective for right hepatolithiasis, especially for patients combined with right hepatic duct stricture. However, it should be noted that the operation is very difficult and has many complications, so the indications and contraindications of right hemihepatectomy should be strictly selected.