Application of the Laennec capsule approach in laparoscopic anatomical sectionectomy / 中华消化外科杂志

Laparoscopic anatomic hepatectomy (LAH) has been widely approved as an essential procedure for safety and availability, and has gradually become the mainstream method of hepatec-tomy. Through a renewed understanding of the Laennec capsule, the authors have found that there exists a natural gap between the Laennec capsule and the adjacent tissues, such as Glisson pedicles and hepatic veins. Consequently, Laennec capsule can serve as the anatomical approach for LAH. The left lobe, right anterior lobe and right posterior lobe has an independent Glisson pedicle respectively, which can be used to perform Glisson pedicle transection sectionectomy via Laennec capsule approach without damaging the liver parenchyma. The exposure of hepatic veins on the detached plane can also be achieved through this approach. Laennec capsule approach provides a new idea for laparoscopic anatomic liver sectionectomy, which is safe, reliable, convenient and highly repeatable.

Treatment strategies of complicated extrahepatic bileduct stones / 中华消化外科杂志

Complicated extrahepatic bile duct stone is defined as not easy to achieve the treatment standard of total stone clearance, stricture removal, unobstructed drainage and recurrence preventing in a single operation or combined with other liver diseases, which include hepatic hilar bile duct stones incarceration, distal bile duct stone incarceration, Mirizzi syndrome, residual cystic duct stones, recurrent extrahepatic bile duct stones, and combined with portal hypertension or intrahepatic bile duct stones. Through comprehensive and meticulous preoperative evaluation, we can clarify the cause of extrahepatic bile duct stones, the location of stones and bile duct stenosis, the variability of bile duct, the anatomy of the hepatoduodenal ligament, the condition of liver function and biliary tract infection, and make the proper surgery plan. During the surgery, we apply the perihilar surgical techniques, pancreatic hilar plate reduction techniques, Oddi sphincter incision and shaping, and choledochoscopic lithotripsy and lithotomy comprehensively to achieve the goal of reducing residual stone rate and recurrence rate. It is important that reasonably select endoscopic retrograde cholangiopancreatography indications, correctly hold indications of bilioenteric anastomosis, and prevent iatrogenic injury of extrahepatic bile ducts on the premise of clearing stones.

Treatment strategies of complicated extrahepatic bileduct stones / 中华消化外科杂志

Complicated extrahepatic bile duct stone is defined as not easy to achieve the treatment standard of total stone clearance,stricture removal,unobstructed drainage and recurrence preventing in a single operation or combined with other liver diseases,which include hepatic hilar bile duct stones incarceration,distal bile duct stone incarceration,Mirizzi syndrome,residual cystic duct stones,recurrent extrahepatic bile duct stones,and combined with portal hypertension or intrahepatic bile duct stones.Through comprehensive and meticulous preoperative evaluation,we can clarify the cause of extrahepatic bile duct stones,the location of stones and bile duct stenosis,the variability of bile duct,the anatomy of the hepatoduodenal ligament,the condition of liver function and biliary tract infection,and make the proper surgery plan.During the surgery,we apply the perihilar surgical techniques,pancreatic hilar plate reduction techniques,Oddi sphincter incision and shaping,and choledochoscopic lithotripsy and lithotomy comprehensively to achieve the goal of reducing residual stone rate and recurrence rate.It is important that reasonably select endoscopic retrograde cholangiopancreatography indications,correctly hold indications of bilioenteric anastomosis,and prevent iatrogenic injury of extrahepatic bile ducts on the premise of clearing stones.

Anatomy and clinical significance of hilar plate / 中国实用外科杂志

The concept of hepatic hilar plate was first proposed by Couinaud in 1957. After more than 60 years of exploration and clinical practice, the related techniques of hepatic hilar plate exposure, including lowering hepatic hilar plate technique, extra-glissonean pedicle approach technique,have been used in hepatic vascular inflow occlussion of open and laparoscopic anatomical hepatectomy, resection of hepatic hilar complex tumors, management of hepatolithiasis and traumatic benign stricture of high bile duct. Hilar plate detachment and glissonean pedicle approach technique are more and more widely used, which have become a compulsory course for hepatobiliary surgeons to reduce the difficulty of perihilar surgery and increase the safety of liver surgery.

Application of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy / 中华消化外科杂志

Objective To explore the application value of hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy.Methods The clinical data of 15 patients who underwent laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique at the First People's hospital of Foshan between August 2012 and May 2014 were retrospectively analyzed.The hilar plate was bluntly dissected to expose the left and right Glissonean pedicles.Either side of Glissonean pedicle was tied up with a turnable aspirator with a cotton rope or shoelace and then bypassed the back of hilar plate.Anatomic hepatectomy was performed when hemi-hepatic blood flow was occluded.The follow-up by telephone interview and outpatient examination was done till October 2014.Results Among the 15 patients,the conversion to open surgery was done in 1 patient,Pringle maneuver in 1 patient,and hemi-hepatic blood flow occlusion by descending the hilar plate in 14 patients.Thirteen patients received succesfully laparoscopic anatomic hepatectomy by hemi-hepatic blood flow occlusion using descending hilar plate technique,including 4 of left hemihepatectomy,4 of left lateral lobectomy,2 of right hemihepatectomy,1 of right posterior lobectomy,1 of segment Ⅳ hepatectomy and 1 of segment Ⅵ hepatectomy.Bile duct exploration was applied to 4 patients with left hepatic duct stones and T-tube was placed in 2 patients.Nine and 4 patients received left and right hemi-hepatic blood flow occlusion,respectively.The operation time,mean volume of intraoperative blood loss and time of hemi-hepatic blood flow occlusion in 13 patients were (196 ±63)minutes,320 mL (range,50-1 200 mL) and (51 ± 20)minutes,respectively.The time of descending the hilar plate in 14 patients was (10 ±4)minutes.Among the 13 patients,bile leakage was detected in 1 patient with a maximum volume of drainage of 120 mL/day,liver wound bleeding in 1 patient with a volume of abdominal bloodstained drainage of 400 mL at postoperative day 2.Two patients were cured by conservative treatment,and no liver failure and perioperative death were occurred.The duration of hospital stay was (6.9 ± 2.4)days.Among the 15 patients,2 patients were loss to follow-up and other patients were followed up for 5-26 months with good survival,1 patient died.Conclusion Hemi-hepatic blood flow occlusion through descending hilar plate in laparoscopic anatomic hepatectomy is safe and feasible.