ABSTRACT
Mesohepatectomy was performed in seven patients with a primary or secondary central liver tumor. We describe the surgical procedure for mesohepatectomy (removal of segments IVa/IVb/V/VIII +/- I) in the treatment of central hepatic tumors. This technically demanding but safe approach requires careful vascular dissection to maintain blood supply and venous drainage of the two remaining liver parts. Mesohepatectomy results in one or two large resection planes bearing a considerable risk of parenchymal necrosis or biliary leakage. Its major advantage over extended hepatectomy is the preservation of functioning liver tissue. Thus, the risk of postoperative liver failure is reduced and, in case of intrahepatic recurrence, the chance for repeat hepatectomy improved. Mesohepatectomy should be considered in selected cases of central liver tumors in which extended resection would be associated with a high risk of liver insufficiency.
Subject(s)
Adenoma, Liver Cell/surgery , Carcinoma, Hepatocellular/surgery , Colorectal Neoplasms/surgery , Focal Nodular Hyperplasia/surgery , Hepatectomy/methods , Histiocytoma, Benign Fibrous/surgery , Liver Neoplasms/surgery , Adenoma, Liver Cell/diagnosis , Adenoma, Liver Cell/pathology , Adult , Aged , Carcinoma, Hepatocellular/diagnosis , Carcinoma, Hepatocellular/pathology , Colorectal Neoplasms/diagnosis , Colorectal Neoplasms/pathology , Diagnosis, Differential , Female , Focal Nodular Hyperplasia/diagnosis , Focal Nodular Hyperplasia/pathology , Follow-Up Studies , Histiocytoma, Benign Fibrous/diagnosis , Histiocytoma, Benign Fibrous/pathology , Humans , Image Processing, Computer-Assisted , Imaging, Three-Dimensional , Liver/pathology , Liver Neoplasms/diagnosis , Liver Neoplasms/pathology , Liver Neoplasms/secondary , Male , Middle Aged , Neoplasm Staging , Tomography, X-Ray ComputedABSTRACT
Living liver donation is a prominent and innovative method in the therapy of terminal liver disease in children and adults. Live donation of livers was first used in 1989 for children. After only 10 years, the concept was also established for application in adults. Due to the imminent lack of donor organs and the constantly increasing need of liver transplantation, this method will continue to grow in importance.
Subject(s)
Liver Diseases/surgery , Liver Transplantation/methods , Living Donors , Tissue Donors/supply & distribution , Adult , Cadaver , Cause of Death , Child , Cross-Cultural Comparison , Ethics, Medical , Germany , Hepatectomy/methods , Hepatectomy/mortality , Humans , Liver Diseases/congenital , Liver Diseases/mortality , Liver Transplantation/mortality , Living Donors/supply & distribution , Postoperative Complications/mortality , Prognosis , Survival Rate , Treatment OutcomeABSTRACT
The acceptance of computer assisted surgical planning was studied by polling 500 German surgeons. 500 questionnaires were sent, from which 105 have been returned, from which 102 could be analysed. The questionnaire consisted of 14 questions relating to the current practice of surgery planning as well as to desired improvements. In general, the computer assisted surgical planning was assessed as a promising tool in the future. 82 % of the surgeons expected a benefit by computer assisted surgical planning. Better assessment of resectability, better training of residents and more safety of surgical procedures were mentioned in the majority. Computer assisted surgical planning should focus on 3D visualization of spatial relations between lesions and vascular structures, on facilities for the preoperative trial of resection strategies and on the documentation of the planned procedure. The current version of a research prototype (Surgery-Planner) is presented which is dealing with these goals.
