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Liver resection technique

Y L Cao, W Li
Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) which represented a new two-steps liver resection procedures has been considered a revolutionary innovation for liver surgery technique in recent 10 years, it was first discovered by Professor Lang in Germany in 2007.The first step of the classic surgical procedures for portal vein ligation and liver parenchyma, until the future liver remnant (FLR) increased to a sufficient remnant then resect the right three-leaf liver.With the development of ALPPS, the method of hepatic parenchyma separation and isolation materials have been modified, which improves the safety of operation...
April 1, 2018: Zhonghua Wai Ke za Zhi [Chinese Journal of Surgery]
Nahide Ekici Günay, Sabahattin Muhtaroğlu, Abdulkadir Bedirli
BACKGROUND: Free radical damage is known to occur during liver regeneration. The Ginkgo biloba extract EGb761 has antioxidant properties due to its ability to scavenge free radicals. FK506 has been widely used as an immunosuppressant that stimulates hepatocyte proliferation following partial hepatectomy. AIMS: To explore whether EGb761 enhances liver regeneration after hepatectomy in rats, we investigated the effects of EGb761 alone and in combination with FK506 on the liver regenerative process...
March 15, 2018: Balkan Medical Journal
Hanisah Guro, Jai Young Cho, Ho-Seong Han, Yoo-Seok Yoon, YoungRok Choi, Sungho Kim, Kilhwan Kim, In Gun Hyun
BACKGROUND: To compare the surgical outcomes of major laparoscopic liver resection (LLR) and open liver resection (OLR) for hepatocellular carcinoma (HCC). METHODS: We retrospectively reviewed the medical records of 177 patients who underwent major liver resection for HCC between January 2004 and June 2015. We divided the 177 patients into two groups according to the type of procedure: major LLR (LLR group; n = 67) and major OLR (OLR group; n = 110). RESULTS: Procedures in the LLR group were right hepatectomy (30 patients), right posterior sectionectomy (28), left hepatectomy (11), right anterior sectionectomy (6), extended right hepatectomy (6), and central bisectionectomy (2)...
March 2018: Surgical Oncology
Marco Vito Marino, Galyna Shabat, Domenico Guarrasi, Gaspare Gulotta, Andrzej Lech Komorowski
BACKGROUND: Despite potential benefits of robotic liver surgery, it is still considered a "development in progress" technique. METHODS: The outcomes of 14 patients undergoing robotic right hepatectomy were analyzed and compared with the results of 20 laparoscopic right hepatectomies consecutively performed by the same young surgeon. RESULTS: The overall mean operative time was less in robotic arm (425 ± 139 vs. 565.18 ± 183.73, p = 0...
March 14, 2018: Digestive Surgery
Dezső Kelemen, Zoltán Lőcsei, Róbert Papp, Sándor Ferencz, András Vereczkei
CASE PRESENTATION: After neoadjuvant oncological therapy the surgical treatment of distal pancreatic tumour - infiltrating the celiac axis and the stomach - was reported. During the operation resection of the trunc, distal pancreatectomy, splenectomy, total gastrectomy, resection of the left adrenal gland and cholecystectomy were carried out. The patient's clinical course was uneventful, only transient alteration of liver functions was detected. Histological work-up revealed R1 resection, so adjuvant oncological therapy was decided...
March 2018: Magyar Sebészet
Safi Dokmak, Béatrice Aussilhou, Tiziana Marchese, Nizar Kardoun, François Cauchy, Anne Sophie Schneck, Olivier Soubrane
BACKGROUND: Hepatocellular carcinoma (HCC) can be complicated by major vascular invasion, and resection can be beneficial in some patients.1 Some of these patients are traditionally operated under total vascular exclusion (TVE), refrigeration, extracorporeal circulatory bypass, and cardiac surgery, with high morbidity and mortality.2 However, HCC thrombi are not adherent to the venous wall, and with advances in surgical techniques, resection can be simplified and performed during short-duration TVE alone...
March 13, 2018: Annals of Surgical Oncology
Guoqing Jiang, Dousheng Bai, Ping Chen, Jianjun Qian, Shengjie Jin
BACKGROUND: Liver resection was not formerly recommended in patients with both hepatocellular carcinoma (HCC) and portal hypertension because of difficult perioperative bleeding control and postoperative liver failure. Splenectomy is a proven method with which to overcome these problems. To investigate the safety and feasibility of synchronous laparoscopic splenectomy and azygoportal disconnection with hepatectomy (LSDH) for treatment of portal hypertension accompanied with HCC, we describe a clinical cohort of 10 patients who underwent a new technique of synchronous LSDH...
March 1, 2018: Surgical Innovation
Andrey Elchaninov, Timur Fatkhudinov, Natalia Usman, Irina Arutyunyan, Andrey Makarov, Anastasia Lokhonina, Irina Eremina, Viktor Surovtsev, Dmitry Goldshtein, Galina Bolshakova, Valeria Glinkina, Gennady Sukhikh
AIM: To investigate the influence of the umbilical cord-derived multipotent stromal cells (MSCs) on recovery of the liver after the subtotal resection, that is, removal of 80% of the organ mass, a renowned model of the small-for-size liver remnant syndrome. METHODS: The MSCs were obtained from the intervascular tissue of umbilical cords, dissected from rat fetuses, by the explant culture technique. The vital labeling of MSCs with РКН26 was carried out on the 3rd passage...
February 27, 2018: World Journal of Hepatology
Arpad Ivanecz, Bojan Krebs, Andraz Stozer, Tomaz Jagric, Irena Plahuta, Stojan Potrc
Background: The aim of the study was to compare the outcome of pure laparoscopic and open simultaneous resection of both the primary colorectal cancer and synchronous colorectal liver metastases (SCLM). Patients and methods: From 2000 to 2016 all patients treated by simultaneous resection were assessed for entry in this single center, clinically nonrandomized trial. A propensity score matching was used to compare the laparoscopic group (LAP) to open surgery group (OPEN)...
March 2018: Radiology and Oncology
Davit L Aghayan, Egidijus Pelanis, Åsmund Avdem Fretland, Airazat M Kazaryan, Mushegh A Sahakyan, Bård I Røsok, Leonid Barkhatov, Bjørn Atle Bjørnbeth, Ole Jakob Elle, Bjørn Edwin
Background: Laparoscopic liver resection (LLR) of colorectal liver metastases (CLM) is increasingly performed in specialized centers. While there is a trend towards a parenchyma-sparing strategy in multimodal treatment for CLM, its role is yet unclear. In this study we present short- and long-term outcomes of laparoscopic parenchyma-sparing liver resection (LPSLR) at a single center. Patients and methods: LLR were performed in 951 procedures between August 1998 and March 2017 at Oslo University Hospital, Oslo, Norway...
March 2018: Radiology and Oncology
Changjun Jia, Chaoliu Dai, Hailiang Wang, Yi Wan, Yunyu Qiao, Feng Xu, Songlin Peng, Yang Zhao, Chuang Zhao, Liang Zhao
Background/Aims: Hepatic ischemia-reperfusion (I/R) injury is a serious concern during hepatic vascular occlusion. The objectives of this study were to assess effects of three techniques for hepatic vascular occlusion on I/R injury and to explore the underlying mechanisms. Methods: Liver cirrhotic rats had undertaken Pringle maneuver (PR), hemihepatic vascular occlusion (HH), or hepatic blood inflow occlusion without hemihepatic artery control (WH). Levels of tumor necrosis factor alpha (TNF- α ), nuclear factor kappa B (NF- κ B), toll-like receptor 4 (TLR4), TIR-domain-containing adapter-inducing interferon- β (TRIF), and hemeoxygenase 1 (HMOX1) were assayed...
2018: Gastroenterology Research and Practice
Luis Ruso Martinez
Regarding the history of liver surgery, Latin American pioneers have only occasionally been mentioned in the Anglo-Saxon literature. One of such rare cases was Uruguayan surgeon Gerardo Caprio, who in 1931 published a report about a resection of the left lobe of the liver. This was done during an uneventful period in the development of ideas on this surgical technique, following the remarkable advances made in the last quarter of the 19th Century. The anatomic and liver manipulation concepts used by Caprio had been developed by Merola in reports dating back to 1916 and 1920, which revealed well-grounded disagreements with the most renowned anatomists of the time...
March 1, 2018: Digestive Surgery
Víctor Lago, Santiago Domingo, Luis Matute, Pablo Padilla-Iserte, Marta Gurrea
In order to reach cytoreduction in advanced ovarian cancer, peritonectomy and diaphragmatic stripping are procedures required to remove the disease in the upper abdomen. Diaphragm involvement is estimated in up to 40% of cases. Nevertheless, in some of these patients, the tumour volume may constitute a limitation of the technique due to the association with abdominal wall involvement, bulky tumour at the Morrison's pouch or liver infiltration. Extensive upper abdominal procedures should represent a basic resource for the gynaecologic oncologist in order to reach an optimal cytoreduction...
2018: Ecancermedicalscience
Marco Vito Marino, Anastasiia Glagolieva, Domenico Guarrasi
INTRODUCTION: Firstly described in 2002, the robotic liver surgery has not spread widely due to its high cost and the lack of a standardized training program. Still being considered as a 'development in progress' technique, it has however a potential to overcome the traditional limitations of the laparoscopic approach in liver interventions. METHODS: We analyzed the postoperative outcomes of 10 patients who had undergone robotic partial resection of the caudate lobe (Spiegel lobe) from March 2014 to May 2016 in order to evaluate the advantages of robotic technique in hands of a young surgeon...
February 21, 2018: Cirugía Española
Nicolae Bacalbasa, Irina Balescu, Cristian Balalau, Olivia Ionescu, Claudia Stoica
BACKGROUND/AIM: Diaphragmatic surgery in advanced-stage ovarian cancer has been considered since long time to increase the rates of postoperative complications. However, improvement of surgical techniques and perioperative management of these patients has lead in the last decade to a safe association of such procedures as part of debulking process. The aim of the current paper was to report our experience regarding the role of diaphragmatic resections as part of debulking surgery for advanced stage ovarian cancer...
March 2018: In Vivo
F Oldhafer, K I Ringe, K Timrott, M Kleine, O Beetz, W Ramackers, S Cammann, J Klempnauer, F W R Vondran, H Bektas
PURPOSE: Treatment of malignancies invading the hepatic veins/inferior vena cava is a surgical challenge. An ante situm technique allows luxation of the liver in front of the situs to perform tumor resection. Usually, cold perfusion and veno-venous bypass are applied. Our experience with modified ante situm resection relying only on total vascular occlusion is reported. METHODS: Retrospective analysis on an almost 15-year experience with ante situm resection without application of cold perfusion or veno-venous bypass RESULTS: The ante situm technique was applied on eight patients...
February 22, 2018: Langenbeck's Archives of Surgery
Mohit Girotra, Kaartik Soota, Amaninder S Dhaliwal, Rtika R Abraham, Mauricio Garcia-Saenz-de-Sicilia, Benjamin Tharian
Hepatocellular carcinoma constitutes over 90% of the primary liver tumors, the rest being cholangiocarcinoma. It has an insidious presentation, which is responsible for the delayed presentation. Hence, the management strategy relies on screening to diagnose it an early stage for curative resection and/or treatment with local ablative techniques or chemotherapy. However, even with different screening programs, more than 60% of tumors are still detected at an advanced stage, leading to an unchanged mortality rate, thereby implying a room for improvement in the screening and diagnostic process...
February 16, 2018: World Journal of Gastrointestinal Endoscopy
Simon Kirste, Gian Kayser, Anne Zipfel, Anca-Ligia Grosu, Thomas Brunner
BACKGROUND: Perivascular epithelioid cell tumors (PEComas) are rare mesenchymal tumors occurring in various anatomic regions. Although diagnostic criteria and treatment management are not established, current treatment options consist of surgery and chemotherapy including mTOR inhibitors. Stereotactic body radiation therapy (SBRT) is a non-invasive ablative treatment which has shown excellent control rates for more common types of unresectable liver tumors and metastases. In this report we present a rare case of PEComa of the liver that was treated by stereotactic radiotherapy followed by resection...
February 20, 2018: Radiation Oncology
Duarte Rego, Paulo Almeida, Paulo Soares, Rui Almeida
INTRODUCTION: Celiac artery (CA) occlusions/stenosis are infrequently associated with liver ischemia due to its unique vascularization where portal vein provides about 75% of liver's perfusion. Collateral flow from gastroduodenal artery also provides, in most cases, enough blood supply to prevent ischemic hepatitis. In cases where these collateral pathways are compromised severe liver ischemia can occur. METHODS: We present a case of acute mesenteric ischemia following gastric surgery that was treated with a hybrid retrograde CA stenting...
February 15, 2018: Annals of Vascular Surgery
Cheng-Maw Ho, Go Wakabayashi, Chi-Chuan Yeh, Rey-Heng Hu, Takanori Sakaguchi, Yasushi Hasegawa, Takeshi Takahara, Hiroyuki Nitta, Akira Sasaki, Po-Huang Lee
Background: Liver resection is a complex procedure for trainee surgeons. Cognitive task analysis (CTA) facilitates understanding and decomposing tasks that require a great proportion of mental activity from experts. Methods: Using CTA and video-based coaching to compare liver resection by open and laparoscopic approaches, we decomposed the task of liver resection into exposure (visual field building), adequate tension made at the working plane (which may change three-dimensionally during the resection process), and target processing (intervention strategy) that can bridge the gap from the basic surgical principle...
2018: Journal of Visualized Surgery
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