scholarly journals Ligation of the middle hepatic vein to increase hypertrophy induction during the ALPPS procedure

2021 ◽  
Author(s):  
F. Dondorf ◽  
A. Ali Deeb ◽  
A. Bauschke ◽  
P. Felgendreff ◽  
H. M. Tautenhahn ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Odds Ratio ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Morbidity And Mortality ◽  
Colorectal Metastases ◽  
Remnant Liver ◽  
Liver Remnant ◽  
Technical Modification

Abstract Purpose Here, we analyse the technical modification of the ALPPS procedure, ligating the middle hepatic vein during the first step of the operation to enhance remnant liver hypertrophy. Methods In 20 of 37 ALPPS procedures, the middle hepatic vein was ligated during the first step. Hypertrophy of the functional remnant liver volume was assessed in addition to postoperative courses. Results Volumetric analysis showed a significant volume increase, especially for patients with colorectal metastases. Pre-existing liver parenchyma damage (odds ratio = 0.717, p = 0.017) and preoperative chemotherapy were found to be significant predictors (odds ratio = 0.803, p = 0.045) of higher morbidity and mortality. In addition, a survival benefit for maintenance of middle hepatic vein was shown. Conclusion This technical modification of the ALPPS procedure can accentuate future liver remnant volume hypertrophy. The higher morbidity and mortality observed are most likely associated with pre-existing parenchymal damage within this group.

Rescue partial ALPPS for left hemihepatectomy with reconstruction of the middle hepatic vein

2021 ◽  
Author(s):  
Masaharu Kogure ◽  
Takaaki Arai ◽  
Hirokazu Momose ◽  
Ryota Matsuki ◽  
Yutaka Suzuki ◽  
...  
Keyword(s):  
Portal Vein ◽  
Hepatic Vein ◽  
Retention Rate ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Left Hemihepatectomy ◽  
Icg R15

Major hepatectomy in patients with insufficient future liver remnant (FLR) volume and impaired liver functional reserve has considerable risks for posthepatectomy liver failure (PHLF). The patient was a male in his 70 with an intrahepatic cholangiocarcinoma (ICC) in left hemiliver, involving the middle hepatic vein (MHV). Although FLR volume after left hemihepatectomy was estimated to be 64.4% of the total liver volume, an indocyanine green retention rate at 15 min (ICG-R15) value was 24.2%, thus the patient underwent left portal vein embolization (PVE). The FLR volume increased to 71.3%, however, the non-congestive FLR volume was re-estimated as 45.8% after resection of the MHV, the ICG-R15 value was 29.0%, and ICG-Krem was calculated as 0.037. We performed partial rescue ALPPS (Associating Liver Partition and Portal vein occlusion for Staged hepatectomy) for left hemihepatectomy with the MHV reconstruction. On the first stage, partial liver partition was done along Rex-Cantlie’s line, preserving the MHV and sacrificing the remaining branches to segment 8. The FLR volume increased to 77.4% on day 14. The ICG-R15 value was 29.6%, but ICG-Krem after MHV reconstruction was estimated to be 0.059. The second stage operation on day 21 was left hemihepatectomy with the MHV reconstruction using the left superficial femoral vein graft. The usage of rescue partial ALPPS may contribute to preventing PHLF by introducing occlusion of the portal and/or venous branches in the left hemiliver before curative hepatectomy.

scholarly journals Partial Hepatectomy with Middle Hepatic Vein Reconstruction Using a Left Inferior Vena Cava Graft

2017 ◽  
Vol 11 (2) ◽  
pp. 320-328 ◽  
Author(s):  
Yusuke Kawamoto ◽  
Yusuke Ome ◽  
Kazuyuki Kawamoto
Keyword(s):  
Inferior Vena Cava ◽  
Partial Hepatectomy ◽  
Hepatic Vein ◽  
Inferior Vena ◽  
Vena Cava ◽  
Future Liver Remnant ◽  
Middle Hepatic Vein ◽  
Venous Graft ◽  
Liver Remnant ◽  
Hepatic Vein Reconstruction

Duplicated inferior vena cava (IVC) is a rare congenital anomaly. We describe the utility of a new graft from the left IVC in a patient with duplicated IVC for reconstructing the middle hepatic vein (MHV) after partial hepatectomy with MHV resection. A 67-year-old woman with hepatitis C was found to have a liver tumor. Magnetic resonance imaging confirmed that the tumor, which was attached to the MHV, was hepatocellular carcinoma. Central bisectionectomy (S4, S5, and S8 resection) could not be tolerated because of poor liver function and a low future liver remnant volume. Therefore, partial hepatectomy with MHV resection was performed. The left IVC was harvested as a venous graft and was substituted for the resected MHV. She recovered uneventfully and was discharged on postoperative day 12. To the best of our knowledge, this is the first report of using the left IVC as a venous graft. The left IVC is a good candidate graft for the MHV or for portal vein reconstruction because of its length, diameter, and easy harvesting (it did not require an extra incision) in a patient with duplicated IVC.

scholarly journals First two-stage robotic ALPPS in HCC patients with hepatic vein invasion: a step-by-step procedure from a clinical case

2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Ming-Gen Hu ◽  
Jin Wang ◽  
Zhu-Zeng Yin ◽  
Rong Liu
Keyword(s):  
Portal Vein ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Falciform Ligament ◽  
Remnant Liver ◽  
Two Stage ◽  
Liver Remnant ◽  
Technical Aspects ◽  
Estimated Blood Loss ◽  
The Right

Abstract Background The associating liver partitioning and portal vein occlusion for staged hepatectomy (ALPPS) procedure is gaining interest because it brings hope to patients who cannot undergo radical surgical resection due to insufficient remnant liver volume. However, the indications and technical aspects of this procedure are still under debate. This report demonstrates the technical aspects of the first two-stage robotic ALPPS for HCC. Case presentation A 55-year-old man with type II portal vein variation was diagnosed with hepatocellular carcinoma. Preoperative 3D reconstruction of the liver based on CT showed a future liver remnant/standard liver volume (FLR/SLV) of 24.45%. The ALPPS procedure was performed using the da Vinci Si system. At the first stage of the operation, we removed the gallbladder and ligated the right anterior branch of the portal vein and the right posterior branch. Following blocking of the hepatic hilum, the liver parenchyma was removed 1 cm away from the right side of the falciform ligament in an incision manner from the top to the bottom and from shallow to deep. The second-stage operation was performed on the 12th postoperative day with a FLR/SLV of 45.13%. During this step, the right hemiliver plus left medial section was separated and removed. Postoperative pathology showed a negative margin. The operative times were 195 and 217 min, respectively. Estimated blood loss was 250 and 500 ml, respectively. There was no need for transfusion or hospitalization in intensive care. The patient was discharged on the 6th postoperative day. Recovery was uneventful after both stages, and the patient did not present any sign of liver failure. Elevation of liver enzymes was minimal. The patient had no evidence of the disease 14 months after the procedure. Conclusions The two-stage robotic ALPPS procedure is a safe and feasible technique for select patients with HCC.

scholarly journals Evaluation of liver regeneration and post-hepatectomy liver failure after hemihepatectomy in patients with hepatocellular carcinoma

2019 ◽  
Vol 39 (8) ◽  
Author(s):  
Wen-Feng Gong ◽  
Jian-Hong Zhong ◽  
Zhan Lu ◽  
Qiu-Ming Zhang ◽  
Zhi-Yuan Zhang ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Liver Cirrhosis ◽  
Liver Failure ◽  
Liver Regeneration ◽  
Characteristic Curve ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Remnant Liver ◽  
Liver Remnant ◽  
Growth Ratio

Abstract Aim: To explore clinical factors associated with extent of liver regeneration after hemihepatectomy to treat hepatocellular carcinoma (HCC). Methods: Future liver remnant volume (as a percentage of functional liver volume, %FLRV) and remnant liver volume were measured preoperatively and at 1, 5, 9, and 13 weeks postoperatively. Results: After hepatectomy, 1 of 125 patients (0.8%) died within 3 months, 13 (10.4%) experienced liver failure, and 99 (79.2%) experienced complications. %FLRV was able to predict liver failure with an area under the receiver operating characteristic curve of 0.900, and a cut-off value of 42.7% showed sensitivity of 85.7% and specificity of 88.6%. Postoperative median growth ratio was 21.3% at 1 week, 30.9% at 5 weeks, 34.6% at 9 weeks, and 37.1% at 13 weeks. Multivariate analysis identified three predictors associated with liver regeneration: FLRV < 601 cm3, %FLRV, and liver cirrhosis. At postoperative weeks (POWs) 1 and 5, liver function indicators were significantly better among patients showing high extent of regeneration than among those showing low extent, but these differences disappeared by POW 9. Conclusions: FLRV, %FLRV, and liver cirrhosis strongly influence extent of liver regeneration after hepatectomy. %FLRV values below 42.7% are associated with greater risk of post-hepatectomy liver failure.

Future liver remnant portal or hepatic vein reconstruction at stage I of ALPPS—How far can we push the boundaries?

2019 ◽  
Author(s):  
Andrea Schlegel ◽  
Yuhki Sakuraoka ◽  
Marit Kalisvaart ◽  
Chris Coldham ◽  
John Isaac ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Future Liver Remnant ◽  
Stage I ◽  
Liver Remnant ◽  
Hepatic Vein Reconstruction

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver haemangiomas over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background: To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver haemangiomas.Methods: From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver haemangiomas were included in this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results: There were no significant differences in age, sex, tumour location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver haemangioma volume, FLR/SLV, resected normal liver volume/resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19) and the LH group (n=13), patients in the OH group (n=25) had a significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), and time to get-out-of-bed (P < 0.05); a higher VAS score after 24 hours of surgery (P < 0.05); and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P＞0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time in the RH group was significantly shorter than that in the LH group (P＜0.05). There was no significant difference in the operative time between the RH group and the OH group (P＞0.05). The amount of intraoperative blood loss in the RH group was the lowest among the three groups (P＜0.05), and the amount of intraoperative blood loss in the LH group was less than that in the OH group (P＜0.05).Conclusion: Robotic and laparoscopic hemihepatectomies were associated with less intraoperative blood loss,better postoperative recovery and lower pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and a shorter operative time.

scholarly journals Repeatability and reproducibility of deep-learning-based liver volume and Couinaud segment volume measurement tool

2021 ◽  
Author(s):  
Amirkasra Mojtahed ◽  
Luis Núñez ◽  
John Connell ◽  
Alessandro Fichera ◽  
Rowan Nicholls ◽  
...  
Keyword(s):  
Liver Volume ◽  
Future Liver Remnant ◽  
Measurement Tool ◽  
Limits Of Agreement ◽  
Liver Remnant ◽  
Total Liver Volume ◽  
Medical Software ◽  
Segment Volume ◽  
Volume Measurements ◽  
Repeatability And Reproducibility

Abstract Purpose Volumetric and health assessment of the liver is crucial to avoid poor post-operative outcomes following liver resection surgery. No current methods allow for concurrent and accurate measurement of both Couinaud segmental volumes for future liver remnant estimation and liver health using non-invasive imaging. In this study, we demonstrate the accuracy and precision of segmental volume measurements using new medical software, Hepatica™. Methods MRI scans from 48 volunteers from three previous studies were used in this analysis. Measurements obtained from Hepatica™ were compared with OsiriX. Time required per case with each software was also compared. The performance of technicians and experienced radiologists as well as the repeatability and reproducibility were compared using Bland–Altman plots and limits of agreement. Results High levels of agreement and lower inter-operator variability for liver volume measurements were shown between Hepatica™ and existing methods for liver volumetry (mean Dice score 0.947 ± 0.010). A high consistency between technicians and experienced radiologists using the device for volumetry was shown (± 3.5% of total liver volume) as well as low inter-observer and intra-observer variability. Tight limits of agreement were shown between repeated Couinaud segment volume (+ 3.4% of whole liver), segmental liver fibroinflammation and segmental liver fat measurements in the same participant on the same scanner and between different scanners. An underestimation of whole-liver volume was observed between three non-reference scanners. Conclusion Hepatica™ produces accurate and precise whole-liver and Couinaud segment volume and liver tissue characteristic measurements. Measurements are consistent between trained technicians and experienced radiologists. Graphic abstract

scholarly journals Robotic, laparoscopic or open hemihepatectomy for giant liver hemangiomas of over 10 cm in diameter

2020 ◽  
Author(s):  
Minggen Hu ◽  
Kuang Chen ◽  
Xuan Zhang ◽  
Chenggang Li ◽  
Dongda Song ◽  
...  
Keyword(s):  
Blood Loss ◽  
Operative Time ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Oral Intake ◽  
Postoperative Recovery ◽  
Postoperative Outcomes ◽  
Intraoperative Blood Loss ◽  
Liver Remnant ◽  
Significant Difference

Abstract Background To evaluate the clinical efficacy of robotic, laparoscopic, and open hemihepatectomy for giant liver hemangiomas.Methods From April 2011 to April 2017, consecutive patients who underwent hemihepatectomy for giant liver hemangiomas were included into this study. According to the type of operation, these patients were divided into the robotic hemihepatectomy (RH) group, the laparoscopic hemihepatectomy (LH) group, and the open hemihepatectomy (OH) group. The perioperative and short-term postoperative outcomes were compared among the three groups. The study was reported following the STROCSS criteria.Results There were no significant differences in age, sex, tumor location, body surface area (BSA), future liver remnant volume (FLR), standard liver volume (SLV), liver hemangioma volume, FLR/SLV, resected normal liver volume / resected volume, hepatic disease, rates of blood transfusion, liver function after 24 hours of surgery, operative morbidity and mortality among the three groups. Compared with patients in the RH group (n=19), and the LH group (n=13), patients in the OH group (n=25) had significantly longer postoperative hospital stay (P< 0.05), time to oral intake (P < 0.05), time to get-out-of-bed (P < 0.05), a higher VAS score after 24 hours of surgery (P < 0.05) and a shorter operative time (P < 0.05). There were no significant differences in these postoperative outcomes (P>0.05) between the RH group and the LH group. When the setup time in the RH group was excluded, the operative time of the RH group was significantly shorter than the LH group (P<0.05). There was no significant difference in the operative time between the RH group and the OH group (P>0.05). The intraoperative blood loss of the RH group was the least among the three groups (P<0.05) and the intraoperative blood loss of the LH group was less than the OH group (P<0.05).Discussion Robotic, laparoscopic, and open hemihepatectomy were safe and efficacious treatments for giant liver hemangiomas. Robotic and laparoscopic hemihepatectomy were significantly better than open hemihepatectomy in intraoperative blood loss, postoperative recovery and pain score. Compared with laparoscopic hemihepatectomy, robotic hemihepatectomy was associated with significantly less intraoperative blood loss and shorter operative time.

scholarly journals Preoperative Portal Vein Embolization in Hepatic Surgery: A Review about the Embolic Materials and Their Effects on Liver Regeneration and Outcome

2020 ◽  
Vol 2020 ◽  
pp. 1-9
Author(s):  
Jose Hugo M. Luz ◽  
Filipe V. Gomes ◽  
Elia Coimbra ◽  
Nuno V. Costa ◽  
Tiago Bilhim
Keyword(s):  
Portal Vein ◽  
Portal Vein Embolization ◽  
Controlled Trial ◽  
Liver Volume ◽  
Future Liver Remnant ◽  
Embolic Agent ◽  
Cyanoacrylate Glue ◽  
Liver Remnant ◽  
Ethylene Vinyl Alcohol ◽  
Embolic Materials

Liver volume and function after hepatectomies are directly correlated to postoperative complications and mortality. Consequently contemporary liver surgery has focused on reaching an adequate future liver remnant so as to diminish postoperative morbidity and mortality. Portal vein embolization has evolved and is the standard of care as a liver regenerative strategy in many surgery departments worldwide before major liver resections. Different embolic materials have been used for portal vein embolization including gelfoam, ethanol, polyvinyl-alcohol particles, calibrated microspheres, central vascular plugs, coils, n-butyl-cyanoacrylate glue, fibrin glue, polidocanol-foam, alcoholic prolamin solution, and ethylene vinyl alcohol copolymer, as sole occluders or in varied combinations. While to date there has been no prospective controlled trial comparing the efficacy of different embolic materials in portal vein embolization, retrospective data insinuates that the use of n-butyl-cyanoacrylate and absolute ethanol produces higher contralateral liver hypertrophies. In this review, we evaluated publications up to August 2019 to assess the technical and regenerative results of portal vein embolization accomplished with different embolic materials. Special attention was given to specific aspects, advantages, and drawbacks of each embolic agent used for portal vein embolization, its liver regenerative performance, and its influence on patient outcome.

Sign in / Sign up

Export Citation Format

Share Document