scholarly journals Hands-on Cadaveric Major Laparoscopic Liver Resection Course: Should it Become Part of Laparoscopic Liver Surgery Training Programme?

HPB ◽  
2021 ◽  
Vol 23 ◽  
pp. S1029
Author(s):  
P. Estridge ◽  
A. Tanase ◽  
N. Rajaretnam ◽  
S. Aroori
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Laparoscopic Liver Resection ◽  
Training Programme ◽  
Laparoscopic Liver Surgery ◽  
Surgery Training ◽  
Hands On

scholarly journals Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

2021 ◽  
pp. 155335062199122
Author(s):  
Daniel Heise ◽  
Jan Bednarsch ◽  
Andreas Kroh ◽  
Sandra Schipper ◽  
Roman Eickhoff ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Postoperative Morbidity ◽  
Operative Time ◽  
Multivariable Analysis ◽  
Operation Time ◽  
Laparoscopic Liver Surgery ◽  
Surgical Morbidity ◽  
Perioperative Morbidity ◽  
Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

scholarly journals Laparoscopic transthoracic liver resection

2014 ◽  
Vol 27 (4) ◽  
pp. 288-290 ◽  
Author(s):  
Jaime Arthur Pirola KRÜGER ◽  
Fabrício Ferreira COELHO ◽  
Marcos Vinícius PERINI ◽  
Paulo HERMAN
Keyword(s):  
Liver Resection ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Wedge Resection ◽  
The Other ◽  
Laparoscopic Liver Surgery ◽  
Transthoracic Approach ◽  
Technical Description ◽  
Abdominal Interventions ◽  
Segment 8

INTRODUCTION: Minimally invasive laparoscopic liver surgery is being performed with increased frequency. Lesions located on the anterior and lateral liver segments are easier to approach through laparoscopy. On the other hand, laparoscopic access to posterior and superior segments is less frequent and technically demanding. AIM: Technical description for laparoscopic transthoracic access employed on hepatic wedge resection. TECHNIQUE: Laparoscopic transthoracic hepatic wedge resection on segment 8. CONCLUSION: Transthoracic approach allows access to the posterior and superior segments of the liver, and should be considered for oddly located tumors and in patients with numerous previous abdominal interventions.

scholarly journals Robotic and laparoscopic liver resection—comparative experiences at a high-volume German academic center

2021 ◽  
Author(s):  
E. Lorenz ◽  
J. Arend ◽  
M. Franz ◽  
M. Rahimli ◽  
A. Perrakis ◽  
...  
Keyword(s):  
Liver Resection ◽  
Minimally Invasive ◽  
Liver Surgery ◽  
Laparoscopic Liver Resection ◽  
Malignant Tumors ◽  
Statistical Significance ◽  
R0 Resection ◽  
Tumor Diameter ◽  
Safe Procedure ◽  
Minimally Invasive Liver Surgery

Abstract Purpose Minimally invasive liver surgery (MILS) is a feasible and safe procedure for benign and malignant tumors. There has been an ongoing debate on whether conventional laparoscopic liver resection (LLR) or robotic liver resection (RLR) is superior and if one approach should be favored over the other. We started using LLR in 2010, and introduced RLR in 2013. In the present paper, we report on our experiences with these two techniques as early adopters in Germany. Methods The data of patients who underwent MILS between 2010 and 2020 were collected prospectively in the Magdeburg Registry for Minimally Invasive Liver Surgery (MD-MILS). A retrospective analysis was performed regarding patient demographics, tumor characteristics, and perioperative parameters. Results We identified 155 patients fulfilling the inclusion criteria. Of these, 111 (71.6%) underwent LLR and 44 (29.4%) received RLR. After excluding cystic lesions, 113 cases were used for the analysis of perioperative parameters. Resected specimens were significantly bigger in the RLR vs. the LLR group (405 g vs. 169 g, p = 0.002); in addition, the tumor diameter was significantly larger in the RLR vs. the LLR group (5.6 cm vs. 3.7 cm, p = 0.001). Hence, the amount of major liver resections (three or more segments) was significantly higher in the RLR vs. the LLR group (39.0% vs. 16.7%, p = 0.005). The mean operative time was significantly longer in the RLR vs. the LLR group (331 min vs. 181 min, p = 0.0001). The postoperative hospital stay was significantly longer in the RLR vs. the LLR group (13.4 vs. LLR 8.7 days, p = 0.03). The R0 resection rate for solid tumors was higher in the RLR vs. the LLR group but without statistical significance (93.8% vs. 87.9%, p = 0.48). The postoperative morbidity ≥ Clavien-Dindo grade 3 was 5.6% in the LLR vs. 17.1% in the RLR group (p = 0.1). No patient died in the RLR but two patients (2.8%) died in the LLR group, 30 and 90 days after surgery (p = 0.53). Conclusion Minimally invasive liver surgery is safe and feasible. Robotic and laparoscopic liver surgery shows similar and adequate perioperative oncological results for selected patients. RLR might be advantageous for more advanced and technically challenging procedures.

scholarly journals Erector Spinae Plane Block– An Analgesic Technique for Laparoscopic Liver Resection: A Case Series

2020 ◽  
Vol 6 (3) ◽  
Keyword(s):  
Liver Resection ◽  
Postoperative Pain ◽  
Pain Relief ◽  
Liver Surgery ◽  
Laparoscopic Liver Resection ◽  
Erector Spinae ◽  
Transversus Abdominis ◽  
Transversus Abdominis Plane ◽  
Erector Spinae Plane Block ◽  
Analgesic Technique

Introduction: Postoperative pain after liver surgery can be significant and yet difficult to manage. Epidural analgesia is widely used for pain relief after liver surgery. However there has been a progressive reduction in the use of epidural analgesia within an enhanced recovery program. The erector spinae plane block is a recently described regional anesthetic technique for providing abdominal analgesia when performed at the level of the T7 transverse process. Its mechanism of action is not yet clear, despite this providing somatic and visceral analgesia during surgery. Cases presentation: We report five patients undergoing laparoscopic liver resection in which the somatic and visceral intraoperative pain were covered by the right erector spinae plane block. In addition, a transversus abdominis plane plus oblique subcostal transversus abdominis plane blocks were performed on the left hemisome to cover the somatic pain due to skin incision and laparoscopic ports insertion. For postoperative pain relief, a catheter was inserted during the execution of the erector spinae plane block and a levobupivacaine infusion was maintained for 36 hr through it. Conclusions: A continuous right erector spinae plane block could be an effective analgesic technique in patients undergoing laparoscopic liver resection. However, further prospective studies with large number of patients are needed to evaluate the effectiveness of this block in liver surgery. Keywords: ESP block ; Erector spinae plane block ; Regional anesthesia ; Hepatic surgery ; Pain management.

Porcine Model In The Laparoscopic Liver Surgery Training

2015 ◽  
Vol 87 (8) ◽  
Author(s):  
Andrzej L. Komorowski ◽  
Jerzy W. Mituś ◽  
Miguel Angel Sanchez Hurtado ◽  
Francisco Miguel Sanchez Margallo
Keyword(s):  
Liver Surgery ◽  
Porcine Model ◽  
Vena Cava ◽  
Hepatic Veins ◽  
Advanced Training ◽  
Hepatoduodenal Ligament ◽  
Laparoscopic Liver Surgery ◽  
Left Lateral Sectionectomy ◽  
Surgery Training ◽  
Lateral Sectionectomy

AbstractThe aim of the study was to evaluate the possibility to use live anesthetized pigs as a model for laparoscopic liver resection. During two days laparoscopy course two trainees were operating on two live animals performing exposure of the liver, Pringle manoeuver, division of liver ligaments, dissecting of the structures inside the hepatoduodenal ligament, dissection of the hepatic veins and left lateral liver sectionectomy. Exposure of the liver and Pringle manoeuver were performed correctly within 50 and 35 minutes. Left lateral sectionectomy has been performed correctly within 2 hours. The full dissection of the hepatoduodenal ligament and exposure of the hepatic veins were judged as insufficient by experienced laparoscopic tutors. There was one injury to the suprahepatic vena cava that was managed laparoscopically. The porcine model can be used as an advanced training for laparoscopic liver surgery.

scholarly journals The effect of intraoperative imaging on surgical navigation for laparoscopic liver resection surgery

2019 ◽  
Vol 9 (1) ◽  
Author(s):  
Andrea Teatini ◽  
Egidijus Pelanis ◽  
Davit L. Aghayan ◽  
Rahul Prasanna Kumar ◽  
Rafael Palomar ◽  
...  
Keyword(s):  
Liver Resection ◽  
Liver Surgery ◽  
Surgical Navigation ◽  
Intraoperative Imaging ◽  
Preoperative Imaging ◽  
Navigation Systems ◽  
Laparoscopic Liver Surgery ◽  
Patient Registration ◽  
Surgical Navigation Systems ◽  
Annotation Errors

AbstractConventional surgical navigation systems rely on preoperative imaging to provide guidance. In laparoscopic liver surgery, insufflation of the abdomen (pneumoperitoneum) can cause deformations on the liver, introducing inaccuracies in the correspondence between the preoperative images and the intraoperative reality. This study evaluates the improvements provided by intraoperative imaging for laparoscopic liver surgical navigation, when displayed as augmented reality (AR). Significant differences were found in terms of accuracy of the AR, in favor of intraoperative imaging. In addition, results showed an effect of user-induced error: image-to-patient registration based on annotations performed by clinicians caused 33% more inaccuracy as compared to image-to-patient registration algorithms that do not depend on user annotations. Hence, to achieve accurate surgical navigation for laparoscopic liver surgery, intraoperative imaging is recommendable to compensate for deformation. Moreover, user annotation errors may lead to inaccuracies in registration processes.

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