Application of Laparoscopic Radical Resection for Type III and IV Hilar Cholangiocarcinoma Treatment

Background. This study is aimed at investigating the feasibility and safety of the laparoscopic radical resection for treating type III and IV hilar cholangiocarcinoma (III/IV Hilar C). Methods. Six patients with III/IV Hilar C were enrolled in our hospital. All patients underwent total laparoscopic surgery, including basic surgery (laparoscopic gallbladder, hilar bile duct, and common bile duct resection and hepatoduodenal ligament lymph node dissection) combined with left hepatic and caudate lobe resection/portal resection. The tumor size, operation time, intraoperative blood loss, and postoperative complications were observed. The follow-up of the patients after discharge was recorded. Results. Surgery was successfully completed in 6 patients. We found that the tumor size of 6 patients ranged from 1.5 to 3.6 cm, with 4 lymph nodes. The operation time was 540-660 minutes, and the blood loss was 300-500 ml. One patient developed bile leakage after surgery, healed within 2 weeks after drainage. The postoperative hospital stay was 16 (13-24) days. There were 4 cases of negative bile duct margin tumor, 1 case was positive, and 1 case was not reported. All 6 patients were discharged smoothly without perioperative death. Regular examinations were conducted every 3 months after discharge, and the median duration was 7 months. Only 1 patient had a marginal dysplasia, and 5 patients had no obvious signs of recurrence. Conclusions. Application of laparoscopic radical resection for III/IV Hilar C is safe and feasible and has good short-term efficacy with adequate preoperative evaluation, appropriate case selection, and precise operative strategy.

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Laennec’s approach for laparoscopic anatomical hemihepatectomy

World Journal of Surgical Oncology ◽

10.1186/s12957-021-02404-1 ◽

2021 ◽

Vol 19 (1) ◽

Author(s):

Wei Hu ◽

Gongming Zhang ◽

Meng Chen ◽

Chengcheng Zhong ◽

Mingxu Li ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Primary Liver Cancer ◽

Surgical Techniques ◽

Operation Time ◽

Bile Leakage ◽

Hepatic Veins ◽

Hepatic Hemangioma ◽

Conversion To Open Surgery ◽

The Mean

Abstract Background Laennec’s capsule has been found for about 200 years. However, laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using Laennec’s approach are rarely reported. Methods We retrospectively analyzed the technical details and the surgical outcomes of 15 patients who underwent LAH via Laennec’s approach between May 2017 and July 2020. The operation time, intraoperative blood loss, postoperative complications, and hospital stay were recorded and analyzed. Results Four of 15 patients were diagnosed with hepatic hemangioma, 2 had hepatolithiasis, and 9 patients had primary liver cancer. During the surgery, Laennec’s approach was used for LAH without conversion to open surgery. Four patients were treated with LARH, and 11 patients were cured with LALH. The mean age of the patients was 62.1 ± 6.5 years, and four were male. The mean operative time, blood loss, and length of the postoperative hospital stay were 193 ± 49 min, 247 ± 120 mL, and 8.7 ± 2.0 days, respectively. There was no incidence of postoperative bile leakage and bleeding. No mortality occurred. We also demonstrated that Laennec’s capsule does exist around the peripheral hepatic veins with histological confirmation. Conclusions Laennec’s approach is safe and feasible for LAH. Precise isolation of Laennec’s approach based on Laennec’s capsule helps to standardize the surgical techniques for laparoscopic anatomical hepatectomy.

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Application of near-infrared fluorescent cholangiography using indocyanine green in laparoscopic cholecystectomy

Journal of International Medical Research ◽

10.1177/0300060520979224 ◽

2020 ◽

Vol 48 (12) ◽

pp. 030006052097922

Author(s):

Chusi Wang ◽

Wenguang Peng ◽

Jiarui Yang ◽

Yuxuan Li ◽

Jiawei Yang ◽

...

Keyword(s):

Laparoscopic Cholecystectomy ◽

Bile Duct ◽

Postoperative Complications ◽

Blood Loss ◽

Near Infrared ◽

Hepatic Duct ◽

Operation Time ◽

Common Hepatic Duct ◽

Intraoperative Blood Loss ◽

Real Time Identification

Objective Near-infrared fluorescence cholangiography (NIRF-C) can help to identify the bile duct during laparoscopic cholecystectomy. This retrospective study was performed to investigate the effect of NIRF-C in laparoscopic cholecystectomy. Methods Consecutive patients who underwent NIRF-C-assisted laparoscopic cholecystectomy (n = 34) or conventional laparoscopic cholecystectomy (n = 36) were enrolled in this study. Identification of biliary structures, the operation time, intraoperative blood loss, and postoperative complications were analyzed. Results Laparoscopic cholecystectomy was completed in all patients without conversion to laparotomy. The median operation time and intraoperative blood loss were not significantly different between the two groups. No intraoperative injuries or postoperative complications occurred in either group. In the NIRF-C group, the visualization rate of the cystic duct, common bile duct, and common hepatic duct prior to dissection was 91%, 79%, and 53%, respectively. The success rate of cholangiography was 100% in the NIRF-C group. NIRF-C was more effective for visualizing biliary structures in patients with a BMI of <25 than >25 kg/m2. Conclusions NIRF-C is a safe and effective technique that enables real-time identification of the biliary anatomy during laparoscopic cholecystectomy. NIRF-C helps to improve the efficiency of dissection.

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Retroperitoneum ganglioneuroma: imaging features and surgical outcomes of 35 cases at a Chinese Institution

BMC Medical Imaging ◽

10.1186/s12880-021-00643-y ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Qian-Wen Zhang ◽

Tao Song ◽

Pan-Pan Yang ◽

Qiang Hao

Keyword(s):

Blood Loss ◽

Tumor Size ◽

Preoperative Evaluation ◽

Univariate Analysis ◽

Vena Cava ◽

Image Features ◽

Imaging Features ◽

Coronal Image ◽

Surgical Blood Loss ◽

Significant Difference

Abstract Background The preoperative evaluation is crucial for diagnosis and surgical plan of retroperitoneum ganglioneuroma (GN). In this study, we reviewed a relatively large series of histopathological proved retroperitoneum GN cases, summarized the imaging features and further depicted risk factors of increased surgical blood loss. Methods A total of 35 (18 male, 17 female) patients were retrospectively enrolled from January 2012 to June 2019 at our institution. Among them, 24 patients had undergone CT scans and 19 patients had undergone MR examination before treatment. The clinical and radiological features were analyzed and the relationships between image features and surgical blood loss were evaluated. Results The media age of the involved 35 patients was 40 years (range, 14–66 years). The histological tumor size was 10.12 ± 4.56 cm for average. Retroperitoneum GN was relatively low density on unenhanced CT images and showed delayed progressive enhancement on enhanced CT and MR images. The whorled sign could be seen in 14 patients. The vessel encasement sign could be found in 17 patients. Univariate analysis revealed maximal tumor size measured on axial image, maximal tumor size measured on coronal image, encasing one or both renal pedicles, encasing the aorta and/or vena cava and whorled sign on MRI showed significant difference between the blood loss ≥ 400 ml and blood loss < 400 ml group. Logistic regression further detected that maximal tumor size measured on axial images (OR: 1.12; 95% CI: 1.02–1.24; P = 0.023) and encasing one or both renal pedicles (OR: 22.39; 95% CI: 1.35–372.99; P = 0.030) were independently correlated with surgical blood loss. Conclusions Preoperative CT and MR imaging analysis was valuable for both diagnosis and surgical risk prediction of retroperitoneum GN.

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Laennec's Approach for Laparoscopic anatomical Hemihepatectomy

10.21203/rs.3.rs-290569/v1 ◽

2021 ◽

Author(s):

Wei Hu ◽

Gongming Zhang ◽

Meng Chen ◽

Chengcheng Zhong ◽

Mingxu Li ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Primary Liver Cancer ◽

Surgical Techniques ◽

Operation Time ◽

Bile Leakage ◽

Hepatic Veins ◽

Hepatic Hemangioma ◽

Conversion To Open Surgery ◽

Histological Confirmation

Abstract Background: Laennec's capsule has been found for about 200 years. However, laparoscopic anatomical right and left hemihepatectomy (LARH and LALH) using the Laennec's approach are rarely reported. Methods: We retrospectively analyzed the technical details and the surgical outcomes of 15 patients who underwent LAH via Laennec's approach between May 2017 and July 2020. The operation time, intraoperative blood loss, postoperative complications, and hospital stay were recorded and analyzed. Results: 4 of 15 patients were diagnosed with hepatic hemangioma, 2 had hepatolithiasis, and 9 patients had primary liver cancer. During the surgery, Laennec's approach was used for LAH without conversion to open surgery. 4 patients were treated with LARH and 11 patients were cured with LALH. The operative time, blood loss, and hospital stay were 193 ± 49 min, 247 ± 120 mL and 8.7 ± 2.0 days, respectively. There was no incidence of postoperative bile leakage and bleeding. No mortality occurred. We also demonstrated that Laennec's capsule does exist around the peripheral hepatic veins with histological confirmation. Conclusions: Laennec's approach is safe and feasible for LAH. Precise isolation of Laennec's approach based on Laennec's capsule helps to standardize the surgical techniques for laparoscopic anatomical hepatectomy.

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Ứng dụng dao siêu âm Sonastar trong phẫu thuật cắt gan

Journal of Clinical Medicine- Hue Central Hospital ◽

10.38103/jcmhch.2020.65.19 ◽

2020 ◽

Author(s):

Hien Pham Nhu

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Operative Time ◽

Resection Margin ◽

Operation Time ◽

Bile Leakage ◽

Hepatic Veins ◽

Early Results ◽

Solitary Liver ◽

The Mean

Background: Researching specification and evaluating early results after hepatectomy that it’s used with Sonastar ultrasonic tool. Materials and methods: We prospectively examined data of 19 patients who underwent hepatectomy at Hue Central Hospitalfrom 7/2019to 7/2020. Results: The mean ages was 60,7 ± 10,5 range (19 – 90) and males/females was 6:1.. Patients with solitary liver tumor accounted for 79%; while tumors that have satellite cores accounted for 21% of all cases. 68,4% of all patients have tumor that is more than 5cm in size. Blocking hepatic blood flow by clamping of hepatoduodenal ligament accounts for 57,9%, while right and left hepatic vein clamp accounted for 68,4% and 36,8% respectively. In 78,9% of the cases, surgicel was used to cover the liver resection margin, while the in the remainder 21,5% of the cases, BioGlue was used. Large liver resection (2 and more lobes resected) accounted for 73,7% of all cases. Mean liver resection time was 50 ( 45-110) minutes, mean operation time was 125 (90-280) minutes, mean blood loss amount was 250 (150-650)ml. On average, post-operative time was 8 days (7-23). Post-operative complications was observed in 15,9% of cases, and there was 5,3% deceased. Conclusion: Application of Sonastar ultrasonic tool in hepatectomy reduces blood loss, help better manage hepatic veins, thus reducing complications such as bile leakage. It also helps surgeons manage the liver resection margin, minimalizing recurrences cancer

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Subtotal (segment II–VIII) hepatectomy for bilateral diffuse hepatolithiasis with compensatory caudate lobe hypertrophy: a report of two cases

BMC Gastroenterology ◽

10.1186/s12876-020-01503-9 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Wei Wang ◽

ZiJie Zhang ◽

Jian Wang

Keyword(s):

Bile Duct ◽

Portal Vein ◽

Hepatic Artery ◽

Comprehensive Evaluation ◽

Preoperative Evaluation ◽

Case Series ◽

Operation Time ◽

Caudate Lobe ◽

Compensatory Response ◽

Left And Right

Abstract Background Hepatolithiasis often leads to atrophy–hypertrophy complex due to bile duct obstruction, inflammation or infection in the affected liver segments and compensatory response in the normal segments. In severe bilateral diffuse cases, main liver can all be atrophic, leaving the caudate lobe to be extremely hypertrophic. Subtotal (segment II–VIII) hepatectomy can be an option in selected patients under such circumstances. Since rare cases have been reported, our study aims to highlight the preoperative evaluation and key points of this procedure. Case presentation Two patients with primary and secondary bilateral diffuse hepatolithiasis, respectively, were enrolled in this case series. The atrophy of the left and right liver with an exceeding hypertrophy of the caudate lobe were observed. Since the liver anatomy had completely been changed, contrast computed tomography, magnetic resonance imaging combined with 3D liver reconstruction were employed for comprehensive evaluation and pre-operational planning. The patients underwent standard subtotal (segment II–VIII) hepatectomy. During operation, the hepatoduodenal ligament around porta hepatis was dissected firstly to expose the hepatic artery, portal vein, bile duct and their branches successively. And then the vessels and bile duct to caudate lobe were preserved safely through cutting off the left and right hepatic artery, portal vein and bile duct at a safe point distal to the origin of the branches to caudate lobe. Operation time was 300 min and 360 min, respectively. Blood loss was 200 ml and 300 ml. No evidence of liver dysfunction, hepatolithiasis relapse or cholangitis was observed during the follow-up of 12 and 26 months. Conclusions Subtotal (segment II–VIII) hepatectomy may be one of several treatments possible in selected patients with compensatory caudate lobe hypertrophy caused by bilateral diffuse hepatolithiasis.

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Hepatectomy for Hilar Cholangiocarcinoma with Right-Sided Ligamentum Teres Using a Hepatectomy Simulation System

Case Reports in Gastroenterology ◽

10.1159/000480375 ◽

2017 ◽

Vol 11 (3) ◽

pp. 576-583 ◽

Cited By ~ 1

Author(s):

Seikan Hai ◽

Etsuro Hatano ◽

Tadamichi Hirano ◽

Yasukane Asano ◽

Kazuhiro Suzumura ◽

...

Keyword(s):

Bile Duct ◽

Hilar Cholangiocarcinoma ◽

Three Dimensional ◽

Bile Leakage ◽

Ligamentum Teres ◽

Simulation System ◽

Hepatic Bile ◽

Hepatic Bile Duct ◽

The Right ◽

Hepatic Vasculature

Right-sided ligamentum teres (RSLT) is a rare congenital anomaly often accompanied by variation of the hepatic vasculature. We herein report a surgical case of a hilar cholangiocarcinoma with RSLT in whom preoperative hepatectomy simulation proved useful for understanding the anatomical structure of the liver. A 78-year-old male with obstructive jaundice was referred to our department for further examination. The patient was suspected of having a hilar cholangiocarcinoma originating from the left hepatic bile duct by contrast-enhanced computed tomography (CT), and CT also showed right umbilical portion (RUP). Three-dimensional images of the hepatic vasculature and biliary system reconstructed using a hepatectomy simulation system suggested that all portal branches ramified from RUP were right paramedian branches, and three leftward portal branches from these ran parallel to the peripheral bile ducts confluent with the left hepatic bile duct, where the tumor was present. Hepatic resection of part of the ventral area of the right paramedian sector and left hemiliver was performed along the demarcation line drawn after clamping the portal branches; the ratio of estimated liver resection volume was 28.9%. After the operation, bile leakage occurred. However, the leakage was treated with percutaneous drainage alone, and the patient was discharged 77 days after the operation. The patient is doing well without any signs of recurrence 21 months after the operation. The vascular and biliary anatomy in patients with RSLT is complicated and should be evaluated in detail preoperatively using a hepatectomy simulation system.

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Three‐dimensional‐printed customized prosthesis for pubic defect: clinical outcomes in 5 cases at a mean follow‐up of 24 months

BMC Musculoskeletal Disorders ◽

10.1186/s12891-021-04294-6 ◽

2021 ◽

Vol 22 (1) ◽

Author(s):

Yuqi Zhang ◽

Li Min ◽

Minxun Lu ◽

Jie Wang ◽

Yitian Wang ◽

...

Keyword(s):

Blood Loss ◽

Clinical Outcomes ◽

Weight Bearing ◽

Three Dimensional ◽

Operation Time ◽

Pubic Bone ◽

Type Iii ◽

3D Printed ◽

The Mean

Abstract Background Pubic defects resulting from type III hemipelvectomy are commonly not reconstructed due to the need to preserve the weight-bearing axis. However, the opening of the anterior pelvic ring will inevitably lead to increased pelvic instability. To improve long-term pelvic stability, three-dimensional (3D)-printed customized prostheses were designed to reconstruct pubic defects. This study presents and evaluates the short-term clinical outcomes and complications from the use of this construct. Methods Five patients who underwent type III hemipelvectomy and 3D-printed customized prosthesis reconstruction at our institution between 2017 and 2019 were retrospectively analysed. Operation time and blood loss during the operation were recorded. Local and functional recovery was assessed. Prosthetic position and osseointegration were evaluated. Oncology results and complications were recorded. Results The prostheses consisted of three with stems and two without. The mean follow-up time was 23.6 months. At the last follow-up, all five patients were alive with no evidence of disease. No deep infections or local recurrence had occurred. The mean blood loss and mean intraoperative time were 1680 ml and 294 min, respectively. The mean functional MSTS score at the final follow-up was 29.8. Fretting wear around the prosthetic stem was found in 3 patients, while bone wear on the normal-side pubis was found in 2 patients. Osseointegration was observed in all patients. Conclusions 3D-printed customized prostheses for reconstructing pubic bone defects after type III hemipelvectomy showed acceptable early outcomes. The good outcomes were inseparable from the precision prosthesis design, strict surgical procedures, and sensible postoperative management.

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Selective Radical Resection for Unresectable Pancreatic Cancer

BioMedica ◽

10.51441/biomedica/5-88 ◽

2020 ◽

Vol 36 (4) ◽

pp. 405-411

Author(s):

Changku Jia ◽

Ling Liu ◽

Hanzhang Zhu ◽

Weimin Shen ◽

Chunfeng Yang

Keyword(s):

Pancreatic Cancer ◽

Blood Loss ◽

Pancreatic Fistula ◽

Survival Time ◽

Operation Time ◽

Radical Resection ◽

Lower Grade ◽

Unresectable Pancreatic Cancer ◽

Intraoperative Blood Loss ◽

Resectable Pancreatic Cancer

Background and Objective: For inefficiency of chemotherapy and radiation against pancreatic cancer, resection rate for primary unresectable pancreatic cancer remains very low. This study was carried out to evaluate the safety and value of radical resection for unresectable pancreatic cancer (UPC). Methods: Clinical data were analyzed retrospectively. In unresectable group, 360° resection of the involved artery sheath, resection and reconstruction of the involved artery, resection and reconstruction of the involved vein as well as resection and reconstruction of combined organs were performed. Operation time, intraoperative blood loss, ICU transitional treatment, pancreatic fistula, bleeding, reoperation and survival time were analyzed for two groups. Results: Operation time and intraoperative blood loss were greatly increased in the unresectable group. The incidence of intractable diarrhea and abdominal hemorrhage in the unresectable group were higher. However, the rate of ICU transitional therapy, delayed gastric emptying and reoperation were lower. Grade-C pancreatic fistula occurred in neither group. Conclusion: Surgical treatment through stringent selection for patients with unresectable pancreatic cancer is a safer technique and median post-operative survival time is similar to patients with resectable pancreatic cancer.

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Analysis of risk factors for presacral abscess after radical resection of middle and low rectal cancer.

10.21203/rs.3.rs-917464/v1 ◽

2021 ◽

Author(s):

Ang Li ◽

Jun Shi ◽

Binqiao Shi ◽

Xiaohui Shi

Keyword(s):

Risk Factors ◽

Rectal Cancer ◽

Blood Loss ◽

Tumor Size ◽

Operative Time ◽

Preoperative Radiotherapy ◽

Radical Resection ◽

Low Rectal Cancer ◽

Chi Square ◽

Presacral Abscess

Abstract Background and ObjectivesTo investigate the risk factors of presacral abscess after radical resection of middle and low rectal cancer. MethodsClinical data of 2279 patients with middle and low rectal cancer in the department of Colorectal Surgery at the Changhai Hospital of the Second Military Medical University from January 2015 to December 2018 were analyzed retrospectively. Univariate and multivariate analyses were performed to find the risk factors of presacral abscess using Chi-square test and Logistic regression, respectively. ResultsThe median age of all cases was 62 years. Of the 27 cases with presacral abscess, 22 were males and 5 were females. 12 cases were low rectal cancer and 15 cases were middle rectal cancer. Univariate Chi-square test indicated that the relative factors associated with the presacral abscess were tumor size, operative time, blood loss, T stage lesions, receiving preoperative radiotherapy and with preventive terminal ileostomy. Multivariate analysis showed that tumor size, operative time, blood loss, receiving preoperative radiotherapy and with preventive terminal ileostomy were the independent risk factors. ConclusionsPatients with big tumor size, long operative time, high blood loss and preoperative radiotherapy are high-risk groups of presacral abscess after radical resection of middle and low rectal cancer.

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