scholarly journals Successive perioperative management of laparoscopic liver resection in the reverse Trendelenburg position for a patient with Fontan physiology: a case report

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kazutomo Saito ◽  
Hiroaki Toyama ◽  
Moeka Saito ◽  
Masanori Yamauchi
Keyword(s):  
Laparoscopic Surgery ◽  
Liver Resection ◽  
Laparoscopic Liver Resection ◽  
Transpulmonary Thermodilution ◽  
Postural Change ◽  
Central Venous ◽  
Trendelenburg Position ◽  
Open Abdominal Surgery ◽  
Fontan Physiology ◽  
Reverse Trendelenburg Position

Abstract Background Laparoscopic surgery for a patient with Fontan physiology is challenging because pneumoperitoneum and positive pressure ventilation could decrease venous return and the accumulated partial pressure of arterial carbon dioxide (PaCO2) could increase pulmonary vascular resistance, which might lead to disruption of the hemodynamics. Case presentation A 25-year-old man with Fontan physiology was scheduled to undergo laparoscopic liver resection for Fontan-associated liver disease (FALD) with noninvasive monitoring of cardiac output (CO) by transpulmonary thermodilution in addition to transesophageal echocardiography. The abdominal air pressure was maintained low, and we planned to switch to open abdominal surgery promptly if hemodynamic instability became apparent because of the accumulated PaCO2 or postural change. Consequently, the pneumoperitoneum had limited influence on circulatory dynamics, but central venous pressure significantly decreased with postural change to the reverse Trendelenburg position. Laparoscopic liver resection for FALD was performed successfully with no significant changes in CO and central venous saturation. Conclusions With strict circulation management, laparoscopic surgery for a patient with Fontan physiology can be performed safely. Comprehensive hemodynamic assessment by noninvasive transpulmonary thermodilution can provide valuable information to determine the time for shift to open abdominal surgery.

scholarly journals Single Port Laparoscopic Liver Resection for Hepatocellular Carcinoma: A Preliminary Report

2011 ◽  
Vol 2011 ◽  
pp. 1-4 ◽  
Author(s):  
Stephen Kin Yong Chang ◽  
Maria Mayasari ◽  
Iyer Shridhar Ganpathi ◽  
Victor Lee Tswen Wen ◽  
Krishnakumar Madhavan
Keyword(s):  
Hepatocellular Carcinoma ◽  
Laparoscopic Surgery ◽  
Liver Resection ◽  
Blood Loss ◽  
Hospital Stay ◽  
Laparoscopic Liver Resection ◽  
Preliminary Report ◽  
Single Port ◽  
Operating Time ◽  
Length Of Hospital Stay

Single port laparoscopic surgery is an emerging technique, now commonly used in cholecystectomy. The experience of using this technique in liver resection for hepatocellular carcinoma is described in a series of 3 cases with single port laparoscopic liver resection performed during 2010. All patients were male aged 61 to 70 years, with several comorbidities. There were no complications in this early series. The length of hospital stay was 3–5 days. The blood loss was 200–450 mL, with operating time between 142 and 171 minutes. We conclude that this technique is feasible and safe to perform in experienced centers.

scholarly journals Robotic Versus Conventional Laparoscopic Liver Resections: A Systematic Review and Meta-Analysis

2020 ◽  
pp. 145749692092563 ◽  
Author(s):  
S. K. Kamarajah ◽  
J. Bundred ◽  
D. Manas ◽  
L. R. Jiao ◽  
M. A. Hilal ◽  
...  
Keyword(s):  
Systematic Review ◽  
Laparoscopic Surgery ◽  
Liver Resection ◽  
Robotic Surgery ◽  
Blood Loss ◽  
Laparoscopic Liver Resection ◽  
Meta Analysis ◽  
Conventional Laparoscopic Surgery ◽  
Robotic Liver Resection ◽  
Conventional Laparoscopic

Background: Theoretical advantages of robotic surgery compared to conventional laparoscopic surgery include improved instrument dexterity, 3D visualization, and better ergonomics. This systematic review and meta-analysis aimed to determine advantages of robotic surgery over laparoscopic surgery in patients undergoing liver resections. Method: A systematic literature search was conducted for studies comparing robotic assisted or totally laparoscopic liver resection. Meta-analysis of intraoperative (operative time, blood loss, transfusion rate, conversion rate), oncological (R0 resection rates), and postoperative (bile leak, surgical site infection, pulmonary complications, 30-day and 90-day mortality, length of stay, 90-day readmission and reoperation rates) outcomes was performed using a random effects model. Result: Twenty-six non-randomized studies including 2630 patients (950 robotic and 1680 laparoscopic) were included, of which 20% had major robotic liver resection and 14% had major laparoscopic liver resection. Intraoperatively, robotic liver resection was associated with significantly less blood loss (mean: 286 vs 301 mL, p < 0.001) but longer operating time (mean: 281 vs 221 min, p < 0.001). There were no significant differences in conversion rates or transfusion rates between robotic liver resection and laparoscopic liver resection. Postoperatively, there were no significant differences in overall complications, bile leaks, and length of hospital stay between robotic liver resection and laparoscopic liver resection. However, robotic liver resection was associated with significantly lower readmission rates than laparoscopic liver resection (odds ratio: 0.43, p = 0.005). Conclusion: Robotic liver resection appears to offer some advantages compared to conventional laparoscopic surgery, although both techniques appear equivalent. Importantly, the quality of evidence is generally limited to cohort studies and a high-quality randomized trial comparing both techniques is needed.

“Stretching the Limits of Laparoscopic Surgery”: Two-Stage Laparoscopic Liver Resection

2010 ◽  
Vol 20 (1) ◽  
pp. 51-54 ◽  
Author(s):  
Gaurav Jain ◽  
Jitesh Parmar ◽  
Mahfud M. Mohammed ◽  
Tim Bryant ◽  
L. Kitteringham ◽  
...  
Keyword(s):  
Laparoscopic Surgery ◽  
Liver Resection ◽  
Laparoscopic Liver Resection ◽  
Two Stage

scholarly journals Gas embolism under standard versus low pneumoperitoneum pressure during laparoscopic liver resection (GASES): study protocol for a randomized controlled trial

Trials ◽  
2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Danfeng Jin ◽  
Mingyue Liu ◽  
Jian Huang ◽  
Yongfeng Xu ◽  
Luping Liu ◽  
...  
Keyword(s):  
Liver Resection ◽  
Central Venous Pressure ◽  
Laparoscopic Liver Resection ◽  
Controlled Trial ◽  
Venous Pressure ◽  
Vena Cava ◽  
Inflammatory Factors ◽  
Gas Embolism ◽  
Central Venous

Abstract Background Gas embolism induced by CO2 pneumoperitoneum is commonly identified as a risk factor for morbidity, especially cardiopulmonary morbidity, after laparoscopic liver resection (LLR) in adults. Increasing pneumoperitoneum pressure (PP) contributes to gas accumulation following laparoscopy. However, few studies have examined the effects of PP in the context of LLR. In LLR, the PP-central venous pressure (CVP) gradient is increased due to hepatic vein rupture, hepatic sinusoid exposure, and low CVP management, which together increase the risk of CO2 embolization. The aim of this study is to primarily determine the role of low PP (10 mmHg) on the incidence of severe gas embolism. Methods Adult participants (n = 140) undergoing elective LLR will be allocated to either a standard (15 mmHg) or low (10 mmHg) PP group. Anesthesia management, postoperative care, and other processes will be performed similarly in both groups. The occurrence of severe gas embolism, which is defined as gas embolism ≥ grade 3 according to the Schmandra microbubble method, will be detected by transesophageal echocardiography (TEE) and recorded as the primary outcome. The subjects will be followed up until discharge and followed up by telephone 1 and 3 months after surgery. Postoperative outcomes, such as the Post-Operative Quality of Recovery Scale, pain severity, and adverse events, will be assessed. Serum cardiac markers and inflammatory factors will also be assessed during the study period. The correlation between intraoperative inferior vena cava-collapsibility index (IVC-CI) under TEE and central venous pressure (CVP) will also be explored. Discussion This study is the first prospective randomized clinical trial to determine the effect of low versus standard PP on gas embolism using TEE during elective LLR. These findings will provide scientific and clinical evidence of the role of PP. Trial status Protocol version: version 1 of 21-08-2020 Trial registration ChiCTR2000036396 (http://www.chictr.org.cn). Registered on 22 August 2020.

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