Study of caudate lobe of liver in dissected cadaveric liver specimen

AbstractPreviously, isolated caudate lobectomy was rarely performed and the caudate lobe was usually resected along with other segments. Isolated caudate lobe resection is a challenging procedure even for an experienced surgeon. Our aim was to evaluate the feasibility, safety and outcomes of laparoscopic isolated caudate lobectomy and to compare these with the open technique. We retrospectively analyzed 21 patients who underwent isolated caudate lobectomy between January 2005 and December 2018 at Seoul National University Bundang Hospital. Patients who underwent either anatomical or non-anatomical resection of the caudate lobe were included. Patients were divided into two groups according to whether they underwent laparoscopic or open surgery. Intra-operative and postoperative outcomes were compared with a median follow-up of 43 months (4–149). A total of 21 patients were included in the study. Of these, 12 (57.14%) underwent laparoscopic and nine (42.85%) underwent open caudate lobectomy. Median operation time (204.5 vs. 200 minutes, p = 0.397), estimated blood loss (250 vs. 400 ml, p = 0.214) and hospital stay (4 vs. 7 days, p = 0.298) were comparable between laparoscopy and open group. The overall post operative complication rate was similar in both groups (p = 0.375). The 5-year disease free survival rate (42.9% vs 60.0%, p = 0.700) and the 5-year overall survival rate (76.2% vs 64.8%, p = 0.145) was similar between laparoscopy and open group. Our findings demonstrate that with increasing surgical expertise and technological advances, laparoscopic isolated caudate lobectomy can become a feasible and safe in selected patients.

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Dorsal approach with Glissonian approach for laparoscopic right anatomic liver resections

BMC Gastroenterology ◽

10.1186/s12876-021-01726-4 ◽

2021 ◽

Vol 21 (1) ◽

Author(s):

Shaohe Wang ◽

Yang Yue ◽

Wenjie Zhang ◽

Qiaoyu Liu ◽

Beicheng Sun ◽

...

Keyword(s):

Blood Loss ◽

Hospital Stay ◽

Hepatic Vein ◽

Pringle Maneuver ◽

Caudate Lobe ◽

Postoperative Hospital Stay ◽

Dorsal Approach ◽

Glissonian Approach ◽

The Mean ◽

Major Hepatic Vein

Abstract Background Laparoscopic anatomic hepatectomy (LAH) has gradually become a routine surgical procedure. However, how to expose the whole hepatic vein and avoid the hepatic vein laceration is still a challenge because of the caudate lobe, particularly in right hepatectomy. We adopted a dorsal approach combined with Glissionian appraoch to perform laparoscopic right anatomic hepatectomy (LRAH). Methods Twenty patients who underwent LRAH from January 2017 to November 2018 were retrospectively analysed. Of these patients, seven patients underwent laparoscopic right hemihepatectomy (LRH group), seven patients who underwent laparoscopic right posterior hepatectomy (LRPH group), and six patients who underwent laparoscopic hepatectomy for segment 7 (LS7 group). The paracaval portion of caudate lobe could be transected firstly through dorsal approach and the corresponding major hepatic vein could be exposed from its root to the peripheral branches safely. Due to exposure along the major hepatic vein trunk, the remaining liver parenchyma could be quickly transected from dorsal to cranial side. Results The mean age of the patients was 53.8 years and the male: female ratio was 8:12. The median operation time was 306.0 ± 58.2 min and the mean estimated volume of blood loss was 412.5 ± 255.4 mL. The mean duration of postoperative hospital stay was 10.2 days. The mean Pringle maneuver time was 64.8 ± 27.7 min. Five patients received transfusion of 2–4 U of red blood cells. Two patients suffered from transient hepatic dysfunction and one suffered from pleural effusion. None of the patients underwent conversion to an open procedure. The operative duration, volume of the blood loss, Pringle maneuver time, and postoperative hospital stay duration did not differ significantly among the LRH, LRPH, and LS7 groups (P > 0.05). Conclusions Dorsal approach combined with Glissonian approach for right lobe is feasible and effective in laparoscopic right anatomic liver resections.

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Endoscopic ultrasound-guided transgastric drainage of radiologically inaccessible left lobe liver abscess involving segment 4, caudate lobe, and left lateral segments using a modified technique

Endoscopy International Open ◽

10.1055/a-1293-7746 ◽

2021 ◽

Vol 09 (01) ◽

pp. E35-E40

Author(s):

Sharad Chandra ◽

Urvashi Chandra

Keyword(s):

Liver Abscess ◽

Open Surgery ◽

Caudate Lobe ◽

Left Lobe ◽

Ultrasound Guided ◽

Modified Technique ◽

Abscess Drainage ◽

Lateral Segment ◽

Alternative Approach ◽

Left Lateral Segment

AbstractLiver abscess requiring drainage is conventionally managed by interventional radiology-guided percutaneous drainage (PCD). Radiologically inaccessible abscesses are managed with laparoscopic or open surgery, which carries high rates of morbidity and mortality.EUS-guided transluminal liver abscess drainage is minimally invasive and can be an alternative approach for caudate lobe, segment 4, and left lateral segment abscesses. We report on three consecutive patients with radiologically inaccessible left lobe liver abscess involving the caudate lobe, segment 4, and lateral segment in whom EUS-guided transluminal drainage using a modified technique was successful.

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Technical feasibility and short-term outcomes of laparoscopic isolated caudate lobe resection: an IgoMILS (Italian Group of Minimally Invasive Liver Surgery) registry-based study

Surgical Endoscopy ◽

10.1007/s00464-021-08434-w ◽

2021 ◽

Author(s):

Andrea Ruzzenente ◽

◽

Andrea Ciangherotti ◽

Luca Aldrighetti ◽

Giuseppe Maria Ettorre ◽

...

Keyword(s):

Minimally Invasive ◽

Liver Metastases ◽

Hospital Stay ◽

Complication Rate ◽

Liver Surgery ◽

Colorectal Liver Metastases ◽

Caudate Lobe ◽

Open Group ◽

Perioperative Outcomes ◽

Minimally Invasive Liver Surgery

Abstract Background Although isolated caudate lobe (CL) liver resection is not a contraindication for minimally invasive liver surgery (MILS), feasibility and safety of the procedure are still poorly investigated. To address this gap, we evaluate data on the Italian prospective maintained database on laparoscopic liver surgery (IgoMILS) and compare outcomes between MILS and open group. Methods Perioperative data of patients with malignancies, as colorectal liver metastases (CRLM), hepatocellular carcinoma (HCC), intrahepatic cholangiocarcinoma (ICC), non-colorectal liver metastases (NCRLM) and benign liver disease, were retrospectively analyzed. A propensity score matching (PSM) analysis was performed to balance the potential selection bias for MILS and open group. Results A total of 224 patients were included in the study, 47 and 177 patients underwent MILS and open isolated CL resection, respectively. The overall complication rate was comparable between the two groups; however, severe complication rate (Dindo–Clavien grade ≥ 3) was lower in the MILS group (0% versus 6.8%, P = ns). In-hospital mortality was 0% in both groups and mean hospital stay was significantly shorter in the MILS group (P = 0.01). After selection of 42 MILS and 43 open CL resections by PSM analysis, intraoperative and postoperative outcomes remained similar except for the hospital stay which was not significantly shorter in MILS group. Conclusions This multi-institutional cohort study shows that MILS CL resection is feasible and safe. The surgical procedure can be technically demanding compared to open resection, whereas good perioperative outcomes can be achieved in highly selected patients.

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Detection of liver cirrhosis in standard T2-weighted MRI using deep transfer learning

European Radiology ◽

10.1007/s00330-021-07858-1 ◽

2021 ◽

Author(s):

Sebastian Nowak ◽

Narine Mesropyan ◽

Anton Faron ◽

Wolfgang Block ◽

Martin Reuter ◽

...

Keyword(s):

Neural Networks ◽

Liver Cirrhosis ◽

Transfer Learning ◽

Convolutional Neural Networks ◽

Classification Accuracy ◽

Automatic Segmentation ◽

Analysis Data ◽

Caudate Lobe ◽

Natural Image ◽

Liver Segmentation

Abstract Objectives To investigate the diagnostic performance of deep transfer learning (DTL) to detect liver cirrhosis from clinical MRI. Methods The dataset for this retrospective analysis consisted of 713 (343 female) patients who underwent liver MRI between 2017 and 2019. In total, 553 of these subjects had a confirmed diagnosis of liver cirrhosis, while the remainder had no history of liver disease. T2-weighted MRI slices at the level of the caudate lobe were manually exported for DTL analysis. Data were randomly split into training, validation, and test sets (70%/15%/15%). A ResNet50 convolutional neural network (CNN) pre-trained on the ImageNet archive was used for cirrhosis detection with and without upstream liver segmentation. Classification performance for detection of liver cirrhosis was compared to two radiologists with different levels of experience (4th-year resident, board-certified radiologist). Segmentation was performed using a U-Net architecture built on a pre-trained ResNet34 encoder. Differences in classification accuracy were assessed by the χ2-test. Results Dice coefficients for automatic segmentation were above 0.98 for both validation and test data. The classification accuracy of liver cirrhosis on validation (vACC) and test (tACC) data for the DTL pipeline with upstream liver segmentation (vACC = 0.99, tACC = 0.96) was significantly higher compared to the resident (vACC = 0.88, p < 0.01; tACC = 0.91, p = 0.01) and to the board-certified radiologist (vACC = 0.96, p < 0.01; tACC = 0.90, p < 0.01). Conclusion This proof-of-principle study demonstrates the potential of DTL for detecting cirrhosis based on standard T2-weighted MRI. The presented method for image-based diagnosis of liver cirrhosis demonstrated expert-level classification accuracy. Key Points • A pipeline consisting of two convolutional neural networks (CNNs) pre-trained on an extensive natural image database (ImageNet archive) enables detection of liver cirrhosis on standard T2-weighted MRI. • High classification accuracy can be achieved even without altering the pre-trained parameters of the convolutional neural networks. • Other abdominal structures apart from the liver were relevant for detection when the network was trained on unsegmented images.

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