Informativeness of methods of radiation diagnostics in the detection of liver hemangiomas

The use of methods of radiation diagnostics, which, being currently non-invasive and highly effective methods in the diagnosis of secondary liver neoplasms, are of great practical importance in the absence of the specificity of data from both clinical and laboratory methods in the examination of metastatic lesions of the hepatobiliary system organs. Purpose of the study: comparative assessment of the capabilities of radiation methods in the differential diagnosis of liver hemangiomas in patients with overweight and obesity. Materials and research methods. To do this, we conducted a two-step study. The study included 22 patients with primary hepatic hemangioma without liver dystrophy and 18 patients with hemangioma and obesity. At the next stage of the study, the location and number of hemangiomas were studied in 25 patients with hemangioma, but without obesity in the liver, and in 15 people with hemangioma and obesity. The exogenousness of the liver was studied according to the results of ultrasound in patients without (34) and with fatty degeneration of the liver (27). Patients underwent the following examinations: magnetic resonance imaging (MRT), computed tomography (CT) and ultrasound (USI). Study results and discussion: The study showed that localization and hemangiomas in the liver with and without obstruction in 11 of 22 patients identified by MRI had only 1 hemangioma in the liver, which is 50% of the corresponding study group. Numerous hemangiomas were found in the liver in 3 out of 15 patients or in 20% of patients with grade II obesity. Results from MRT and KT studies indicate that patients with or without obesity in the liver are more likely to have single hemangiomas. With the help of ultrasound, it was revealed that in 31 out of 34 patients without steatosis, hyperechogenicity of the liver was observed.

Improving Outcomes Defending Patient Safety: The Learning Journey in Robotic Liver Resections

Background. While laparoscopy is currently adopted for hepatic resections, robotic approaches to the liver have not gained wide acceptance. We decided to analyze the learning curve in the field of robotic liver surgery comparing short-term outcomes between the first and the second half of our series. Methods. We retrospectively reviewed demographics and clinical data of patients who underwent robotic liver resection at our institution from July 2014 through September 2017. 60 patients diagnosed with primary or secondary liver neoplasms or hydatid disease were included in this study. ASA PS >3, heart failure, respiratory insufficiency, and general contraindication to pneumoperitoneum were exclusion criteria. Results. 60 patients were included. We observed a statistically significant decrease in operative time (p<0.001), intraoperative blood loss (p=0.01), and postoperative complications (p<0.001) after 30 cases. From the interpretation of the CUSUM curve, the time of operation appears to be significantly reduced after the first 30 operations. Discussion. This is the first European analysis of the learning curve for robotic liver resection in an HPB and liver transplant referral center. However, more studies are needed to confirm such results outside a HPB referral center. This is crucial to develop formal credentialing protocols for both junior and senior surgeons.