Retroperitoneal laparoscopic partial hepatectomy: A novel approach to posterosuperior right-lobe tumors

BACKGROUNDLaparoscopic hepatectomy has been widely accepted for the treatment of liver tumors. Compared with open surgery, it provides a reduced hospital stay, less intraoperative blood loss, less trauma, and fewer incisional infections, without affecting tumor outcomes. However, lesions in the right lobe of the liver are deep and obstructed by the ribs, making exposure difficult and increasing the degree of surgical difficulty; thus, liver tumors in the deep right lobe pose technical challenges in standard laparoscopic surgery.AIMTo investigate the safety and efficacy of laparoscopic retroperitoneal partial hepatectomy for liver tumors.METHODSThe clinical data of 72 patients who underwent laparoscopic retroperitoneal partial hepatectomy for liver tumors between January 2018 and December 2024 at the First People’s Hospital of Yunnan Province were analyzed. Of the 72 patients included, 34 were male and 38 were female, with ages ranging from 34 years to 72 years (median age, 45 years). The tumors were all located in the right lobe of the liver, with 30 cases in segment S6, 27 cases in segment S7, and 15 cases in segment S8; the mean tumor diameter was 7.5 ± 3.4 cm. The postoperative tumor indices, liver function, and postoperative complications were analyzed to evaluate the clinical efficacy of laparoscopic partial hepatectomy via the retroperitoneal approach.RESULTSThe surgeries were successfully completed in all patients, and conversion to open surgery was required in 10 patients. The mean operative time, blood loss, drain retention time, and length of postoperative hospital stay were 140 ± 30 minutes, 150 ± 46 mL, 3.8 ± 1.2 days, and 8.3 ± 5.3 days, respectively. Liver function tests returned to normal in all patients within two weeks of surgery. Fifteen patients developed atelectasis and pleural effusion and were managed with incision and drainage and antibiotics. Two patients developed uncomplicated minimal ascites, and the remaining patients had no perioperative complications, such as abdominal hemorrhage, infection, liver failure, bile leakage, and other adverse events. All patients were successfully treated.CONCLUSIONLaparoscopic retroperitoneal partial hepatectomy is a safe and effective approach for right hepatic space-occupying lesions, particularly in segments S6, S7, and S8, with fewer postoperative complications, less trauma, and faster recovery times. This procedure provides a new surgical access for resection of deep tumors in the right lobe of the liver and has clear clinical implications.

BackgroundPrimary hepatic extranodal marginal zone B-cell mucosa-associated lymphoid tissue (MALT) lymphoma is very rare, so it is difficult to diagnose preoperatively. And there is no established treatment for hepatic MALT lymphoma. We report herein a case of primary hepatic MALT lymphoma treated by laparoscopic partial hepatectomy, and discuss the usefulness of laparoscopic hepatectomy for a rare liver tumor.Case presentationThis patient was a woman in her 60s, who was diagnosed preoperatively as having synchronous liver metastasis from sigmoid colon cancer; therefore, laparoscopic partial hepatectomy was performed. She had a good course after the operation and was discharged on postoperative day 12. However, she was diagnosed pathologically as having primary hepatic MALT lymphoma. A bone marrow biopsy was also performed, and then she was finally diagnosed as having limited-stage primary hepatic MALT lymphoma. She received no postoperative treatment and showed no recurrence for 4 years postoperatively.ConclusionsWe experienced the good result of the patient with limited-stage primary MALT lymphoma treated by laparoscopic partial hepatectomy. Liver tumors are sometimes misdiagnosed by imaging examinations alone. Laparoscopic hepatectomy has been widespread recently as a minimally invasive procedure, and it may be useful for both diagnosis and treatment.

Before the first laparoscopic hepatectomy (LH) was described in 1991, open hepatectomy (OH) was the only choice for surgical treatment of liver tumors. LH indications were initially based solely on tumor location, size, and type. Use of LH has spread rapidly worldwide because it reduces incision size. This review systematically assesses the current status of LH. As compared with OH, LH is significantly less complicated, requires shorter hospital stays, and results in less blood loss. The long-term survival rates of LH and OH are comparable. Development of new techniques and instruments will improve the conversion rate and reduce complications. Furthermore, development of surgical navigation will improve LH safety and efficacy. Laparoscopic major hepatectomy for HCC remains a challenging procedure and should only be performed by experienced surgeons. In the near future, a training system for young surgeons will become mandatory for standardization of LH, and LH will likely become better standardized and have broader applications.

Outflow control is difficult, and techniques required for effectively handling intraoperative hemorrhage during laparoscopic hepatectomy have not previously been adequately reported. Sixteen patients underwent surgery, of which 15 underwent laparoscopic left hepatectomy and one underwent laparoscopic partial hepatectomy of the caudate lobe. Encircling and taping of the common trunk of the middle (MHV) and left hepatic veins (LHV) was performed in 12 patients, and that of the LHV alone in four patients. Surgical techniques based on anatomical landmarks and histological findings are presented with videos. Histological confirmation of the anatomical landmarks for these procedures was performed in fresh cadavers to understand the anatomical structures and layers involved. The median procedure duration was 15 (6-25) minutes. All procedures were performed safely with no major bleeding. Histological findings showed fibrous connective tissue between the tunica adventitia of the inferior vena cava (IVC) and the Laennec's capsule of the liver. The layer of dissection was along the tunica adventitia of the IVC. The surgical techniques for encircling and taping of the common trunk of the MHV and LHV and the LHV alone based on anatomical landmarks were feasible and could allow for efficient outflow control in laparoscopic hepatectomy.

We have performed laparoscopic hepatectomy (LH) to treat HCC in patients with cirrhosis. In patients with hepatic cirrhosis, the perioperative blood control in cirrhotic patients is more important procedure than that in normal liver patients. Since we initiated LH, the use of pre-coagulation technique with microwave obtained satisfactory hemostasis during liver parenchymal transection. We retrospectively investigated 35 HCC patients with cirrhosis who had performed laparoscopic partial hepatectomy using pre-coagulation. Pre-coagulation technique with laparoscopic coagulation shears was able to performed LH in all cases without Pringle maneuver. Intraoperative blood loss averaged 206.8±234.0 cc. The study group had one case of grade II prolonged fever, two cases of grade II ascites, and one case of grade IIIa biliary fistula. The postoperative length of stay averaged 10.8±5.2 days. Although the development of the energy devices and Pringle maneuver have decreased the use of pre-coagulation technique especially in normal liver, pre-coagulation technique is one of useful options in laparoscopic partial hepatectomy for HCC patients with cirrhosis.

Laparoscopic hepatectomy is a standard surgical procedure. However, it is difficult to perform in patients with severe cirrhosis because of fibrosis and a high risk of hemorrhage. We report our recent experience in five cases of pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver in patients with severe cirrhosis. From 2012 to 2014, we performed pure laparoscopic partial hepatectomy in five patients with severe liver cirrhosis (indocyanine green retention rate at 15 min [ICG R15] >30% and fibrosis stage f4). A pure laparoscopic Pringle maneuver was employed in all patients. We investigated operative time, blood loss, duration of hospitalization and the days when discharge was possible, and compared these findings with those of patients with a normal liver (ICG R15 <10%, f0) who underwent pure laparoscopic partial hepatectomy during the same period (n = 7). As a result, operative time, blood loss, duration of hospitalization and the days when discharge was possible were similar in patients with cirrhosis undergoing pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver to those in patients with a normal liver undergoing pure laparoscopic partial hepatectomy. In conclusion, pure laparoscopic hepatectomy combined with a pure laparoscopic Pringle maneuver appears to be safe in patients with severe cirrhosis.

BackgroundTo compare short-term and long-term results of colorectal patients undergoing laparoscopic and open hepatectomy. Moreover, outcomes of laparoscopic versus open procedures for simultaneous primary colorectal tumor and liver metastasis resection were compared.MethodsA systematic search was conducted in the PubMed and EmBase databases (until Oct. 22. 2013) with no limits. Bibliographic citation management software (EndNote X6) was used for extracted literature management. Quality assessment was performed according to a modification of the Newcastle-Ottawa Scale. The data were analyzed using Review Manager (Version 5.1), and sensitivity analysis was performed by sequentially omitting each study.ResultsFinally, 14 studies, including a total of 975 CLM (colorectal liver metastasis) patients, compared laparoscopic with open hepatectomy. 3 studies of them, including a total of 107 CLM patients, compared laparoscopic with open procedures for synchronous hepatectomy and colectomy. Laparoscopic hepatectomy was associated with a significantly less blood loss, shorter hospitalization time, and less operative transfusion rate. In addition, lower hospital morbidity rate (OR = 0.57, 95%CI:0.42–0.78, P = 0.0005) and better R0 resection (OR = 2.44, 95%CI:1.21–4.94, P = 0.01) were observed in laparoscopic hepatectomy. For long-term outcomes, there were no significant differences between two surgical procedures on recurrence and overall survival. In comparison of synchronous hepatectomy and colectomy, laparoscopic procedure displayed shorter hospitalization (MD = −3.40, 95%CI:−4.37–2.44, P<0.00001) than open procedure. Other outcomes, including surgical time, estimated blood loss, hospital morbidity, and overall survival did not differ significantly in the comparison.ConclusionsLaparoscopic hepatectomy with or without synchronous colectomy are acceptable for selective CLM patients. We suggest standard inclusion criteria of CLM patients be formulated.

A Safe and Valid Procedure for Pure Laparoscopic Partial Hepatectomy of the Most Posterosuperior Area: The Top of Segment 7

Objective To investigate the application value of laparoscopic hepatectomy (LH) in the treatment of liver neoplasms. Methods Clinical data of 78 patients with liver neoplasms undergoing hepatectomy in Zhongnan Hospital of Wuhan University from June 2011 to June 2014 were retrospectively analyzed. The patients were divided into the LH group (n=31) and open hepatectomy (OH) group (n=47). The informed consents of all patients were obtained and the local ethical committee approval had been received. Intra- and post-operative situation and liver function of two groups were compared. Normally distributed data of two groups were compared with t test, non-normally distributed data were compared with rank-sum test and the comparison of rate was conducted using Chi-square test. Results Intraoperative blood loss, length of wound, retention time of abdominal drainage catheter, postoperative start time of eating and average postoperative length of hospital stay in the LH group were 150(100-200) ml, 5(4-6) cm, 5(3-6) d, 2(2-2) d and (8±3) d, which were significantly less compared with 300(300-600) ml, 20 (18-20) cm, 8(6-10) d, 3(2-3) d and (12±4) d in the OH group (Z= -5.405, -7.760, -4.366, -3.746; t=-3.608; P<0.05). The hospitalization cost in the LH group was (51±7) thousand yuan, which was significantly higher than (45±10) thousand yuan in the OH group (t=3.198, P<0.05). On the postoperative 1, 3 day, the levels of aspartate aminotransferase (AST) and aspartate aminotransferase (ALT) in the LH group were 94(62-114), 47(42-58) and 116(68 -136), 46(39-50) U/L, which were significantly lower than 110(93-158), 152(95-220) and 141(97-236), 49(42-120) U/L in the OH group (Z=-2.416, -6.539, -2.764, -2.229; P<0.05). In the LH group, the serum levels of albumin (ALB) on the postoperative 1, 3 day were (31±6), (35±3) g/L, which were significantly higher compared with (25±5), (34±3) g/L (t=4.958, 2.191; P<0.05). Conclusions LH is an efficacious and safe treatment for liver neoplasms. Compared with OH, LH has obvious advantages of smaller incision and shorter recovery time. Key words: Laparoscopes; Hepatectomy; Liver neoplasms

We are glad to introduce you that the 2021 3rd International Conference on Artificial Intelligence Technologies and Applications (ICAITA 2021) was successfully held on September 10-12, 2021. In light of worldwide travel restriction and the impact of COVID-19, ICAITA 2021 was carried out in the form of virtual conference to avoid personnel gatherings. Because most participants were still highly enthusiastic about participating in this conference, we chose to carry out ICAITA 2021 via online platform according to the original schedule instead of postponing it.ICAITA 2021 is to bring together innovative academics and industrial experts in the field of Artificial Intelligence Technologies and Applications to a common forum. The primary goal of the conference is to promote research and developmental activities in Artificial Intelligence Technologies and Applications and another goal is to promote scientific information interchange between researchers, developers, engineers, students, and practitioners working all around the world. The conference will be held every year to make it an ideal platform for people to share views and experiences in Artificial Intelligence Technologies and Applications and related areas.This scientific event brings together more than 100 national and international researchers in artificial intelligence technologies and applications. During the conference, the conference model was divided into three sessions, including oral presentations, keynote speeches, and online Q&A discussion. In the first part, some scholars, whose submissions were selected as the excellent papers, were given about 5-10 minutes to perform their oral presentations one by one. Then in the second part, keynote speakers were each allocated 30-45 minutes to hold their speeches.We were pleased to invite three distinguished experts to present their insightful speeches. Our first keynote speaker, Prof. Yau Kok Lim, from Sunway University, Malaysia. His research interests include Applied artificial intelligence, 5G networks, Cognitiveradio networks, Routing and clustering, Trust and reputation, Intelligent transportation system. And then we had Prof. Peter Sincak, from Technical University of Kosice, Slovakia. His research includes Artificial Intelligence and Intelligent Systems. Lastly, we were glad to invite Chinthaka Premachandra, from Shibaura Institute of Technology, Sri Lanka. His research interests include Artificial Intelligence, image processing and robotics. In the last part of the conference, all participants were invited to join in a WeChat group to discuss and explore the academic issues after the presentations. The online discussion was lasted for about 30-60 minutes. The first two parts were conducted via online collaboration tool, Zoom, while the online discussion was carried out through instant communication tool, WeChat. The online platform enabled all participants to join this grand academic event from their own home.We are glad to share with you that we still received lots of submissions from the conference during this special period. Hence, we selected a bunch of high-quality papers and compiled them into the proceedings after rigorously reviewed them. These papers feature following topics but are not limited to: Artificial Intelligence Applications & Technologies, Computing and the Mind, Foundations of Artificial Intelligence and other related topics. All the papers have been through rigorous review and process to meet the requirements of international publication standard.Lastly, we would like to express our sincere gratitude to the Chairman, the distinguished keynote speakers, as well as all the participants. We also want to thank the publisher for publishing the proceedings. May the readers could enjoy the gain some valuable knowledge from the proceedings. We are expecting more and more experts and scholars from all over the world to join this international event next year.The Committee of ICAITA 2021List of titles Committee member, General Conference Chair, Technical Program Committee Chair, Academic Committee Chair, Technical Program Committee Member, Academic Committee Member are available in this Pdf.

This article describes the operative procedures, varying difficulties, and required instrumentation for performing laparoscopic hepatectomy (LH) on the basis of a lesion's extrahepatic growing (EG) index, as calculated by computed tomography (CT). Laparoscopic partial hepatectomy cases were divided into the following two groups: an EG tumor group (n = 11) and an intrahepatic tumor group (n = 8). The surgical procedures, operative results, and laparoscopic instrumentation for these two groups were compared based on the EG index (/cm2; maximum diameter of tumor pedicle/maximum vertical diameter of tumor/area of the tumor). The mean operative time was significantly shorter and the mean blood loss was significantly less in the EG tumor group than in the intrahepatic tumor group. In addition, in the EG tumor group, there were significant differences in mean operative time and mean blood loss related to the values associated with the EG index (p <0.05, P <0.01). The selection of laparoscopic instruments was based on the EG index, as follows: (a) lesions with an EG index >5/cm2 underwent resection in combination with a microwave tissue coagulator and an ultrasonic surgical aspirator (13 cases, including intrahepatic tumor cases); (b) lesions with an EG index of 5-15/cm2 underwent resection in combination with a microwave tissue coagulator and laparosonic coagulating shears (four cases); (c) lesions with an EG index <%15/cm2 underwent resection with a laparoscopic linear stapler (two cases). Our preliminary experience leads us to believe that it is useful to calculate the EG index by CT scan before formulating the technical strategy for a subsequent LH procedure.

The purpose of this study was to compare the clinical effect of laparoscopic right hepatectomy (LRH) and open right hepatectomy (ORH) in the treatment of liver tumor. Patients and Methods We systematically searched PubMed, web of science, EMBASE, clinicaltrials.gov , and Cochrane Central Register for studies (study published August 1947 to December 2019). In this study, the perioperative data of laparoscopic right hepatectomy and open right hepatectomy were analyzed. Our meta-analysis included 7 studies involving 633 patients who underwent two types of surgery, laparoscopic right hepatectomy and open right hepatectomy. This study showed that compared with open right hepatectomy, there was no significant difference in operative time (weighted mean difference (WMD): 35.28, 95% confidence interval (CI): − 9.04–79.60, P = 0.12), but the result of laparoscopic right hepatectomy’s R0 resections (odd ratio (OR): 2.34, 95% confidence interval (CI): 0.60–9.11, P = 0.22), transfusion (odd ratio (OR): 0.64, 95% confidence interval (CI): 0.34–1.20, P = 0.17), mortality (odd ratio (OR): 0.44, 95% confidence interval (CI): 0.14–1.45, P = 0.18) was similar to that of open right hepatectomy. Laparoscopic right hepatectomy resulted in shorter hospital stay (weighted mean difference (WMD): − 4.75, 95% confidence interval (CI): − 5.96–3.55, P<0.00001) and less estimated blood loss (EBL) (weighted mean difference (WMD): − 161.97, 95% confidence interval (CI): − 257.47–66.46, P = 0.0009). The clinical effect of laparoscopic right hepatectomy in the treatment of liver tumor was similar to that of open right hepatectomy, which was safe, feasible, and has a good prognosis.

Retroperitoneal laparoscopic surgery has been widely used for kidney and adrenal gland resection. However, there have not been any reports of laparoscopic hepatectomy performed using a retroperitoneal approach. Herein, we report on a successful case of laparoscopic hepatectomy using a retroperitoneal approach. Further, we discuss the key technical points, feasibility, and indications of this method. A 48-year-old male patient with multiple hepatic metastases of the left lateral and right posterior segments of the liver following radical colon carcinoma resection underwent laparoscopic partial hepatectomy of the right posterior segment using a retroperitoneal approach, followed by laparoscopic hepatic left-lateral segmentectomy using a transabdominal approach. The operation time was 120 minutes and the blood loss volume was 150 mL. The patient was discharged at nine days post-surgery. There were no complications, including hemorrhage and bile leakage. The results of this case study provide evidence that a retroperitoneal approach is a novel, rapid, and safe method for laparoscopic hepatectomy that can be applied to the partial resection of small and superficial tumors of the right posterior segment of the liver.

Vascular endothelial growth factor (VEGF) is overexpressed in hepatocellular carcinoma (HCC), and findings have shown that its upregulation in these tumors has an impact on tumor growth. The authors hypothesized that compared with open liver resection, laparoscopic hepatectomy would result in a decreased local angiogenic response in residual tumor cells. Right- and left-lobe hepatomas were induced in Buffalo rats via laparoscopically guided subcapsular injection of Morris hepatoma cells. After 1 week, the animals were randomized to laparoscopic or open left lateral hepatectomy. In 14 days after resection, the rats were killed, the residual right lobe tumors were measured, and tissue was procured for RNA extraction. Transcript levels of VEGF messenger RNA (mRNA) were quantified with reverse transcriptase-polymerase chain reaction (RT-PCR), and VEGF serum levels were measured by enzyme-linked immunoassay (ELISA) both before resection and at the time of tissue harvest. None of the animals had development satellite liver lesions or distant metastases in the abdomen or thorax. The median residual tumor volume was 320 mm(3) in the open group compared with 180 mm(3) in the laparoscopic group (p = 0.164). The animals that underwent open resection had a 1.3-fold increase in VEGF mRNA transcript levels compared with the laparoscopic resection group (p = 0.008). The serum VEGF levels were not significantly different between the laparoscopic and open groups at baseline (open tumor resection [OR], 23.7 +/- 12.0 pg/ml; laparoscopic tumor resection [LR], 30.7 +/- 15.5 pg/ml; p = 0.334) nor at the time of tissue harvest (OR, 19.9 +/- 19.6 pg/ml; LR, 26.9 +/- 34.5 pg/ml; p = 0.549). Laparoscopic hepatic resection produces decreased VEGF mRNA expression in residual hepatoma cells compared with open resection. Decreased stimulation of angiogenesis promoters in the tumor microenvironment after minimally invasive liver resection may contribute to a lower residual disease burden and ultimately lead to a lower recurrence rate.

BackgroundImmune checkpoint inhibitors (ICIs) are emerging agents used for the treatment of various malignant tumors. As ICIs are generally used for unresectable malignant tumors, there have been only a few reports of patients who underwent surgery after receiving these drugs. Therefore, it remains unclear how immune-related adverse events (irAEs) affect the postoperative course. Here, we report a patient with advanced gastric cancer who underwent laparoscopic hepatectomy for liver metastases after an objective response with lenvatinib plus pembrolizumab and developed hypothyroidism and hypopituitarism as irAEs in the immediate postoperative period.Case presentationA 73-year-old man had undergone total gastrectomy for pT4aN2M0 gastric cancer followed by adjuvant chemotherapy with S-1 and docetaxel, and developed liver metastases in segments 6 and 7. He was enrolled in phase 2 clinical trial of lenvatinib plus pembrolizumab. He continuously achieved a partial response with the study treatment, and the liver metastases were decreased in size on imaging. The tumors were judged to be resectable and the patient underwent laparoscopic partial hepatectomy for segments 6 and 7. From the 1st postoperative day, the patient continuously presented with fever and general fatigue, and his fasting blood glucose level remained slightly lower than that before the surgery. On the 4th postoperative day, laboratory examination revealed hypothyroidism and hypopituitarism, which were suspected to be irAE caused by lenvatinib plus pembrolizumab after surgery. He received hydrocortisone first, followed by levothyroxine after adrenal insufficiency was recovered. Subsequently, his fever, general fatigue, and any abnormality regarding fasting blood glucose level resolved, and he was discharged on the 12th postoperative day. After discharge, his laboratory data for thyroid and pituitary function remained stable while receiving hydrocortisone and levothyroxine without recurrence of gastric cancer.ConclusionWe present a case of laparoscopic hepatectomy after receiving lenvatinib plus pembrolizumab and developed hypothyroidism and hypopituitarism after surgery. Regarding surgery after ICI therapy, it is important to recognize that irAEs might occur in the postoperative period.