Laparoscopic Hepatic Surgery Research Articles

Life-threatening event in laparoscopic hepatic surgery: Training curriculum on sudden hepatic artery haemorrhage

BackgroundExposure of the hepatic artery is a fundamental step in many surgeries, during which iatrogenic hepatic artery injury may occur. Although the incidence of hepatic artery haemorrhage is low, its occurrence can lead to life-threatening haemorrhage. It is difficult and dangerous to accumulate clinical experience in laparoscopic hepatic artery repair in actual patients, and simulation training models for laparoscopic hepatic artery repair are currently lacking. In this study, a 3D printed model was designed to simulate the training curriculum for sudden hepatic artery haemorrhage, but whether training with the 3D printed model could yield superior skill improvement for surgeons remained to be determined.MethodsA new 3D printed model was designed for this study. Surgeons from the General Surgery Department of Sir Run Run Shaw Hospital participated in this simulation training. The surgical performance of each model was compared, and the authenticity of the model was evaluated and mechanically tested.ResultsExperienced surgeons performed better on the 3D printed model. After repeated training, inexperienced surgeons showed significant improvement of their laparoscopic hepatic artery repair skills. The authenticity of the model was generally satisfactory, but shortcomings persisted in the mechanical testing of artery wall tearing, necessitating further improvement.ConclusionsFew studies have investigated laparoscopic simulation training for sudden hepatic artery haemorrhage. This simulation model distinguishes surgeons with different levels of experience and allows those with less experience to improve their laparoscopic hepatic artery repair skills through training on the model.

Advantages of laparoscopic hepatic hemangioma surgery in quality of life: a prospective study.

Surgical intervention is the most accurate method for the treatment of hepatic hemangioma. The advantages of laparoscopic surgery on quality of life should be clarified by prospective studies. The sample sizes of the laparoscopic and open surgery groups were calculated based on previous retrospective literature. Intraoperative and postoperative parameters were prospectively collected and analyzed. Quality of life in both groups was predicted by a mixed linear model. Sixty patients were enrolled in the laparoscopic surgery group and open surgery group. The laparoscopic group had a longer operation time (P = 0.040) and more hospitalization expenses (P = 0.001); however, the Clavien-Dindo classification and comprehensive complication index suggested a lower incidence of surgical complications in the laparoscopic group, with P values of 0.049 and 0.002, respectively. After mixed linear model prediction, between-group analysis indicated that the laparoscopic group had little impact on role-physical functioning and role-emotional functioning; in addition, within-group analysis showed a rapid recovery time on role-physical functioning and role-emotional functioning in the laparoscopic group. Quality of life in both groups recovered to the preoperative level within 1 year after the operation. The advantages of laparoscopic hepatectomy for hepatic hemangioma were fewer postoperative complications, lower impact on quality of life and faster recovery from affected quality of life.

Laparoscopic resection of liver tumors in children

BackgroundLaparoscopy for the resection of liver tumors in children has remained undeveloped in comparison to adults. Most of the indications for pediatric laparoscopic hepatic surgery have been limited to diagnostic laparoscopy (biopsy). Over the past ten years, however, laparoscopic liver resections for pediatric hepatic diseases have been performed successfully, and many case reports have been published. MethodsThe authors report 6 cases of laparoscopic hepatic resection of benign tumors in children. The most important aspects of surgical technique are presented. There were 3 boys and 3 girls, with age between 4 months and 16 years. The lesions were located in the following segments: II and III (4 patients), I (1), V (1). The maximum tumor size was 7 cm. ResultsOne anatomical (left bisegmentectomy) and 5 nonanatomical resections were performed. Conversion to laparotomy was necessary in 1 patient owing to bleeding from the posterior branch of the right hepatic artery. There were no postoperative complications and patients were discharged on postoperative day 4, 5, 5, 5, 7 and 3 accordingly. The postoperative pathology of the specimens confirmed their benign nature: infantile hemangioendothelioma (1), nested stromal epithelial tumor (1), focal nodular hyperplasia (3), mixed benign tumor (hamartoma + vascular malformation) (1). ConclusionsThis report demonstrates the feasibility of a laparoscopic hepatic resection in children. On the other hand, laparoscopic liver resection is challenging and teamwork and specific training are necessary.

Left Hepatic Lobectomy in the Living Donor—Comparison Between Open vs Laparoscopic Surgery

Laparoscopic hepatic surgery dramatically changed surgical practice in the last decades, improving outcomes in correctly selected patients. The reduction of postoperative pain, lower rate of complication, early return to work activities, and better esthetic result have been well described in several studies. The success of these procedures would inevitably clash in the more complex and delicate field of hepatectomy in the living donor. The 2nd International Consensus of the Conference on Laparoscopic Liver Surgery considers laparoscopic hepatectomy in the donor as an ideal procedure. The aim of this study is to compare the results between conventional and laparoscopic surgery; prospective data and retrospective analysis of 55 cases of live liver donor lobectomy were collected between January 2013 and June 2018. The mean age was 30.4 years in the video laparoscopic technique and 32.1 years in conventional surgery; the majority of donors were male in both groups. The mean time of ischemia was 70.2 minutes (range, 50–120 minutes) in laparoscopic surgery and 80.2 minutes (range, 50–165 minutes) in conventional surgery. The surgical time ranged from 270 to 800 minutes (mean, 452 minutes) in laparoscopic surgery and ranged from 300 to 600 minutes (mean, 424 minutes) in conventional surgery. The mean length of hospital stay was 2.2 days in laparoscopy and 3.97 days in conventional surgery. Laparoscopic left liver lobectomy in the living donor is safe and feasible. There was no significant difference in surgical time; however, the time of hospitalization was lower in patients submitted to laparoscopic technique.

Laparoscopic liver surgery: towards a day-case management.

Ambulatory surgery (AS) is a contemporary subject of interest. The feasibility and safety of AS for solid abdominal organs are still dubious. In the present study, we aimed at defining potential surgical criteria for AS by analyzing a large database of patients who underwent laparoscopic liver surgery (LLS) in two French expert centers. This study was performed using prospectively filled databases including patients that underwent pure LLS between 1998 and 2015. Patients whose perioperative medical characteristics (ASA score<3, no associated extra-hepatic procedure, surgical duration≤180min, blood loss≤300mL, no intraoperative anesthesiological or surgical complication, no postoperative drainage) were potentially adapted for ambulatory LLS were included in the analysis. In order to determine the risk factors for postoperative complications, multivariate analysis was carried out. During the study period, pure LLS was performed in 994 patients. After preoperative and intraoperative characteristics screening, 174 (17.5%) patients were considered for the final analysis. Lesions (benign (46%) and liver metastases (43%)) were predominantly single with a mean size of 37±32mm in an underlying normal or steatotic liver parenchyma (94.8%). The vast majority of LLS performed were single procedures including wedge resections and liver cyst unroofing or left lateral sectionectomies (74%). The global morbidity rate was 14% and six patients presented a major complication (Dindo-Clavien≥III). The mean length of stay was 5±4days. Multivariate analysis showed that major hepatectomy [OR 29.04 (2.26-37.19); P=0.01] and resection of tumors localized in central segments [OR 41.24 (1.08-156.47); P=0.04] were independent predictors of postoperative morbidity. In experienced teams, approximately 7% of highly selected patients requiring laparoscopic hepatic surgery (wedge resection, liver cyst unroofing, or left lateral sectionectomy) could benefit from ambulatory surgery management.

Laparoskopische Leberchirurgie

Laparoscopic liver surgery has become an established procedure in the treatment of liver tumors. Due to its short-term and long-term advantages, the number of centers with experience in laparoscopic liver surgery has greatly increased in the last few years. The complexity of the interventions performed has nearly reached the level of open surgery. This article describes the importance of laparoscopic hepatic surgery and discusses the evidence for the procedure. In addition, the indications for the most frequently resected tumors, metastases of colorectal cancer and hepatocellular carcinoma are explained together with important aspects of certain tumor localizations. In addition, the authors explain the technical aspects of the surgical technique and give an overview on new developments. To illustrate the possibilities of laparoscopic liver surgery, a video of acomplete laparoscopically performed associating liver partition and portal vein ligation (ALPPS) procedure is available as supplementary material.

Bleeding control during laparoscopic hepatic surgery: usefulness of vascular clamps and barbed sutures

Bleeding control during laparoscopic hepatic surgery: usefulness of vascular clamps and barbed sutures

Minimally-invasive volaemic monitoring through stroke volume variation leads to better intraoperative outcomes in laparoscopic hepatic surgery

Minimally-invasive volaemic monitoring through stroke volume variation leads to better intraoperative outcomes in laparoscopic hepatic surgery

Ambulatory laparoscopic minor hepatic surgery: Retrospective observational study

Over the last decade, laparoscopic hepatic surgery (LHS) has been increasingly performed throughout the world. Meanwhile, ambulatory surgery has been developed and implemented with the aims of improving patient satisfaction and reducing health care costs. The objective of this study was to report our preliminary experience with ambulatory minimally invasive LHS. Between 1999 and 2014, 172 patients underwent LHS at our institution, including 151 liver resections and 21 fenestrations of hepatic cysts. The consecutive series of highly selected patients who underwent ambulatory LHS were included in this study. Twenty patients underwent ambulatory LHS. Indications were liver cysts in 10 cases, liver angioma in 3 cases, focal nodular hyperplasia in 3 cases, and colorectal hepatic metastasis in 4 cases. The median operative time was 92 minutes (range: 50-240 minutes). The median blood loss was 35 mL (range: 20-150 mL). There were no postoperative complications or re-hospitalizations. All patients were hospitalized after surgery in our ambulatory surgery unit, and were discharged 5-7 hours after surgery. The median postoperative pain score at the time of discharge was 3 (visual analogue scale: 0-10; range: 0-4). The median quality-of-life score at the first postoperative visit was 8 (range: 6-10) and the median cosmetic satisfaction score was 8 (range: 7-10). This series shows that, in selected patients, ambulatory LHS is feasible and safe for minor hepatic procedures.

Laparoscopic habib bipolar radiofrequency ablation for bloodless laparoscopic liver resection

Background. In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made laparoscopic hepatic surgery feasible and safe. In spite of this laparoscopic liver resection remains a surgical procedure of great challenge because of the risk of massive bleeding during liver transection and the complicated biliary and vascular anatomy in the liver. A new laparoscopic device can help and assist liver resection.

Role of Laparoscopy in Changing the Management of Hepatocellular Carcinoma

Background: Laparoscopic approach offers the advantages of intra-operative laparoscopic ultrasonography (IOLUS), which provides better resolution of the number and location of liver tumors, and liver condition. In recent years the progress of laparoscopic procedures and the development of new and dedicated technologies have made laparoscopic hepatic surgery feasible and safe. The aim of this study is to present the results of our experience in laparoscopic management of Hepatocellular carcinoma (HCC) in cirrhotic patients. Patients and methods: Between September 2010 and January 2013, Four hundred patients with HCC in liver cirrhosis were referred from HCC clinic at National Hepatology and Tropical Medicine Research Institute (NHTMRI). 65 patients were submitted to diagnostic laparoscopy. 33 patients had Laparoscopic Radiofrequency Ablation with IOLUS guidance and 14 patients had laparoscopic non-anatomical resection while 18 patients had been converted to open laparotomy. Operation time, hospital stay, post-procedure complications were recorded. Spiral CT scan one month postoperative was mandatory during follow up. Results: Laparoscopic management was completed in 47 patients. The IOLUS examination identified new HCC in three patients. A total of 50 lesions were treated laparoscopically. The mean operative time was 120 ± 50 minutes; eight procedures were associated in six patients: cholecystectomy (6) and adhesiolysis (2). A complete tumor ablation was observed in treated patients by LRFA which were documented via spiral computed tomography (CT scan) one month after treatment. In resection group, histopathology was confirmed that, all tumor resection were with safety margin. Conclusion: Laparoscopic procedure proved to have a role in changing the management of HCC either by resection or by LRFA. Laparoscopy proved to be a safe and effective technique.

Stellenwert laparoskopischer Leberresektionen

Whereas in other fields of surgery minimally invasive techniques have replaced the open surgery approach, liver resection is still a domain of conventional surgery. However, it is internationally emerging that laparoscopic hepatic surgery will become more important by conceptional improvements. This article describes the technical aspects of laparoscopic liver resection, in particular the procedure with respect to the individual liver segments. The advantages and disadvantages of the minimally invasive technique and also the indications for laparoscopic liver resection will be discussed.

3D virtual reality and selective vascular control for laparoscopic left hepatic lobectomy

Careful control of haemostasis is particularly important in laparoscopic hepatic surgery, since a bloodless operative field results in safer and smoother procedures. A selective vascular control for a left lateral segmentectomy may be facilitated by the use of three-dimensional (3D) virtual reality. A 67-year-old male patient presenting with a 3.5-cm hepatocellular carcinoma (HCC) located between segment II and III of the liver was referred for hepatic resection. Transplant was contraindicated due to previous head and neck cancer surgery. Preoperative 3D reconstruction was used for preoperative planning and allowed a virtual resection to be done as well as peroperative simulation. Five ports were used. The first step was primary control of the hepatic pedicle. 3D virtual-reality reconstruction demonstrated the position of the tumor in the segment and regarding the vessels. The left hepatic artery and the portal vein were successively dissected and controlled. The real anatomy was compared to the virtual-reality reconstruction. Both demonstrated the same anatomy. Vascular section was completed and this resulted in a typical color change of the left lateral segment as well as a small decrease in size. The bisegmentectomy was performed using harmonic dissectors (Autosonix(R), Tyco Healthcare), bipolar cautery, clips, and application of Endo GIA vascular staples (Tyco Healthcare) on the portal pedicles. The procedure was completed following isolation and control of the left hepatic vein. After section, the specimen was placed in a bag and extracted following enlargement of the camera port. Follow-up was uneventful and there was no elevation of hepatic enzymes or postoperative ascites. The patient left the hospital on the fifth postoperative day. 3D reconstruction allowed the procedure to be simulated preoperatively. This facilitated the intraoperative identification of the vascular anatomy and the control of the left lateral segment arteries and veins, thus preventing intraoperative bleeding. The use of this approach in preoperative planning is recommended.

An initial experience and evolution of laparoscopic hepatic resectional surgery

The use of minimally invasive procedures has revolutionized modern surgery. Only recently has laparoscopy been introduced for use in hepatic surgery. Patient demographics, tumor characteristics, and outcomes were evaluated for all initial cases of laparoscopic hepatic resection. Twenty-one resections were performed in 17 patients; 5 were performed for malignancy, of which 3 had underlying cirrhosis, and the remaining 12 for benign symptomatic disease. Mean patient age was 55.4 (range, 24-82 years). The mean number of lesions was 1.4 (range, 1-5), having an average size of 7.6 cm (range, 2-30 cm). Mean operative time was 2.8 hours (range, 2-5 hours) hours. Most resections involved 1 or more Couinaud segments. Mean blood loss was 288 cc (range, 50-150 cc). Complications included re-operation for hemorrhage (n=2), biliary leakage (n=1), and death from hepatic failure (n=1). Mean length of stay was 2.9 days (range, 1-14). When compared with our series of 100 patients who underwent open hepatic resection for benign tumors, significantly greater means ( P <.05) were noted for blood loss (485 cc), operative time (4.5 hours), and length of stay (6.5 days). Laparoscopic hepatic surgery, though complex, can be performed safely and efficaciously. Minimally invasive surgery appears to provide several distinct advantages over traditional open hepatic surgery. However, techniques for the laparoscopic control of bleeding and bile leak remain in their infancy.

Minimal access surgery for hydatid cyst disease: laparoscopic, thoracoscopic, and retroperitoneoscopic approach.

Surgery has remained the mainstay for the treatment of hydatid cyst. The rapid development of laparoscopic techniques has encouraged surgeons to replicate principles of conventional hydatid surgery using a minimally invasive approach. Several reports have confirmed the feasibility of laparoscopic hepatic hydatid surgery. We report the use of a laparoscopic approach for cysts located in the liver, lung, and retroperitoneum. Fifteen patients with hydatid cysts, including one patient with a recurrent cyst, of various organs, including the liver, lung, and retroperitoneum, were operated on laparoscopically. Sixteen hydatid cysts were drained in a total of 15 patients. The mean operative time was 84 +/- 6 minutes (60-125 minutes). The mean duration of the hospital stay was 2.3 days (1-6 days). The mean cyst diameter was 9.2 cm (6.4-13.5 cm). No conversions to open surgery were required. One complication, a trocar-induced bowel perforation, occurred, and there was no mortality. During 3 to 44 months (mean, 27 months) of follow-up, no recurrences developed. Minimal access surgery is a safe, effective, and viable option for the management of selected patients with hydatid cysts in various locations, such as the liver, lung, and retroperitoneum.

22: Lessons Learned in an Initial Experience With Laparoscopic Hepatic Surgery: Operative Results

22: Lessons Learned in an Initial Experience With Laparoscopic Hepatic Surgery: Operative Results