Laparoscopic Hepatobiliary Surgery Research Articles

Application of ERAS Guided Health Education Nursing Pathway Model in Patients Undergoing Laparoscopic Hepatobiliary Surgery

Application of ERAS Guided Health Education Nursing Pathway Model in Patients Undergoing Laparoscopic Hepatobiliary Surgery

Magnetic Resonance Imaging under Image Enhancement Algorithm to Analyze the Clinical Value of Placement of Drainage Tube on Incision Healing after Hepatobiliary Surgery.

This study was aimed at exploring the application value of magnetic resonance imaging (MRI) based on image enhancement algorithm in analyzing the placement of drainage tubes in the healing of incisions after hepatobiliary surgery. A total of 70 patients with liver cancer undergoing laparoscopic hepatobiliary surgery were selected, including 34 males and 36 females. According to the detection method of postoperative recovery, they were divided into a group A (conventional MRI detection) and a group B (MRI detection based on Retinex algorithm). Patients were divided into two groups according to whether subcutaneous drainage tubes were placed: group C (no subcutaneous drainage tubes were placed) and group D (subcutaneous drainage tubes were placed), with 35 patients in each group. The results showed that there was no significant difference between group A and group B in tumor residual or recurrence. The detection rate of tumor capsule in group B was significantly higher than that in group A (P < 0.05). The sensitivity, specificity, and accuracy of group A for the detection of recurrent lesions were 63.40%, 86.90%, and 78.60%, respectively; those in group B were 82.70%, 98.50%, and 93.20%, respectively. Therefore, the difference between the two groups was statistically significant (P < 0.05). The incidence of poor wound healing and infection in group C were significantly lower than those in group D (P < 0.05). Therefore, the effect of MRI detection based on image enhancement algorithm was more conducive to the evaluation of postoperative recovery due to the traditional MRI detection. In addition, the drainage tube was helpful to the postoperative wound healing and showed high clinical value.

Indocyanin greens cholangiography for intra-operative bile duct visualization during pediatric laparoscopic hepato-biliary surgery

Intraoperative cholangiography involving the excretion of fluorescent indocyanine green (NIR/ICG) into the bile is used to determine biliary anatomy in adult laparoscopic cholecystectomy (LC) and other hepatobiliary surgery. This study aimed to evaluate the features of intraoperative ICG cholangiography in 3 cases The 1st case of pediatric LC with previous cholelithiasis & Cholecystitis, and The 2nd and 3rd cases of choledochal cyst with previous pancreatitis then compare the delineation of the hepatic duct (HD), cystic duct (CD), common bile duct (CBD) between ICG cholangiography, magnetic resonance cholangiopancreatography (MRCP) and intraoperative finding. The ICG 0.2 mg/kg was injected intravenously before operation 2 hours to demonstration. We performed 3 cases of pediatric laparoscopic hepato-biliary surgery under NIR/ICG visualization. No conversions to open occurred. No adverse and allergic reactions to NIR/ICG or other postoperative complications were reported. Indocyanin Green cholangiography for intraoperative bile duct visualization during laparoscopic surgery enables a better identification of the biliary tree and thus increases surgical safety.

Postoperative pain after intrathecal analgesia in laparoscopic liver resection: a retrospective chart review.

Intrathecal analgesia (IA) has been recommended by the enhanced recovery after surgery (ERAS) Society for laparoscopic colon resections; however, although IA is used in open liver resections, it has not been extensively studied in laparoscopic hepatobiliary surgery. This retrospective chart review was undertaken to explore postoperative pain within 48 hours among patients who underwent laparoscopic liver resections (LLR), receiving either IA with or without patient-controlled analgesia (IA±PCA) versus PCA alone. After ethics approval, charts were reviewed for adult patients who underwent LLR between January 2016 and April 2019, and had IA±PCA or PCA alone. Patients with any contraindication to IA with morphine, obstructive sleep apnea, body mass index >40 kg/m2, history of chronic pain, and/or history of drug use were excluded. Descriptive statistics used to describe postoperative pain levels at 48 hours by treatment group for each pain outcome. Of 111 patients identified, 79 patients were finally included; 22 patients had IA±PCA and 57 patients had PCA only. There were no statistically significant differences in baseline characteristics, use of non-opioid pain control, and postoperative complications between the two groups. IA use was associated with reduced postoperative opioid consumption (measured in oral morphine equivalents) compared to PCA alone (mean difference [95% confidence interval] -45.92 [-83.10 to -8.75]; P=0.016). IA has the potential to decrease postoperative opioid use for patients undergoing LLR, and appears to be safe and effective in the setting of LLR. These findings are consistent with the ERAS Society recommendations for laparoscopic colorectal surgery.

Effect of remifentanil on MACBAR of sevoflurane in patients with hepatic dysfunction undergoing laparoscopic surgery

Objective To evaluate the effect of remifentanil on the minimum alveolar concentration of sevoflurane required to blunt the adrenergic response (MACBAR) in the patients with hepatic dysfunction undergoing laparoscopic surgery. Methods The patients, aged 18-64 yr, with body mass index < 30 kg/m2, undergoing elective laparoscopic hepatobiliary surgery, were selected.Patients with normal liver function were selected as control group (C group), and patients with liver dysfunction (Child-Pugh grade B) were selected as test group and divided into 3 subgroups by a random number table method: no remifentanil group (R0 group) and different target plasma concentrations of remifentanil groups (R1 group and R2 group). Anesthesia was induced by intravenously injecting propofol 2-3 mg/kg, remifentanil 2 μg/kg and cisatracurium 0.15 mg/kg.After endotracheal intubation, mechanical ventilation was performed.The end-tidal sevoflurane concentration was adjusted to the preset concentration in each group and maintained at the level for 20 min before the pneumoperitoneum was established.Anesthesia was maintained as follows: remifentanil was not used in C group and R0 group, and the target plasma concentration of remifentanil was 1 and 2 ng/ml in group R1 and group R2, respectively, and sevoflurane was inhaled.The MACBAR of sevoflurane was determined using the sequential method.The initial end-tidal sevoflurane concentrations were 5.0%, 4.6%, 2.6% and 2.4% in group C, group R0, group R1 and group R2, respectively.MAP and HR were recorded and blood samples were collected before and after pneumoperitoneum, and the plasma epinephrine and norepinephrine concentrations were measured by enzyme-linked immunosorbent assay, and the difference in MAP and HR before and after pneumoperitoneum was calculated. Results A total of 14 cases in group C, 19 cases in group R0, 19 cases in group R1 and 15 cases in group R2 completed the study.Compared with group C, the MACBAR of sevoflurane and plasma adrenergic concentration before and after pneumoperitoneum were significantly decreased (P 0.05). Compared with group R0, the MACBAR of sevoflurane was significantly decreased in group R1 and group R2, and HR before and after pneumoperitoneum and the difference were significantly decreased in group R2(P<0.05). The MACBAR of sevoflurane was significantly lower in group R2 than in group R1 (P<0.05). Conclusion Remifentanil can decrease the MACBAR of sevoflurane and enhance the efficacy in inhibiting the stress responses in the patients with hepatic dysfunction undergoing laparoscopic surgery. Key words: Anesthetics, inhalation; Piperidines; Hepatic insufficiency; Dose-response relationship, drug

Application of image-guided navigation system for laparoscopic hepatobiliary surgery.

To achieve safety of the operation, preoperative simulation became a routine practice for hepatobiliary and pancreatic (HBP) surgery. The use of intraoperative ultrasonography (IOUS) is essential in HBP surgery. There is a limitation in the use of IOUS in laparoscopic surgery (LS), for which a new intraoperative system is expected. We have developed an image-guided navigation system (IG-NS) for open HBP surgery since 2006, and we have applied our system to LS. The aim of this study is to evaluate the results of clinical application of IG-NS in LS. Eight patients underwent LS using IG-NS; LS consisted of cholecystectomy and hepatectomy in four patients each. After registration, the 3D models were superimposed on the surgical field. We performed LS while observing the navigation image. Moreover, we developed a support system for operations. The average registration error was 8.8 mm for LS. Repeated registration was effective for organ deformation and improved the precision of IG-NS. By using various countermeasures, identification of the tumor's position and the setting of the resection line became easy. As IG-NS provided real-time detailed and intuitive information, this intraoperative assist system may be an effective tool in LS.

In vivoporcine training model of laparoscopic common bile duct repair with T-tube insertion under the situation of iatrogenic common bile duct injury

PurposeWe introduce a training porcine model for laparoscopic common bile duct (CBD) repair with T-tube insertion. The model could be the feasible training tool for a surgeon learning hepatobiliary surgery.MethodsTotally laparoscopic CBD repair with T-tube insertion was performed on 9 pigs by 9 trainees naïve in hepatobiliary surgery. Similar to the situation of iatrogenic injury, CBD was transected by laparoscopic scissors at the middle part about 1 cm in length, and the transected CBD was repaired through end-to-end anastomosis with T-tube insertion. A secureness of anastomosis was confirmed by saline leakage test and all animals were sacrificed after the surgery.ResultsAll novice surgeons completed operations successfully without complications. Total mean operative time was 85 ± 1.7 minutes and the mean time spent performing the CBD repair with T-tube insertion was 71 ± 3 minutes. There was no bile leakage after primary anastomosis in all animals.ConclusionThis porcine training model for laparoscopic CBD repair with T-tube insertion could be a feasible and effective training tool for surgeons with little experience in laparoscopic hepatobiliary surgery.

Fluorescence guided surgery in liver tumors: applications and advantages.

The use of fluorescence-guided surgery for benign and malignant hepatobiliary (HPB) neoplasms has significantly increased and improved imaging methods creating new interesting perspectives. A major challenge in HPB surgery is performing radical resection with maximal preservation of the liver parenchyma and obtaining a low rate of complications. Despite the developments, visual inspection, palpation, and intraoperative ultrasound remain the most utilized tools during surgery today. In laparoscopic and robotic HPB surgery palpation is not possible. Fluorescence imaging enables identification of subcapsular liver tumors through accumulation of indocyanine green (ICG), after preoperative intravenous injection, in cancerous tissues of hepatocellular carcinoma and in noncancerous hepatic parenchyma, around intrahepatic cholangiocarcinoma and liver metastases, and it can also be used for visualizing extrahepatic bile duct anatomy and hepatic segmental borders, increasing the accuracy and the easiness of open and minimally invasive hepatectomy. (www.actabiomedica.it)

Effects of intraoperative protective lung ventilation on postoperative pulmonary complications in patients with laparoscopic surgery: prospective, randomized and controlled trial.

Respiratory functions are usually impaired during pneumoperitoneum for laparoscopic surgery. This randomized, controlled and single-blinded study was performed to evaluate whether intraoperative protective lung ventilation influences postoperative pulmonary complications after laparoscopic hepatobiliary surgery. Sixty-two patients were randomized to receive either conventional ventilation with alveolar recruitment maneuver (tidal volume of 10ml/kg with inspiratory pressure of 40 cmH2O for 30s after the end of pneumoperitoneum, group R), or protective lung ventilation (low tidal volume of 6ml/kg with positive end-expiratory pressure [PEEP] of 5 cmH2O, group P). Induction and maintenance of anesthesia were done with balanced anesthesia. Respiratory complications such as atelectasis, pneumonia or desaturation were observed postoperatively. The length of hospital stay, arterial blood gas analysis, peak inspiratory pressure and hemodynamic variables were also recorded. Results are presented as mean±SD or number of patients (%). Postoperative pulmonary complications (P=0.023) and desaturation below 90% (P=0.016) occurred less frequently in group P than in group R. Eight patients of group R and 3 patients of group P showed atelectasis. Pneumonia was diagnosed in 1 patient of group R. No differences were observed in the length of hospital stay, arterial blood gas analysis (pH, PaO2, PaCO2 and PAO2) and hemodynamic variables except PAO2, AaDO2 and peak inspiratory pressure between the two groups. Protective lung ventilation (low tidal volume with PEEP) during pneumoperitoneum was associated with less incidences of pulmonary complications than conventional ventilation with alveolar recruitment maneuver after laparoscopic hepatobiliary surgery.

Study of Abnormal Anatomical Variations in Extrahepatic Biliary Apparatus and Its Related Vessels in Cadavers

Background: In the current era, the laparoscopic procedure such as laparoscopic cholecystectomy, laparoscopic hepatobiliary surgery and other open procedures such as open cholecystectomy, biliary stricture surgery, are performed regularly throughout the world and extrahepatic biliary tract is one of the most common sites of the surgical procedures. The incidence of biliary tract injury by laparoscopic cholecystectomy has been found to be higher than open cholecystectomy. Apart from various other causes of biliary injuries aberrant anatomical course of extrahepatic biliary system is a well established fact of iatrogenic ductal injury. Thus, an adequate recognition and awareness of anatomical abnormalities of extra hepatic biliary tree with its vessel, can decrease the morbidity and mortality related to the surgery.

The Role of Minimally Invasive Surgery in Gallbladder Carcinoma, is it Time to Change our Approach?

The safety and utility of the laparoscopic approach to definitive gallbladder . Within the last 5 years, safely performed laparoscopic extended resections in specialized centers have begun to be published as well. The aim of this review is to revisit the dogma of only open surgical approach for gallbladder cancer. Traditional limitations and restraints of minimally invasive approach are discussed and advance in laparoscopic hepatobiliary surgery is emphasized.

Robotic spleen preserving distal pancreatectomy: how I do it (with video).

Laparoscopic hepatobiliary surgery, although technically demanding, gains popularity due to the patient benefits of a mini-invasive approach. Laparoscopic distal pancreatectomy is a technically feasible and reproducible operation that doesn't require complex digestive reconstruction. It requires advanced laparoscopic skill for vascular dissection and control. Due to the absence of trials proving its oncological results it is mainly indicated for benign or borderline tumours of the pancreatic body and tail. Since for these tumours there is no indication for a lymph node dissection, there are benefits for the patient if the spleen is preserved. There is some evidence that robotic assistance facilitates the procedure and makes it accessible to surgeons diminishing the necessity of advanced laparoscopic skills. In this technical multimedia article, we present our method for a robotic mini-invasive spleen preserving distal pancreatectomy with preservation of the splenic vessels. The technique is presented in a stepwise approach with an accompanying video. We believe that the use of the Da Vinci robotic platform facilitates this demanding procedure.

Robotic hepatobiliary and gastric surgery

Hepatobiliary surgery is a challenging surgical subspecialty that requires highly specialized training and an adequate level of experience in order to be performed safely. As a result, minimally invasive hepatobiliary surgery has been met with slower acceptance as compared to other subspecialties, with many surgeons in the field still reluctant about the approach. On the other hand, gastric surgery is a very popular field of surgery with an extensive amount of literature especially regarding open and laparoscopic surgery but not much about the robotic approach especially for oncological disease. Recent development of the robotic platform has provided a tool able to overcome many of the limitations of conventional laparoscopic hepatobiliary surgery. Augmented dexterity enabled by the endowristed movements, software filtration of the surgeon's movements, and high-definition three-dimensional vision provided by the stereoscopic camera, allow for steady and careful dissection of the liver hilum structures, as well as prompt and precise endosuturing in cases of intraoperative bleeding. These advantages have fostered many centers to widen the indications for minimally invasive hepatobiliary and gastric surgery, with encouraging initial results. As one of the surgical groups that has performed the largest number of robot-assisted procedures worldwide, we provide a review of the state of the art in minimally invasive robot-assisted hepatobiliary and gastric surgery.The English full-text version of this article is available at SpringerLink (under supplemental).

Imaging of Complications After Laparoscopic Hepatobiliary Surgery

Imaging of Complications After Laparoscopic Hepatobiliary Surgery