Laparoscopic Liver Resection For Tumors Research Articles

The application of a single-hand-operated hepatic pedicle clamping clamp in laparoscopic hepatectomy.

In this paper, a single-hand-operated hepatic pedicle clamp was introduced, and its application value in laparoscopic liver tumor resection was preliminarily discussed. The clinical data of 67 patients who underwent laparoscopic liver tumor resection at the First Affiliated Hospital of Wannan Medical College from March 2019 to October 2023 were retrospectively analyzed. The Pringle maneuver was performed with a hepatic pedicle clamp during the operation. The preoperative, intraoperative and postoperative clinical data were observed and recorded. Sixty-seven patients had a median block number, block time, intraoperative blood loss, and postoperative length of hospital stay of 4, 55 min, 400 ml, and 7 days, respectively. The average operation time was 304.9±118.4 min, the time required for each block was 3.2±2.4 s, and the time required for each removed block was 2.6±0.7 s.None of the patients developed portal vein thrombosis or hepatic artery aneurysm formation. The hepatic pedicle clamping clamp is simple to use in laparoscopic hepatectomy, optimizes the operation process, and has a reliable blocking effect. It is recommended for clinical application.

Color Doppler Intraoperative Ultrasonography Evaluation of Hepatic Hemodynamics for Laparoscopic Parenchyma-Sparing Liver Resections

BackgroundTumors involving the hepatic veins at the hepatocaval confluence often require major or extended hepatectomies. Color Doppler intraoperative ultrasonography (CD-IOUS) evaluation of liver hemodynamics to assess congestion in the veno-occlusive parenchyma provides real-time information helpful in parenchyma-sparing surgery (PSS). This study evaluated the feasibility of CD-IOUS in patients undergoing laparoscopic liver resections for such tumors and its capacity to allow PSS. MethodsConsecutive patients undergoing laparoscopic liver resection for tumors at the hepatocaval confluence requiring resection of at least one hepatic vein between January 2010 and August 2020 were included. Patients were divided in 3 groups: (A) patients not assessed with CD-IOUS because it would not change the scheduled operation; patients assessed with CD-IOUS and treated with (B) PSS and (C) no-PSS. Portal blood flow in the veno-occlusive parenchyma was assessed using CD-IOUS at baseline and after clamping the concerned hepatic vein. ResultsThe study included 43 out of 47 patients with tumors at the hepatocaval confluence. There were 19 patients in group A. Among patients assessed with CD-IOUS, the resection of 26 hepatic veins was planned: 25 were resected, and 1 was spared. Group B included 22 patients treated with PSS, whereas group C included 2 patients with resection of all veno-occlusive parenchyma. No postoperative mortality or major morbidity was observed. The median length of hospital stay was 5 days. ConclusionsSelected patients with tumors involving the hepatocaval confluence can be safely approached using laparoscopy. CD-IOUS evaluation of the veno-occlusive area can increase the success rate of PSS.

A case of lymphoepithelioma-like carcinoma in the liver diagnosed via laparoscopic liver tumor resection

A case of lymphoepithelioma-like carcinoma in the liver diagnosed via laparoscopic liver tumor resection

Radiopaque Fiducials Guiding Laparoscopic Resection of Liver Tumors.

Background:Minimal invasive laparoscopic resection of liver tumors is less traumatic compared with open surgical resection and may be a better option for many patients. However, localization of intrahepatic tumors remains a challenge. Availability of hybrid operating rooms, equipped for high performance radiologic imaging, allows for new methods of surgical navigation.Methods:Twelve patients planned for laparoscopic resection of liver tumors were included. Before resection started, tumors were marked with radiopaque fiducials. Four fiducials were positioned with ultrasound within 1 cm of the tumor. Tumor and fiducials were localized with contrast enhanced cone beam computed tomography. Fluoroscopy with an overlay of cone beam computed tomography markings was projected side-by-side on the same screen as the laparoscopic view to visualize tumor location. The fiducials were eventually removed. Laparoscopic ultrasound, the standard method of localizing a tumor, was also used. The benefits of the 2 visualization methods were estimated by the operator. Procedure times, radiation doses and resection margins were recorded.Results:Fluoroscopy with radiopaque fiducials provided valuable information, complementing the laparoscopic ultrasound, particularly during the early phase of resection. In the later phase, mobilization of the tumor-containing liver segment caused significant displacement of the fluoroscopic overlay. The technique evolved during course of the study, with decreasing procedure times and radiation doses. Radical resection was achieved for all patients.Conclusions:Radiopaque fiducials and fluoroscopy can complement laparoscopic ultrasound for guiding resection of liver tumors. Combining radiologic and optical imaging in a hybrid operating suit may facilitate development of augmented reality techniques for surgical navigation.

Standardized Technique of Selective Left Liver Vascular Exclusion During Laparoscopic Liver Resection for Benign and Malignant Tumors

BackgroundTumors located close to major hepatic veins pose a technical challenge to standard laparoscopic liver resection. Hepatic outflow occlusion may reduce the risks of bleeding from hepatic vein and gas embolism. The aim of this study was to detail our standardized laparoscopic approach for a safe extrahepatic control of the common trunk of middle and left hepatic veins during laparoscopic liver resection and to assess its feasibility in patients with tumors located in both right and left lobes of the liver. MethodsData of 25 consecutive patients who underwent laparoscopic liver resection with extrahepatic control of the common trunk of middle and left hepatic veins were reviewed. ResultsAll patients underwent primary hepatectomy. The vast majority (84%) of patients had malignant tumors. The control of the common trunk of middle and left hepatic veins was achieved in 96% of patients. There were 14 (56%) major hepatectomies and 11 (44%) minor hepatectomies. Some form of vascular clamping was performed in 23 (62%) patients: Pringle maneuver in 17 (median time = 45 min; range, 10–109) and selective vascular exclusion of the liver in 6 patients (median time = 30 min; range, 15–94). The median duration of operation was 254 min (range, 70–441). There was one case (4%) of gas embolism but without any complications during the postoperative course. Conversion to open surgery was performed in 2 (7.7%) patients: 1 for oncologic reason and 1 for non-progression during the transection plane. Perioperative blood transfusion rate was nil. The overall morbidity rate was 24%. ConclusionsThe laparoscopic approach for an extrahepatic control of the common trunk of middle and left hepatic veins is reproducible, safe, and effective, and can be applied during laparoscopic liver resection for tumors close to major hepatic veins.

Laparoscopic Resection for the Treatment of Liver Tumors

Open hepatectomy remains the fundamental and one of the most common surgical techniques for the treatment of primary and secondary liver tumors, but Laparoscopic Liver Resection (LLR) is now gaining more and more importance. The aim of the study was to evaluate the efficacy and safety of laparoscopic resection of liver tumors based on the clinical experience of the authors. LLR was performed in 53 patients (26 women and 27 men). The most common indication for the laparoscopic resection of liver tumors was metastatic colon cancer. We performed 19 non-anatomical (wedge) resections, 11 segmentectomies, 10 anatomical resections, 8 hemihepatectomies, 3 radicalizations due to gallbladder cancer, and 2 liver cyst fenestrations. Simultaneous procedures were performed in 5 cases. The mean operating time for the laparoscopic resection of liver tumors was 307 min. The mean intraoperative blood loss was 270 ml. Complications were reported in 10% of cases. The mean hospitalization time was 7 days. Slightly longer operating time and greater blood loss were found in patients treated with LLR compared to those who had open surgery. Recovery time was shorter in patients who had laparoscopic surgery. Early results of cancer treatment were comparable to those for open surgeries. LLR was associated with lower rates of postoperative complications. Laparoscopic liver resections reduce intraoperative trauma and the number of postoperative complications, and shorten the hospitalization time and recovery. These procedures are safe in cancer patients. A particular advantage of laparoscopic surgery is observed in patients with cirrhosis, the elderly, and patients with coexisting internal diseases.

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.

A case of hepatic angiosarcoma diagnosed by laparoscopic liver tumor resection

A case of hepatic angiosarcoma diagnosed by laparoscopic liver tumor resection

Laparoscopic liver tumor resection under indocyanine green fluorescent navigation: A single center experience of 60 patients to study the optimal preoperative injection timing of indocyanine green

Objective To study the optimal timing of preoperative injection of indocyanine green in laparoscopic liver tumor resection under indocyanine green fluorescent navigation to obtain the most satisfactory fluorescence imaging effects. Methods 60 patients with liver tumors who underwent laparoscopic hepatectomy from April 2017 to October 2018 were retrospectively studied on the intraoperative fluorescence imaging effects. A simple grading of the fluorescence imaging effects was developed. The ICG R15 and preoperative injection times of ICG were correlated with the intraoperative fluorescence imaging effects. Results Of 60 patients with liver tumors, 59 patients underwent laparoscopic liver resection and one patient was converted to open surgery. The overall satisfaction rate of intraoperative fluorescence imaging was 73.4% (44/60). In the patients with an ICG R15 rate ≤ 7%, it was easier to obtain good fluorescence imagings when the preoperative administration time was longer than 48 hours. Even when the preoperative administration time was longer than 5 days, satisfactory fluorescence imaging effect could still be obtained in these patients. In the patients with an ICG R15 rate > 7%, intraoperative fluorescence imagings were unsatisfactory when the administration time was less than 6 days. Relative better imagings were obtained in these patients when the preoperative administration time was more than 6 days. Conclusions When the pre-operative ICG injection dose was not changed, the preoperative administration time should be adjusted according to the value of the ICG R15 to obtain better intraoperative fluorescence imaging effects of the liver tumors. The optimal timing needs to be further studied by a large case study. Key words: Hepatectomy; Laparoscopes; Liver neoplasms; Liver cirrhosis; Indocyanine green (ICG); Fluorescence imaging

P-125 - Laparoscopic liver resection for tumors in proximity to major vasculature and the impact of neo-adjuvant systemic therapy

P-125 - Laparoscopic liver resection for tumors in proximity to major vasculature and the impact of neo-adjuvant systemic therapy

Laparoscopic robot-assisted resection of tumors located in posterosuperior liver segments.

Laparoscopic resection of liver tumors located in the posterosuperior segments is a challenging operation that could be facilitated by robotic assistance. Laparoscopic resection of 12 tumors located in posterosuperior segments (IVa: 1; VII: 5; VIII: 6) was carried out under robotic assistance. All patients had a single tumor nodule. Data were collected prospectively and analyzed retrospectively. Surgery required a mean of 260.4 min (115-430) and was completed laparoscopically in all but one patient, who required conversion to mini-laparotomy because of intolerance of pneumoperitoneum (8.3%). Mean estimated blood loss was 252.7 ml (50-600), making transfusion necessary in 3 patients (25.0%). Post-operative complications occurred in 4 patients (33.3%), being of Clavien-Dindo grade II in 3 patients (25.0%) and Clavien-Dindo grade IV in 1 patient (8.3%). Reoperation was required in 1 patient, who subsequently had a long hospital stay, because of decompensated cirrhosis. Median length of hospital stay was 8.5 days (7-96). No patient was readmitted. Pathology showed hepatocellular carcinoma in 7 patients (58.3%), liver metastasis in 2 patients (16.6%), and hepatic adenoma, focal nodular hyperplasia, and hemangioma in one patient each (8.3%). All patients had a margin negative resection. After a mean follow-up period of 21.4 months (±24.4), no patient with malignant histology developed recurrence. Our initial experience confirms that laparoscopic robot-assisted resection of tumors located in the posterosuperior segments is feasible. Further experience is needed before final conclusions can be drawn and meaningful comparison with other surgical techniques becomes possible.

Pure laparoscopic liver resection for large malignant tumors: does size matter?

Laparoscopic liver resection (LLR) for large malignant tumors can be technically challenging. Data on this topic are scarce, and many question its feasibility, safety, and oncologic efficiency. This study aimed to assess outcomes of LLR for large (≥ 5 cm) and giant (≥ 10 cm) malignant liver tumors. A prospectively collected database of 422 LLRs was reviewed from August 2003 to August 2013. The data for 52 patients undergoing LLR for large malignant tumors were analyzed. A subgroup analysis of giant tumors also is reported. During the period studied, 52 LLRs were performed (males, 53.8 %; mean age, 64.6 years) for large malignant tumors. Colorectal liver metastasis was the most common indication (42.3 %). The 52 LLRs included 32 major (61.5 %) and 20 minor (38.5 %) LLRs for tumors with a mean diameter of 83 mm. The median operative time was 240 min [interquartile range (IQR), 150-330 min], and the blood loss was 500 ml (IQR, 200-1,373 ml). Eight conversions (15.4 %) were performed. Six patients experienced complications (11.5 %). Among the 44 patients with successful LLRs, two patients (4.5 %) had an R1 resection. The median hospital stay was 5 days (range, 1-21 days), and no mortality occurred during a 90-day period. A subgroup analysis of patients with giant tumors showed greater blood loss (p = 0.002) and a longer operative time (p = 0.052) but no difference in terms of conversions (p = 0.64) or complications (p = 0.32). The findings showed that LLR is feasible and safe for large malignant tumors and can be performed with acceptable morbidity and oncologic efficiency. When used for giant malignant tumors, LLR is associated with greater blood loss and a longer operative time but no increase in complications.

Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8.

Performing laparoscopic liver resection for lesions located in segment 7 and 8 is technically difficult, as the operative field is far from the conventional trocar site, and the liver impedes free motion of the laparoscopic instrument. Inserting the port through the intercostal space (ICS) may facilitate liver resection for these lesions. From January 2012 to July 2013, five patients (four men and one woman) underwent laparoscopic S7 or 8 segmentectomy for liver metastasis and hepatocellular carcinoma (HCC). Ports were inserted at the 7th and 9th ICS, respectively, in addition to conventional abdominal ports. The mean age was 58 ± 10 (45-74) years; operation time, 197 ± 68 (110-300) minutes; blood loss, 161 ± 138 (40-320) ml; and length of hospital stay, 7 ± 3 (4-12) days. Pathologic findings revealed three, one, and one case(s) of colon cancer metastasis, breast cancer metastasis, and HCC, respectively. The mean tumor size and tumor-free margin were 2.2 ± 1.1 cm and 5.8 ± 1.9 mm, respectively. There were no postoperative complications. Laparoscopic liver resection using intercostal trocars could be a useful method for tumors located in segments 7 and 8 of the liver in selected patients.

Pure laparoscopic hepatectomy in semiprone position for right hepatic major resection

BackgroundPure laparoscopic liver resection is technically difficult for tumors located in the dorsal anterior and posterior sectors. We have developed a maneuver to perform pure laparoscopic hepatectomy in the semiprone position which was developed for resecting tumors located in these areas.MethodsThe medical records have been reviewed retrospectively in 30 patients who underwent laparoscopic liver resection in the semiprone position for carcinoma in the dorsal anterior or posterior sectors of the right liver between 2008 and 2011.ResultsSeventeen liver tumors were primary liver tumors and 13 were colorectal metastases. Of the 30 patients, 11 (36.6 %) underwent major hepatectomy [right hemihepatectomy in 7 (23.3 %) and posterior sectionectomy in 4 (13.3 %)]. Anatomical minor resection, such as S6 or S7 segmentectomy, was performed in five patients (16.6 %). Five patients with liver metastasis underwent a simultaneous laparoscopic resection. There was no mortality, reoperation, or conversion to open procedures. There were no hepatectomy-related complications such as postoperative bleeding, bile leakage, or liver failure.ConclusionsPure laparoscopic hepatectomy in the semiprone position for tumors present in the dorsal anterior and posterior sectors is feasible and safe. This method expands the indications for laparoscopic liver resection for tumors.Electronic supplementary materialThe online version of this article (doi:10.1007/s00534-012-0558-y) contains supplementary material, which is available to authorized users.

Three Trocars Laparoscopic Resection of Angiomyolipoma of the Liver

Angiomyolipoma of the liver (AML) is an infrequent neoplasm composed of three tissues (adipose, muscle and vessels). In spite of advances in radiology, preoperative correct diagnosis is difficult. Clasically, a conservative management strategy was adopted in patients with asymptomatic tumors less than 5 cm with undoubtful diagnosis. But after publishing some few cases of malignant angiomyolipoma a more radical has been advocated. Laparoscopic resection of liver tumors is becoming a excellent approach for operating on benign liver tumors. Usually is performed using five trocars but in some cases a less invasive technique with three trocars could be used. We present a laparoscopic resection of liver angiomyolipoma in a 65 year-old male using only three trocars and also discuss the optimal management of AML and technical tips of three-trocar technique.

Laparoscopic liver resection for hepatocellular carcinoma in cirrhotic patients. Feasibility of nonanatomic resection in difficult tumor locations

BACKGROUND:Surgical resection for hepatocellular carcinoma (HCC) in cirrhotic patients remains controversial because of high morbidity and recurrence rates. Laparoscopic resection of liver tumors has recently been developed and could reduce morbidity. The aim of this study was to evaluate retrospectively our results for laparoscopic liver resection (LLR) for HCC including lesions in the posterosuperior segments of the liver in terms of feasibility, outcome, recurrence and survival.MATERIALS AND METHODS:Between June 2005 and February 2009, we performed 20 LLR for HCC. Median age of the patients was 66 years. The underlying cirrhosis was staged as Child A in 17 cases and Child B in 3.RESULTS:LLR included anatomic resection in six cases and nonanatomic resection in 14. Eleven procedures were associated in nine (45%) patients. Median tumor size and surgical margins were 3.1 cm and 15 mm, respectively. A conversion to laparotomy occurred in one (5%) patient for hemorrhage. Mortality and morbidity rates were 0% and 15% (3/20). Median hospital stay was 8 days (range: 5-16 days). Over a mean follow-up period of 26 months (range: 19–62 months), 10 (50%) patients presented recurrence, mainly at distance from the surgical site. Treatment of recurrence was possible in all the patients, including orthotopic liver transplantation in three cases.CONCLUSIONS:LLR for HCC in selected patients is a safe procedure with good short-term results. It can also be proposed in tumor locations with a difficult surgical access maintaining a low morbidity rate and good oncological adequacy. This approach could have an impact on the therapeutic strategy of HCC complicating cirrhosis as a treatment with curative intent or as a bridge to liver transplantation.

Feasibility of laparoscopic liver resection for tumors located in the posterosuperior segments of the liver, with a special reference to overcoming current limitations on tumor location

Laparoscopic liver resection is usually limited to the anterolateral segments of the liver (AL; Segments II, III, V, VI, and the inferior part of IV). We evaluated the feasibility of laparoscopic liver resection in the posterosuperior segments (PS; Segments I, VII, VIII, and the superior part of IV). We analyzed retrospectively the clinical data of 82 patients who underwent laparoscopic liver resection for tumors from September 2003 to September 2007. Patients were classified into 2 groups according to tumor location: group AL (n=54) and group PS (n=28). There was no mortality, reoperation, or major complications. Four (5%) conversions to open procedures were necessary. There were no differences in tumor characteristics, including mean tumor size and number of tumors between 2 groups (P = .427 and .611); however, there was a greater proportion of deeply seated tumors in group PS than group AL (P < .001). The predominant type of resection was a minor liver resection (left lateral sectionectomy, segmentectomy, or tumorectomy) in group AL, and a major liver resection (hemihepatectomy or right posterior sectionectomy) in group PS (P < .001). The median operative time in group PS was greater than that in group AL (320 vs 210 min; P < .001). There were no differences in the conversion rate (P = .113), median blood loss (P = .214), rate of intraoperative transfusion (P = .061), median tumor-free margin (P = .613), median hospital stay (P = .166), and rate of complications (P = .148) between the 2 groups. Laparoscopic liver resection for tumors located in PS is more difficult than in AL but is feasible in selected patients.

Laparoscopic Liver Resection for Peripheral Hepatocellular Carcinoma in Patients With Chronic Liver Disease

Report the midterm results of laparoscopic resection for hepatocellular in chronic liver disease (CLD). Surgical resection for hepatocellular carcinoma (HCC) in chronic liver disease (CLD) remains controversial because of high morbidity and recurrence rates. Laparoscopic resection of liver tumors has recently been developed and could reduce morbidity. From 1998 to 2003, patients with HCC and CLD were considered for laparoscopic liver resection. Inclusion criteria were chronic hepatitis or Child's A cirrhosis, solitary tumor < or =5 cm in size, and location in peripheral segments of the liver. Mortality, morbidity, recurrence rates, and survival were analyzed. A total of 27 patients were included. Liver resections included anatomic resection in 17 cases and non anatomic resection in 10. Seven conversions to laparotomy (26%) occurred for moderate hemorrhage in 5 cases and technical difficulties in 2 cases. Mortality and morbidity rates were 0% and 33%, respectively. Postoperative ascites and encephalopathy occurred in 2 patients (7%) who both had undergone conversion to laparotomy. Mean surgical margin was 11 mm (range, 1-47 mm). After a mean follow-up of 2 years (range, 1.1-4.7), 8 patients (30%) developed intrahepatic tumor recurrence of which one died. Treatment of recurrence was possible in 4 patients (50%), including orthotopic liver transplantation, right hepatectomy, radiofrequency ablation, and chemoembolization in 1 case each. There were no adhesions in the 2 reoperated patients. Overall and disease-free 3-year survival rates were 93% and 64%, respectively. Our study shows that laparoscopic liver resection for HCC in selected patients is a safe procedure with very good midterm results. This approach could have an impact on the therapeutic strategy of HCC complicating CLD as a treatment with curative intent or as a bridge to liver transplantation.

Hand-assisted laparoscopic hepatectomy for solid tumor in the posterior portion of the right lobe: initial experience.

To prove the feasibility of hand-assisted laparoscopic liver resection for tumors located in the posterior portion of the right hepatic lobe. Use of laparoscopic liver resection remains limited due to problems with technique, especially when the tumor is located near the diaphragm, or in the posterior portion of the right lobe. Between October 2001 and June 2002, a total of 7 patients with solid hepatic tumors involving the posterior portion of the right lobe of liver underwent hand-assisted laparoscopic hepatectomy with the HandPort system at our hospital. Surgical techniques used included CO2 pneumoperitoneum and the creation of a wound on the right upper quadrant of the abdomen for HandPort placement. The location of tumor and its transection margin were decided by laparoscopic ultrasound. The liver resection was performed using the Ultrashear without portal triad control, with the specimens obtained then placed in a bag and removed directly via the HandPort access. The 5 male and 2 female patients ranged in age from 41 to 76 years (mean 62.3 +/- 14.4). Surgical procedures included partial hepatectomy for 6 patients and segmentectomy for one, all successfully completed using a variant of the minimally invasive laparoscopic procedure without conversion to open surgery. The mean duration of the operation was 140.7 +/- 42.2 minutes (90-180). The blood loss during surgery was 257.1 +/- 159 mL (250-500), without any requirement for intraoperative or postoperative transfusion. Pathology revealed hemagioma (n = 2), colon cancer metastasis (n = 2), and hepatocellular carcinoma (n = 3). There were no deaths postoperatively, with 1 patient suffering bile leakage. Mean hospital stay was 5.3 +/- 1.3 days postsurgery. The results of this study suggest that laparoscopic liver resection using the HandPort system is feasible for selected patients with lesions in the posterior portion of the right hepatic lobe requiring limited resection. Individuals with small tumors may benefit; because a large abdominal incision is not required, the wound-related complication rate might be reduced.