Total Laparoscopic Hepatectomy Research Articles

Indocyanine green fluorescence guided laparoscopic hepatectomy of segment VI for metachronous colorectal liver metastases in a severely obese patient

Purpose: Liver resections in severely obese patients (BMI > 35) are related with increased post-operative morbidity. The use of the laparoscopic approach is associated with fewer complications vs open approach. Indocyanine green (ICG) fluorescence has been recently used for tumour identification in laparoscopic liver resections. We describe a total laparoscopic hepatectomy of segment VI using ICG fluorescence guided technique in a severely obese patient. Method: 68 years old male patient was referred to our unit for management of metachronous liver metastases of segment VI. He had undergone open sigmoidectomy three years ago for a pT4aN2a sigmoid adenocarcinoma. Upon diagnosing metachronous metastatic liver disease, five cycles of preoperative chemotherapy were administered with a good response, as reflected by Carcinoembryonic antigen values and radiological assessment (PET-CT and CT abdo). The patient was severely obese (BMI:37) with a post-operative midline hernia. A laparoscopic approach was decided. Material: ICG (2,5 mg) was administered intravenously 24 hrs prior to surgery. In theatre, the patient was placed in a left lateral decubitus position. Initially, an intraoperative U/S was performed. Total laparoscopic resection of segment VI was performed. Liver transection was performed using laparoscopic Cusa, harmonic scalpel, and intermittent Pringle manoeuvre application. Liver resection with clear macroscopically margins was facilitated significantly by ICG fluorescence image-guided for tumour identification. The specimen was removed through the previous midline incision, and the incisional hernia was corrected. The post-operative course was uneventful, and the patient was discharged on the 4th post-operative day. Histopathology confirmed the presence of metastatic colon adenocarcinoma with clear resection margins (R0 resection). Conclusion: The use of image-guided techniques, for intra-operative tumour identification, facilitates the safe performance of laparoscopic liver resections in severely obese patients with good post-operative outcome.

Recurrence of Hepatocellular Carcinoma After Laparoscopic Hepatectomy: Risk Factors and Treatment Strategies.

To investigate the risk factors for recurrence and treatment strategies after patients with hepatocellular carcinoma (HCC) undergo total laparoscopic hepatectomy (LH). The study included 109 patients who underwent LH (laparoscopy resection [LR] group, n = 50) or open hepatectomy [OH] (open resection [OR] group, n = 59) for HCC in our hospital between March 2011 and June 2016. Perioperative outcomes, disease recurrence, survival, and risk factors for recurrence were analyzed. Patient characteristics did not significantly differ between groups. The 1- and 3-year survival rates were 90.7% and 78.1%, respectively, for the LR group and 83.1% and 74.4%, respectively, for the OR group (P = .71). The 1- and 3-year disease-free survival rates were 89.6% and 51.4%, respectively, for the LR group and 84.7% and 59.6%, respectively, for the OR group (P = .935). Tumor size, differentiation, vascular invasion, surgical bleeding, and surgical resection margin were risk factors for tumor recurrence after LH. LH for HCC did not increase the risk of recurrence compared with OH. Tumor size, differentiation, vascular invasion, surgical bleeding, and surgical resection margin were risk factors for tumor recurrence. Reducing bleeding during surgery and ensuring sufficient surgical margins were the most important measures to reduce postoperative recurrence of HCC.

Complete laparoscopic resection for recurrent hepatocellular carcinoma

Objective To evaluate the clinical efficacy of complete laparoscopic resection for recurrent hepatocellular carcinoma. Methods 25 patients with recurrent liver cancer were treated by surgery in our hospital from June 2014 to November 2014. There were 12 patients (the laparoscopic group) who underwent laparoscopic liver resection and 13 patients (the control group) who underwent open surgery. The ope-ration time, intraoperative blood loss and pain scores were compared between the two groups. All the patients were followed up for 1 year. Results All the patients were successfully treated. The two groups (laparoscopic vs control) had significant differences in operation time [(117.7±39.5)min vs (149.2±49.7)min, P<0.05], intraoperative blood loss [(117.5±39.5)ml vs (276.9±170.3)ml, P<0.05] and pain scores (P<0.05). The recurrence rates and relapse-free survivals were not significantly different. In the laparoscopic group, patients with contralateral and ipsilateral recurrent hepatocellular carcinoma were compared. There were significant differences in intraoperative blood loss [(51.7±16.0)ml vs (183.3±136.6)ml, P<0.05] and length of hospital stay [(4.6±0.7)d vs (6.2±1.6)d, P<0.05] between these two subgroups. Conclusion For recurrent hepatocellular carcinoma, total laparoscopic hepatectomy has the advantages over open hepatectomy in shorter operation time, less blood loss and faster postoperative recovery, especially for patients with ipsilateral recurrence. Key words: Laparoscopy; Hepatocellular carcinoma; Recurrence; Hepatectomy

Total laparoscopic hepatectomy versus open hepatectomy in treatment of hepatocellular carcinoma in the left lateral lobe: a case-matched analysis

Total laparoscopic hepatectomy versus open hepatectomy in treatment of hepatocellular carcinoma in the left lateral lobe: a case-matched analysis

Laparoscopic liver resection: 5-year experience at a single center

Background Hepatocellular carcinoma (HCC) is a common cancer, especially in the Association of Southeast Asian Nations (ASEAN) region, where the prevalence of hepatitis virus infection is high. Liver resection is a potentially curative and popular therapy for HCC. Laparoscopic surgery using minimally invasive techniques potentially brings benefits to patients who need liver resection for HCC. This study aimed to evaluate the effectiveness, safety, and benefits of laparoscopic liver resection for HCC with long-term follow-up evaluation.MethodsThis cohort study with 5-year results of total laparoscopic hepatectomy for HCC was conducted in one center. Patients with HCC were selected for laparoscopic liver resection by the same team. The operation also was performed by one team of surgeons. The follow-up protocol was similar to that for open surgery. The patients were scheduled to return for examination every 2 months after the operation. The data for the patients were collected and analyzed using SPSS software.ResultsFrom January 2008 to December 2012, 173 enrolled patients with HCC underwent laparoscopic liver resection. The male-to-female ratio was 3:1. The mean age of the patients was 56 years (range 16–83 years). The follow-up period for 130 patients was 21.6 ± 16.0 months (range 0–60 months). The mean tumor size was 3.73 cm (range 2–10 cm). The stages of HCC according to the Barcelona Clinic Liver Cancer (BCLC) categorization were as follows: 0 (6 %), A1 (59.5 %), A2 (6.9 %), A4 (2.9 %), and B (27.2 %). Four patients required conversion to other techniques (2.3 %) because of the potential for major bleeding and tumor perforation. The types of resection were resection of one segment (segments 2, 3, 4, 5, 6, 7, and 8; 43.8 %), resection of two segments (posterior sector, anterior sector, segments 5 and 6, and left lateral sector; 47.9 %), resection of three segments (left and central liver; 4.7 %), and four segments (right liver; 3.6 %). The mean operation time was 112 ± 56 min (range 30–345 min), and the median blood loss was 100 ml (range 20–1,200 ml). The mean hospital stay was 6.5 ± 2.0 days (range, 3–19 days). No perioperative mortality occurred. The overall survival rates were 94.2 % at 1 year, 87 % at 2 years, 72.9 % at 3 years, 72.9 % at 4 years, and 72.9 % at 5 years. The mean overall survival time was 49.7 ± 2.1 months (range 45.5–53.9 months). The disease-free survival rates were 79.1 % at 1 year, 60 % at 2 years, 57 % at 3 years, 52 % at 4 years, and 26.3 % at 5 years. The mean disease-free survival time was 38.9 ± 2.6 months (range 33.9–44.0 months).ConclusionLaparoscopic liver resection for HCC is feasible, safe, and effective, with good oncologic results. Major and anatomic hepatectomy are possible with improved skill and experience. Laparoscopic liver resection is a promising treatment option with minimally invasive benefits for HCC patients.

三回の完全腹腔鏡下肝切除術を行った高齢大腸癌肝転移の1例

症例は86歳，男性．Stage IIIAの盲腸癌およびStage IのS状結腸癌に対する回盲部切除およびS状結腸切除術より7カ月後，肝S5に10mm大の異時性肝転移を指摘された．高齢で，抗癌剤や分子標的薬の長期継続は難しいと考えられ，腫瘍は肝S5表面の単発性であったため，完全腹腔鏡下肝S5部分切除術を施行した．初回肝切除より10カ月後，肝S6に20mmの肝転移を，さらに4カ月後，肝S3およびS8にそれぞれ10mm大，16mm大の肝転移を認め，合計3回の完全腹腔鏡下肝部分切除術を施行した．原発巣手術より2年2カ月を経過した現在，無病生存中で，外来にて経過観察中である．腹腔鏡下肝切除術は根治的かつ低侵襲な治療で，さらに複数回施行することが可能であり，高齢患者に対する治療の第一選択となりうると考えられた．

Total laparoscopic hepatectomy for treatment of hepatolithiasis

Objective To evaluate the clinical results of total laparoscopic hepatectomy for hepatolithiasis. Methods The clinical data of 72 patients with intrahepatic lithiasis receiving total laparoscopic hepatectomy in our hospital from July 2005 to April 2009 were retrospectively analyzed. Results The mean age of the 72 patients was (43. 8±21.7) yrs (16-65 yrs). For laparoscopic hepatectomy, it was anatomical left liver resection in 34 patients, anatomical resection of left lateral liver in 19 and resection of S6 in 16. The operative duration was (262.5± 115.5)min (125-320 min). The median intraoperative blood loss was 150 ml (50-400 ml). The occurring rate of postoperative complications was 12.50 %. Complications included bile duct infection in 8 patients, bile leakage in 6, gastroparesis in 1,postoperative early inflammatory ileus in 1 and subcapsular fluid collection of liver in 1. All the complications were cured by non-surgical means. Conclusion In the era of minimally invasive surgery, total laparoscopic hepatectomy has gradually become the prominent treatment for hepatolithiasis. Key words: Cholelithiasis; Hepatectomy; Laparoscope

The Feasibility of Laparoscopic Hepatectomy for the Patients with Left Intrahepatic Stones

Purpose: Recently, there have been several studies on the early results of hepatectomy for various intrahepatic lesions. We report the early experience of our hospital after total laparoscopic left hepatectomy in patients with intrahepatic stones in the left hemi-liver. Methods: We retrospectively analyzed the medical records of patients who were diagnosed with left intrahepatic stones and underwent hepatectomy between January 2007 and June 2009. The patients were grouped according to operative procedure into open hepatectomy, laparoscopy-assisted hepatectomy, and total laparoscopic hepatectomy. Results: There were 31 patients who underwent Lt hemihepatectomy and Lt lateral sectionectomy during this period. Hepatectomy with open method, laparoscopy-assisted method, and total laparoscopy method were performed in 10, 14, and 7 cases. There were no significant differences between the three methods for operating time and postoperative complications. But the number of fasting times and hospital days was shorter with total laparoscopic hepatectomy than with others. Conclusion: Total laparoscopic liver resection is a safe and useful method for treating patients with intrahepatic stones and offers the advantage of quick patient recovery. Careful selection of appropriate patients and further development in the laparoscopic surgical technique resulting from accumulated experiences will help enable the laparoscopic hepatectomy to be performed more easily and safely in patients with intrahepatic stones.

Combination of endoscopy and laparoscopic hepatectomy in the treatment of intra- and extrahepatic bile duct stones.

Objective To study the approach of the combination of endoscopy and laparoscopic hepatectomy in the treatment of intra-and extrahepatic bile duct stones.Methods Eighty-one patients with intra-and extrahepatic bile duct stones who had been admitted to Nankai Hospital from July 2004 to March 2008 were divided by random number table into 2 groups.Twenty patients in group A underwent open hepatectomy+biliary exploration.Sixty-one patients in group B received duodenoscopy first,and patients with successful clearance of stones in the extrahepatic bile duct underwent total laparoscopic hepatectomy or hand-assisted laparoscopic hepateetomy according to the location of the stones in the liver;patients with residual stones in the extrahepatic bile duct underwent hand-assisted laparoscopie hepateetomy+biliary exploration.The changes of the indexes during perioperative period of the 2 groups were analyzed by t test.Results Minimally invasive surgeries were successfully carried out in group B.Satisfactory outcomes were obtained,and no severe complication was observed.The gastrointestinal function recovery time of patients who underwent hand-assisted laparoscopic hepatectomy+biliary exploration in group B was significantly shorter than in group A(t:3.062,P＜0.05),but there was no significant difference in operation time and perioperative blood loss between the 2 groups(t=0.953,0.911,P＞0.05).Compared with patients who underwent hand-assisted laparoscopic hepateetomy,the operation time was significantly longer,hut the gastrointestinal function recovery time was significantly shorter in patients who underwent total laparoscopic hepatectomy(t:2.046,2.316,P＜0.05),there was no significant difference in operation time between the 2 groups(t=0.874,P＞0.05).Conclusion Endoscopy+laparoscopic hepatectomy is safe and effective,and can decrease the trauma to the minimum for patients with intra-and extrahepatic bile duct stones. Key words: Endoscopes; Laparoscopy; Hepatectomy; Intra-and extrahepatic bile duct stone