Atypical laparoscopic liver resection

The laparoscopic resection of small benign hepatic lesions located peripherally is described in three cases. The histology revealed adenomas in two patients and a focal nodular hyperplasia in a third patient. The area of resection measured between 9 and 15 cm2. Following laparoscopic endosonography with localisation of adjacent vascular structures to the tumor the lesion was resected by combined ultrasonographic dissection (endocusa) and clipligature. Bloodloss was limited to a maximum of 130 ml. The time of hospitalisation was 3 to 5 days.     

Single-incision laparoscopic liver resection

Background  

Laparoscopic liver surgery has become a safe and effective approach to the surgical management of liver disease. Recently developed, single-port-access surgery is of growing interest in an attempt to minimize abdominal wall trauma. Various abdominal procedures have already been performed via single-port access, but to date, single-port-access surgery has never been reported for liver resection.     

机器人肝切除术与腹腔镜肝切除术的疗效比较

目的 配对比较机器人与传统腹腔镜肝切除的术中及术后结果,评价机器人肝切除术的安全性和优势。方法 对我院2010年3月至2017年8月实施的88例微创肝切除术病人的资料进行回顾性分析,按手术方式的不同分为机器人组(n=44)和腹腔镜组(n=44)。采用倾向匹配分析方法,按照1:1的比例,根据病人的性别、年龄、有无肝炎和肝硬化、体质量指数、美国麻醉师协会分级、肝脏切除范围在机器人组病人中进行配对。结果 两组病人的术中出血量、术中输血率、术后住院时间、术后并发症发生率和R0切除率无统计学差异。机器人组手术时间较腹腔镜组长[（183.36±64.40） min比（156.25±71.53） min, P=0.013]。但与腹腔镜组相比,机器人组中转开腹率较低（4.5%比22.7%,P=0.013）。结论 虽然机器人肝切除手术时间较长,但中转开腹率较低,与传统腹腔镜肝切除术具有相似的安全性。     

Possibilities of laparoscopic liver resection

The aim of this study was to report the results of our experience in liver surgery by laparoscopy. From 1989 to 1996, 30 patients (20 women, 10 men; age, 23–88 years; mean age, 53.9 years) underwent laparoscopic liver surgery at our Institute for the following pathology: 10 for biliary cysts, 7 for polycystic diseases, 8 for benign tumors, 3 for hydatid cysts, 1 for chronic abscess, and 1 for metastasis. The locations of these lesions were: 19 in the left lobe, 4 in the right lobe, and 7 in both lobes. Their average size was 8.45 cm (range, 2.5–22 cm). The largest lesions were biliary cysts; among benign tumors, the maximum diameter was 8 cm. Surgical treatment was as follows: 17 deroofings, 3 pericystectomies, 7 tumorectomies, and 3 left lobectomies. The mean operative time was 79 min (range, 45–527 min). Three of the 30 laparoscopic procedures (10%) were converted to open surgery, because of bleeding in 2 patients with polycystic disease and because it was impossible to carry out the dissection in 1 patient with liver-cell adenoma adjacent to the left portal branch. There were no deaths in this series and 6 patients showed morbidity: 2 patients with polycystic disease developed ascites and required intensive care unit recovery, 1 patient had phlebitis, 1 had infection of the urinary tract, and 2 had local septic complications. Preliminary findings show that the laparoscopic approach to liver lesions may represent safe and effective treatment in selected patients, on condition that several technical details are respected. Of fundamental importance are the surgical equipment, the presence of two experienced operators to do four-hands surgery, and the careful selection of indications, reserving laparoscopic treatment only for those lesions located in easily accessible areas, mainly in the lateral and anterior hepatic segments. Received for publication on Aug. 21, 1999; accepted on Sept. 2, 1999     

腹腔镜肝切除应用体会

目的探讨腹腔镜在肝脏手术中应用的可行性。方法8例原发性肝癌，9例肝海绵状血管瘤，3例肝局限性增生结节，4例肝内胆管结石，1例肝脂肪瘤，1例肝脏多发性肉芽肿。在全气腹状态下行肝叶、段切除术。结果所有病例均获得成功，无中转开放手术。手术时间60-240min，平均120min。术中出血50-800ml，平均490ml。术后恢复顺利，无胆漏、出血等并发症，住院时间为3～15d，平均9d。随访3～24个月，平均18个月，肝内胆管结石病人手术后1个月胆道镜检查，无结石残留，肝癌病人1例手术后6个月复发，手术后10个月死亡。结论应用腹腔镜进行肝脏手术是安全、有效、不需输血或少输血，且创伤小、恢复快、住院时间短，可有效减少并发症。     

腹腔镜肝切除术的研究进展

腹腔镜手术具有创伤小,术后恢复快等优点.近年来,随着腹腔镜外科技术的不断成熟及腹腔镜器械的改进创新,手术安全性不断提高,腹腔镜手术貂已向腹部外科的各个领域渗透.     

腹腔镜肝叶切除的纷争

腹腔镜肝切除术(LLR)用于良性肝脏肿瘤及肝癌肝切除术中,手术微创、术后较轻疼痛、消化道功能快速恢复,较传统开腹肝切除术(OLR)具有无法比拟的优势。远期疗效上LLR能够得到与OLR相当的预后和长期生存。同时腹腔镜各种器械的发展可减少LLR手术时间,减少术中出血及术后胆漏等并发症。术者专业知识储备及实践操作技能训练积累可明显减少术中及术后并发症的发生。LLR的纷争极大地促进了微创外科技术的迅速发展。     

Perspective of laparoscopic liver resection for hepatocellular carcinoma

Liver resection(LR) for hepatocellular carcinoma(HCC) in patients with chronic liver disease(CLD) is associated with high risks of developing significant postoperative complications and multicentric metachronous lesions, which can result in the need for repeated treatments. Studies comparing laparoscopic procedures to open LR consistently report reduced blood loss and transfusionsrequirements, lower postoperative morbidity, and shorter hospital stays, with no differences in oncologic outcomes. In addition, laparoscopic LR is associated with reduced postoperative ascites and a lower incidence of liver failure for HCC patients with CLD, due to the reduced surgery-induced parenchymal injury to the residual liver and limited destruction of the collateral blood/lymphatic flow around the liver. Finally, this procedure facilitates subsequent repeat LR due to minimal adhesion formation and improved vision/manipulation between adhesions. These characteristics of laparoscopic LR may lead to an expansion of the indications for LR. This editorial is based on the review and meta-analysis presented at the 2nd International Consensus Conference on Laparoscopic Liver Resection in Iwate, Japan, in October 2014(Chairperson of the congress is Professor Go Wakabayashi from the Department of Surgery, Iwate Medical University School of Medicine), which is published in the Journal of Hepato-Biliary-Pancreatic Sciences.     

关于腔镜肝手术入路的选择

正腔镜肝切除发展得太快,笔者认为腔镜肝切除的适应证与开放肝切除的适应证应该是约等于的,这是结论吗?还远远达不到结论的程度,目前对于肿瘤学的效果还没有数据,所以我们大家都在做腔镜,微创的意义是毋容置疑的,微创的好处肯定是多方面的,比如,创伤小、可以做多次手术、炎症反应小等。但是,对于一些临界可切除的肿瘤,开放手术也可以切得非常干净,腔镜手术是否能够达到和开放     

经蓝碟(LapDisc)手助腹腔镜肝血管瘤切除术

目的探讨经蓝碟(LapDisc)手助腹腔镜下肝血管瘤切除的可行性及方法. 方法完成LapDisc手助腹腔镜下肝血管瘤切除8例,男6例,女2例,年龄30～72岁,平均47.6岁. 结果 8例手术均获成功,平均手术时间196.3 min(110～350 min),平均出血量307.5 ml(100～750 ml),平均住院时间7.9 d(6～15 d).无胆漏、腹腔出血及感染等术后并发症. 结论对有手术适应证的肝血管瘤行LapDisc手助腹腔镜下肝血管瘤切除安全可行.     

Outcome of laparoscopic major liver resection for colorectal metastases

Background

Minimally invasive liver resection (MILR) for colorectal liver metastases (CRLM) is gaining widespread acceptance. However, data are still lacking on the feasibility, long- and short-term outcomes of laparoscopic major hepatectomy (i.e., three or more liver segments).

Methods

Between October 2002 and December 2008, prospectively collected data of 117 patients who underwent major liver resection [97 open (OMLR) and 20 laparoscopic (LMLR) procedures] for CRLM were analyzed. Twenty patients in the LMLR group were matched with 20 patients of the OMLR based on 13 parameters. We compared the long- and short-term outcomes between these two groups.

Results

Median duration of surgery was 257.5 (range 75–360)?min in LMLR versus 232.5 (range 120–400)?min in OMLR (P?=?0.228). Median blood loss during surgery was 550?ml in each group (range 100–4,000 vs. 100–2,500?ml, P?=?0.884). There was no statistically significant difference in the rate of postoperative complications (both severity and location). Median magnitude of tumor-free resection margin was 7.5 versus 5.5?mm in the laparoscopy versus open group, respectively (P?=?0.651). Median disease-free survival (DFS) of the entire study population was 18.4?months [95% confidence interval (CI) 11.9–50.0?months]. Median overall survival (OS) was 50.7?months (95% CI 36.2?months to undetermined). The estimated DFS and OS rates at 1, 2, and 5?years were comparable in the two groups (P?=?0.637 and 0.872, respectively).

Conclusion

Laparoscopic MLR for selected CRLM is feasible and might result in comparable oncologic outcomes as in open liver resection.     

腹腔镜与开腹肝切除术治疗肝癌疗效的Meta分析

目的：系统评价腹腔镜肝切除术（LLR）与开腹肝切除术（OLR）治疗肝癌的近、远期疗效和安全性。方法：检索相关期刊、资料、会议文献和学位论文数据库,收集比较LLR与OLR治疗肝癌疗效的病例-对照研究。按MOOSE 规范对纳入研究进行分析,提取数据并用RevMan5.3软件对数据进行Meta分析。
　　结果：最终共纳入15篇病例-对照研究,共1246例患者,LLR组499例,OLR组747例。Meta分析结果显示,LLR组与OLR组的手术时间,1、3、5年生存率,1、3、5年无瘤生存率,3年肿瘤复发率组间差异均无统计学意义（均P>0.05）;LLR与OLR相比术中出血量少、术后并发症发生率低、围手术期死亡率低、术后住院天数少（均P<0.05）。
　　结论：LLR可以达到与OLR同样的根治效果,两者近、远期疗效无明显差异,且LLR围手术期不良事件少于OLR。     

3D腹腔镜肝切除术治疗原发性肝癌的临床应用价值

目的:探讨3D腹腔镜肝切除术治疗原发性肝癌的临床应用价值。方法:采用前瞻性非随机对照研究的方法,选择2012年3月—2015年10月间收治的90例原发性肝癌患者,分别行3D高清腹腔镜肝切除术(3D组,48例)和传统2D腹腔镜肝切除术(2D组,42例),比较两组患者相关临床指标。结果:两组患者术前资料具有可比性。两组患者手术方式、术中出血量、术中输血量、术后并发症发生率、术后住院时间、住院总费用方面差异均无统计学意义(均P0.05),但3D组手术时间明显少于2D组(522 min vs.566 min,P=0.001)。结论:3D高清腹腔镜肝切除术有助于精准解剖,缩短手术时间,同时不增加副损伤和住院总费用,是一种安全、有效、经济的微创外科手段。     

腹腔镜肝切除术中出血的控制

腹腔镜技术应用于肝脏外科尚处于探索阶段,尤其是腹腔镜肝切除术只能在少数医疗中心开展,而且大多数是小范围的非解剖性肝切除术.出现这种现象的主要原因是因为肝切除过程中创面出血难以控制.入肝血流阻断是肝切除过程中控制创面出血的主要方法,腹腔镜肝切除术中如采用全肝门血流阻断,会减少术中创面出血,但会引起余肝缺血再灌注损伤、胃肠道淤血等不良反应,在减少出血量的同时给机体带来了新的创伤,有悖于腹腔镜手术微创的宗旨.     

Techniques for performing laparoscopic liver resection in various hepatic locations

Many studies have recently reported on laparoscopic liver resection, although its development has been slow compared to laparoscopy in other fields. The indications for the location of laparoscopic liver resection have previously been limited to easily accessible lesions. Performing laparoscopic liver resection in the posterior and superior parts of the liver has been considered difficult due to inadequate exposure, the poor operative field and the difficulty with parenchymal dissection. Flexible endoscopy, high definition imaging and various kinds of equipment for parenchymal transection have been introduced for clinical use. In addition, much experience with this procedure has been accumulated at many centers. Accordingly, there are an increasing number of reports on laparoscopic liver resection in difficult locations. At our institution, the location of the tumor is no longer a limitation to laparoscopic liver resection. However, for safer laparoscopic liver resection, the patient positioning and trocar placement should be individualized according to the tumor location. The type of resection also may depend on the remaining liver’s functional capacity. We describe here the technical considerations for performing laparoscopic liver resection, including the technical considerations for performing laparoscopic liver resection for lesions located in the postero-superior segments of the liver.