Remain recipient partial liver during liver transplant after Hassab

Background

The Hassab procedure is the primary method for treating and preventing recurrent esophagogastric variceal bleeding in portal hypertension patients. These patients have worsening liver function and eventually require liver transplantation. Abnormal anatomical structures and severe tissue adhesion caused by the Hassab procedure increase the risks of transplantation. We investigated the safety and efficacy of retaining part of the left lateral hepatic lobe during transplantation.

Materials and methods

This retrospective study evaluated outcomes in 22 patients who underwent the Hassab procedure followed by liver transplantation. The patients were separated into two groups: group A (complete liver resection, n = 14) and group B (incomplete liver resection with left lateral remnant, n = 8). We statistically analyzed pre-, intra-, and post-operative variables in both groups.

Results

Preoperative demographic data showed no significant differences between the groups. Operation time was significantly greater in group A (10.85 ± 0.79 h) than in group B (7.25 ± 0.59 h), and median blood loss (2807 ± 472 mL) was significantly greater in group A than in group B (1023 ± 141 mL, P < 0.05 for both). Overall complication rates were not significantly different; the 1- and 3-y survival rates were 85.7% and 71.4% for group A and 87.5% and 75.0% for group B, respectively (P > 0.05).

Conclusions

Retention of some left hepatic lobe tissue during liver transplantation after the Hassab procedure is safe and feasible because it increases the success rate by reducing surgical difficulty and time.     

Laparoscopic left lateral liver resection should be a standard operation

Background  

Laparoscopic liver resection was first performed by Gagner in 1992. In the following years, laparoscopic left lateral liver resection rapidly gained the interest of hepatobiliary surgeons due to the easy accessibility of the left lateral segment. This study aimed to gather and analyze available data from the observational studies that have compared laparoscopic and open left lateral hepatic resections.     

Combined suture retraction of the falciform ligament and the left lobe of the liver during laparoscopic total gastrectomy

Background  

The inferior surface of the liver’s left lobe overlies important structures such as the hepaticoduodenal ligament, the lesser omentum, and the gastroesophageal junction. Exposure of these structures is mandatory during dissection of lymphatic basin when total laparoscopic gastrectomy is performed. This report describes a liver retraction technique using a suture that simultaneously retracts both the falciform ligament and the left lobe of liver.     

Video-assisted thoracoscopic surgery: hepatectomy for liver neoplasm

Background  

Laparoscopic liver resection has recently gained wide acceptance for various liver tumors, thanks to advances in surgical techniques and devices. However, if the tumor is located in the subdiaphragmatic area of segments 7 and 8, resection is difficult. We demonstrate herein a novel technique for video-assisted thoracoscopic surgery hepatectomy (VATS-H) for liver tumors located in the subdiaphragmatic area.     

Parenchyma-preserving hepatic resection for colorectal liver metastases

Background  

Hepatic resection of colorectal liver metastases is the only curative treatment option. As clinical and experimental data indicate that the extent of liver resection correlates with growth of residual metastases, the present study analyzes the potential benefit of a parenchyma-preserving liver surgery approach.     

Laparoscopic Liver Resection for Hepatocellular Carcinoma in the Left Liver: Pringle Maneuver Versus Tourniquet Method

Background  

A good postoperative outcome after partial hepatectomy is highly dependent on limiting operative blood loss. This study evaluated the feasibility and efficacy of the tourniquet method compared with the Pringle maneuver in laparoscopic liver resection for hepatocellular carcinoma (HCC) in the left liver.     

Evolution of laparoscopic left lateral sectionectomy without the Pringle maneuver: through resection of benign and malignant tumors to living liver donation

Background  

Laparoscopic left lateral sectionectomy (LLS) has gained popularity in its use for benign and malignant tumors. This report describes the evolution of the authors’ experience using laparoscopic LLS for different indications including living liver donation.     

Sewed revascularization for arterialized liver transplantation in mice

Background

Mouse models of liver transplantation are powerful tools for biomedical research. The cuff method is currently the most popular approach for revascularization of mouse liver grafts, as it is relatively easy to perform hence reducing the anhepatic time. However, the use of cuffs may induce a tissue reaction, causing chronic obstruction of anastomosed vessels, leading to portal hypertension. Here, we applied the suture technique for arterialized liver transplantation in mice.

Materials and methods

Liver transplantation was performed on 14 pairs of C57BL/6 mice. All hepatic vessels were anastomosed by sewing. The bile duct was connected with a stent. The liver grafts were harvested for histology on day 30 after surgery. Serum aspartate transaminase, alkaline phosphatase and bilirubin were measured at d 3, 7, and 30 after implantation.

Results

With a mean anhepatic time of 25.78 ± 3 min, the survival rate was 86% (n = 14) at 30 d following surgery. During this period, no significant liver injury was observed as assessed by serum markers and histology. Survival remained stable when grafts were exposed to 6 h cold ischemia prior to implantation. Vessel examination at the end of the studied period revealed an intact patency and a lack of collateral vessel growth.

Conclusion

Arterialized liver transplantation with sewed revascularization in mice is technically feasible. Both sewing and arterialization seem to be important factors promoting the survival of mouse recipients. The mouse model of suture arterialized orthotopic liver transplantation provides a novel tool for modern transplantation research and might be particularly suited for studies requiring longer-term survival of recipients.     

Retraction-related liver lobe necrosis after laparoscopic gastric surgery

Background:

Liver retraction is necessary for optimal exposure during laparoscopic gastric surgery. Though transient venous congestion of the retracted lobe of the liver is invariably seen during operations, major parenchymal injury is rare. We describe a case of Nathanson liver retractor-induced left lobe liver necrosis and review the pertinent literature.

Case Report:

A 78-year-old man underwent a laparoscopic-assisted total gastrectomy for gastric cancer. A Nathanson liver retractor was used to retract a large fatty left liver lobe. The operation was prolonged due to splenic bleeding requiring splenectomy. On the second postoperative day, the patient deteriorated rapidly and developed multi-organ failure. A computerized tomogram confirmed necrosis of the left lobe of the liver with gas in the liver parenchyma. The necrotic liver lobe was excised at reoperation. The patient died from a postoperative myocardial infarction.

Discussion:

Though minor liver injuries, in the form of intraoperative trauma and congestion, are common with laparoscopic liver retraction, major lacerations and necrosis are rare. Prolonged surgery and enlarged fatty liver lobe increases the risks of major injury. In our report, we discuss various types of retractor-related liver injuries and their management and highlight the importance of intermittent release of retraction during prolonged surgery.     

Outcomes of non-anatomic liver resection for hepatocellular carcinoma in the patients with liver cirrhosis and analysis of prognostic factors

Purpose  

In the east countries, patients with hepatocellular carcinoma (HCC) are usually associated with varied degrees of liver cirrhosis, and anatomic resection is therefore limited to use, especially in those with severe liver cirrhosis. This study aims to evaluate the clinical value of non-anatomic resection in HCC patients with cirrhosis.     

Preoperative 3D volumetric analysis for liver congestion applied in a patient with hilar cholangiocarcinoma

Background and aims  

Postoperative hepatic failure preceded by insufficient remnant liver function is one of the major causes of mortality. The aim of this article was to present the usefulness of preoperative three-dimensional volumetric analysis applied in liver resection to avoid congestion in the remnant liver.     

Techniques of radiofrequency-assisted precoagulation in laparoscopic liver resection

Background  

Although radiofrequency-assisted (RF) precoagulation has been described for open resections, there is little data evaluating precoagulation options in laparoscopic liver resection. The purpose of this study is to provide an algorithm for the use of monopolar and bipolar RF devices in laparoscopic liver resection.     

Morphology of liver

Background  

Liver size is related to body surface area. The present study was conducted to assess liver size and to find its relationship with body parameters. Also, the external surface of liver was studied for presence of fissures, which may demarcate the vascular segments and the blood vessels beneath them and may help the surgeon for resection of liver segment.     

Extending the limitations of liver surgery: outcomes of initial human experience in a high-volume center performing single-port laparoscopic liver resection for hepatocellular carcinoma

Background

Single-port laparoscopic surgery is slowly but steadily gaining popularity among surgeons performing minimally invasive abdominal surgeries. The aim of the present study is to assess our initial experience with single-port laparoscopic liver resection for hepatocellular carcinoma.

Methods

Between March 2009 and April 2011, 24 patients underwent single-port laparoscopic liver resection for hepatocellular carcinoma. Of these, 13 were laparoscopic segmentectomies, 4 were laparoscopic left lateral sectionectomies, 1 was a right hepatectomy, 1 was a left hepatectomy, and 4 were nonanatomical resections.

Results

Median operating time and blood loss were 205?min (95–545?min) and 500?ml (100–2,500?ml), respectively. Two procedures were converted to multiport laparoscopic hepatectomy due to instrument length limitations, and four were converted to open surgery. There were no serious intraoperative or postoperative complications in this series. Median postoperative stay was 8.5?days (5–16?days).

Conclusions

Although the procedure requires a lot of technical expertise added to the skill of liver surgery, single-port laparoscopic liver resection for hepatocellular carcinoma seems a feasible approach in a variety of well-selected cases. In spite of the demanding nature of the procedure and the requirement of better instrumentation for single-port laparoscopic surgery, the results seem to compare favorably with conventional laparoscopic surgery and open surgery.     

Functional liver reserve parameters predictive for posthepatectomy complications

Background

Posthepatectomy complications have markedly decreased with advances in techniques and management; however, surgical risk to patients with injured livers is still not negligible. We evaluated several preoperative parameters of functional liver reserve tests in patients with various liver diseases as predictors of posthepatectomy complications. A comprehensive evaluation of preoperative liver functions is necessary for the prediction of the risk of posthepatectomy complications.

Methods

Over a 10-y period, we examined 442 patients who underwent hepatectomy for liver and biliary diseases. The patients' background liver diseases included chronic viral liver diseases in 211 patients, obstructive jaundice in 29 patients, and normal liver in 202 patients. Hepatectomy-related postoperative complications (i.e., long-term ascites, intra-abdominal infection, and hepatic failure) occurred in 115 (26%) patients. A multivariate logistic analysis was performed to detect the predictive parameters, and a multivariate linear regression analysis was performed to derive a predictive formula for complications.

Results

A univariate analysis identified 15 significant parameters associated with hepatectomy-related complications, and eight parameters (i.e., presence of chronic hepatic injury, clearance index by technetium-99 m galactosyl human serum albumin liver scintigraphy of ≥0.60, total bilirubin level of >1 mg/dL, serum hyaluronic acid level of ≥75 ng/mL, major hepatectomy, blood loss of ≥950 mL, operating time of ≥500 min, and combined resection of another organ or major vessel) were independent predictive factors identified in the multivariate analysis. Clearance index by technetium-99 m galactosyl human serum albumin liver, bilirubin level, hyaluronic acid level, and major hepatectomy were the parameters included in the predictive formula.

Conclusions

In the present study, we present a comprehensive formula based on the predictive parameters for hepatic complications for prospective assessment to avoid posthepatectomy morbidity.     

Total laparoscopic limited anatomical resection for centrally located hepatocellular carcinoma in cirrhotic liver

Background

Limited anatomical liver resection for hepatocellular carcinoma (HCC) is complicated in cirrhotic patients with centrally located HCC and limited liver reserve. We present a case of total laparoscopic left medial and right ventroanterior sectionectomy performed using the intrahepatic Glissonian approach in a cirrhotic liver for curative resection of HCC.

Methods

The patient was a 69-year-old man with a 6.5-cm-diameter HCC located at segments 4, 5, and 8 and which was compressing the middle hepatic vein (MHV). Child–Pugh class A liver cirrhosis was noted, and the 15-min retention rate for indocyanine green was 14 %. Preoperative surgical planning suggested the feasibility of limited anatomical subsegmental resection. The patient was placed in the supine position and 5 trocars were used for the procedure. The operation began with cholecystectomy, division of liver ligaments, and exposure of the right hepatic vein root and the umbilical Glissonian pedicles to the left medial segment. Parenchymal transection was performed using a laparoscopic harmonic scalpel and Cavitron Ultrasonic Surgical Aspirator until the MHV was reached. After exposing the ventral branches of the right anterior Glissonian pedicle and dividing them, resection was continued along the demarcation line. Fissure veins draining to the MHV root were identified and divided. The MHV root was closed using an automatic stapler.

Results

The operation time was 565 min and estimated blood loss was 665 ml; blood transfusion was not required. Pathological examination confirmed a moderately differentiated HCC with all resected margins free of malignancy. Postoperative recovery was uneventful and the patient was discharged on the postoperative day 7. There was no tumor recurrence 18 months after the operation.

Conclusions

Total laparoscopic left medial and right ventroanterior sectionectomy via the intrahepatic Glissonian approach is feasible for HCC in a cirrhotic liver with limited liver reserve. Preoperative planning is essential in order to compute successful hepatic function. Standardization of surgical techniques may aid in safely performing this procedure.     

Risk factors for early recurrence after curative hepatectomy for colorectal liver metastases

Purpose  

With the broadening indications for hepatectomy to treat colorectal liver metastases (CRLM), early recurrence is a major problem. The aim of this study is to identify risk factors of early recurrence, defined as recurrence within 1 year after surgery.     

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.     

Total laparoscopic liver resection for hepatocellular carcinoma located in all segments of the liver

Background  

Laparoscopic liver resection (LLR) is still not a well-established treatment modality for hepatocellular carcinoma (HCC). Moreover, most reported cases have been limited to tumors in the anterolateral (AL) segments (segments 2, 3, 4b, 5, and 6). We evaluated clinical and oncologic outcomes after LLR for HCC located in all segments, including lesions located in the posterosuperior (PS) segments (segments 1, 4a, 7, and 8).