Total laparoscopic left lateral sectionectomy performed in a child with benign liver mass

Despite the increasing number of recent reports on laparoscopic liver resection in adults, there are only rare reports on such a procedure being performed in children. The authors report here on a total laparoscopic left lateral sectionectomy that was performed in a 5-year-old girl who had a cystic tumor of the liver. The operative time was 150 minutes, the estimated blood loss was about 100 mL, and no intraoperative transfusion was required. The patient was discharged on postoperative day 11 without any significant complications. The postoperative pathology of the specimen confirmed it to be a mesenchymal hamartoma of the liver with a disease-free resection margin. This case demonstrates that laparoscopic liver resection can be a safe and feasible operative procedure for the pediatric patient with liver disease.     

Robotic versus laparoscopic left lateral sectionectomy of liver

Background

A few studies have reported only short-term outcomes of various robotic and laparoscopic liver resection types; however, published data in left lateral sectionectomy (LLS) have been limited. The aim of this study was to compare the long- and short-term outcomes of robotic and laparoscopic LLS.

Methods

We retrospectively compared demographic and perioperative data as well as postoperative outcomes of robotic (n = 12) and laparoscopic (n = 31) LLS performed between May 2007 and July 2013. Resection indications included malignant tumors (n = 31) and benign lesions (n = 12) including intrahepatic duct (IHD) stones (n = 9).

Results

There were no significant differences in perioperative outcomes of estimated blood loss, major complications, or lengths of stay, but operating time was longer in robotic than in laparoscopic LLS (391 vs. 196 min, respectively) and the operation time for IHD stones did not differ between groups (435 vs. 405 min, respectively; p = 0.190). Disease-free (p = 0.463) and overall (p = 0.484) survival of patients with malignancy did not differ between groups. The 2- and 5-year disease-free survival rates were 63.2 and 36.5 %, respectively. However, robotic LLS costs were significantly higher than laparoscopic LLS costs ($8183 vs. $5190, respectively; p = 0.009).

Conclusions

Robotic LLS was comparable to laparoscopic LLS in surgical outcomes and oncologic integrity during the learning curve. Although robotic LLS was more expensive and time intensive, it might be a good option for difficult indications such as IHD stones.

     

肝脏良恶性肿瘤行腹腔镜解剖性肝左外叶切除术的初步经验

目的 初步总结肝脏良恶性肿瘤行腹腔镜解剖性肝左外叶切除的安全性及疗效.方法 2005年4月至2008年5月共对11例肝脏良恶性肿瘤患者行腹腔镜下解剖性肝左外叶切除术(男性7例、女性4例,平均年龄51.7岁).其中原发性肝癌4例,伴不周程度肝硬化;结肠癌术后转移性肝癌1例;肝血管瘤5例(2例合并胆囊结石同时切除胆囊);巨大肝血平滑肌脂肪瘤1例.肿瘤最大径2.1～12.0 com,平均5.8cm,所有肿瘤均位于肝左外叶(Ⅱ、Ⅲ段).结果 手术时间为120～180 min,平均147 min.无中转开腹手术病例,无输血,无手术并发症.术后平均住院5.9 d.结论 对于位于Ⅱ、Ⅲ段的肝脏肿瘤施行腹腔镜下肝左外叶切除术是安全的.     

肝左外叶切除“金标准”术式:腹腔镜肝左外叶切除术

<正>肝左外叶独特的解剖结构使得腹腔镜肝左外叶切除术(laparoscopic left lateral segment liver resection,LLLR)成为开展较早、应用较多的腹腔镜肝切除术(laparoscopic hepatectomy,LH)术式[1-5]。该术式在手术时     

完全腹腔镜下肝左外叶部分切除术:附6例报告

背景虽然腹腔镜下肝脏切除的技术进展缓慢，但是仍有证据表明在选择性病例中运用腹腔镜技术进行一些较小型的肝切除，特别是肝左外叶切除术是安全的。目的探讨运用腹腔镜技术进行肝左外叶切除的操作技术和经验。方法回顾性分析我院在2004—2005年间接受完全腹腔镜下肝左外叶切除的6例病人的临床资料，包括围手术期数据、病理结果、随访数据等。结果6例病人均行完全腹腔镜下肝左外叶切除术，无需中转开腹，无术中死亡和术后并发症；全组病例平均手术时间为195min，术中平均出血量170ml；其中4例病理诊断为肝细胞性肝癌，1例为局灶性结节样增生，1例为肝血管瘤；4例肝癌病人的手术切缘不少于1cm;平均住院时间为3d（2～6d），中位随访时间为12个月；4例肝癌病人至今均未见复发。结论采用完全腹腔镜下肝左外叶切除，技术安全可行，并能大大减轻病人的手术创伤。     

Conventional laparoscopic and robot-assisted laparoscopic liver resection for benign and malignant pathologies: a cohort study

The aim of our study was to evaluate different minimally invasive surgical approaches for liver resection in a tertiary surgical center. The study cohort comprised 104 consecutive patients who underwent total laparoscopic liver resection (n?=?17), hand-assisted laparoscopic liver resection (n?=?55), or robot-assisted laparoscopic liver resection (n?=?32) in our center between October 1998 and January 2011. Surgical complications, postoperative course, disease-free survival, and overall survival for malignancy were assessed. These 104 resections were performed on 55 men and 49 women with a mean age of 60.4?years; 43.3% of patients had liver cirrhosis. The liver pathologies comprised malignant tumors (64.4%) and benign lesions (35.6%). The most common laparoscopic liver resection was left lateral sectionectomy (53.9%), wedge resection (26.9%), segmentectomy (13.5%), right hepatectomy (3.8%), and left hepatectomy (1.9%). Conversion from laparoscopy to open approach and from laparoscopy to hand-assisted approach occurred in 1.9 and 1% of the cases, respectively. Overall mortality was 0%, and morbidity was 17.3%. The median follow-up period was 24?months. The 5-year overall survival for hepatocellular carcinoma (HCC) was 52%, and the 3-year overall survival for colorectal liver metastasis was 88%. Based on these results, we conclude that laparoscopic liver resection is feasible and safe in appropriately selected patients. In our patient cohort, it was associated with a low complications rate and favorable survival outcome.     

机器人与腹腔镜肝左外叶切除手术的经济学分析

目的从经济学角度探讨机器人肝左外叶切除手术的可行性。 方法回顾性分析2015年1月至2016年3月,在解放军总医院肿瘤外二科行机器人和腹腔镜肝左外叶切除手术的39例患者资料,其中机器人手术10例(机器人手术组),腹腔镜手术29例(腹腔镜手术组)。比较两组患者的年龄、性别、诊断、肿瘤直径等一般资料,以及平均手术时间、术后住院时间、手术费用、西药费用和住院总费用等。 结果两组患者均顺利实施肝左外叶切除,无中转开腹且术后均未出现全身和局部并发症,围手术期未输血。两组的术后住院时间分别为(4.9 ± 1.4) d和(4.4 ± 1.4 )d,两组比较,差异无统计学意义 (P＝0.502)。机器人手术组的手术时间为(124.2 ± 22.7)min,明显长于腹腔镜手术组(76.4 ± 22.0)min(P＝0.010)。机器人手术组的住院总费用(7.61 ± 0.86)万元,明显高于腹腔镜手术组(4.86±0.98万元)(P＝0.001)。两组的手术费用分别为(3.32 ± 0.29)万元和(1.57 ± 0.16)万元(P＝0.001)。两组的西药费用比较,差异无统计学意义(P＝0.624)。 结论选择传统腹腔镜手术还是选择机器人手术时,有必要进行成本效益分析并建立一套科学的评估系统。目前肝左外叶切除的手术方式仍以模式化的腹腔镜肝左外切除为首选。     

选择性肝血流阻断技术在腹腔镜左肝外叶切除术中的应用

目的 探讨选择性肝血流阻断技术在腹腔镜左肝外叶切除术中应用的可行性和有效性。方法 回顾分析18例术中采用选择性肝血流阻断技术实施腹腔镜左肝外叶切除术患者的临床资料。结果 全组均在腹腔镜下完成手术,无中转开腹,无围手术期死亡。平均手术时间（140±58）min,平均术中出血量（160±148）mL,均未术中输血。术后1例患者发生左膈下积液,术后并发症发生率为5.56%（1/18）,平均术后住院时间（6.4±2.5）d。结论 腹腔镜左肝外叶切除术中采用选择性肝血流阻断技术可有效减少术中出血和术后并发症,安全可行。     

Laparoscopic left lateral sectionectomy in living donors: safety and reproducibility of the technique in a single center

BACKGROUND DATA AND OBJECTIVE: Left lateral sectionectomy for liver transplantation in children performed through laparoscopy is an innovative procedure that was developed by considering our acquired experience in both laparoscopic liver resection and graft harvesting in living donors. The main goal was to minimize donor morbidity while preserving the abdominal wall. Herein, we report the technical feasibility and reproducibility, and compared it with open liver resection (OLR). METHODS: Sixteen successive donors underwent a laparoscopic liver resection (LLR) from 2001 to 2005. They were compared with 14 other donors who underwent a standard open liver resection (OLR) during a first period (1998-2004). First, this report describes the technical features of laparoscopic resection. Second, perioperative morbidity and graft characteristics were compared according to the use or not of the laparoscopic approach. RESULTS: Laparoscopic harvesting was successfully performed in 15 of 16 cases in an intention-to-treat basis. One conversion was required to ensure the quality of the laparoscopic repair of a left portal vein injury occurring during the pedicle dissection. No specific complication related to laparoscopy was observed. As compared with OLR, the operation was longer (320 +/- 67 vs. 244 +/- 55 minutes, P < 0.005). The blood loss was significantly lower in the LLR group (18.7 +/- 44.2 vs. 199.2 +/- 185.4 mL, P < 0.005). The morbidity rate was similar in both groups (18.7% in LLR vs. 35.7% in OLR). One donor in the LLR group experienced a bile leak treated by redo laparoscopy. Grafts were anatomically similar irrespective of the use of laparoscopy. The duration of hospital stay and use of self-infused morphine pump was not different between the 2 groups. CONCLUSION: Left lateral section harvesting by laparoscopy is a safe and reproducible procedure, allowing to obtain similar grafts as compared with laparotomy and can therefore be recommended to transplant centers that have previous experience in laparoscopic liver resection.     

Liver resection for benign liver tumors: indications and outcome

BACKGROUND: The indications for intervention in cases of benign liver tumors include symptoms, suspicion of malignancy, or risk of malignant change. METHODS: Eighty-four liver resections for benign tumors were performed in our hospital from June 1996 to December 2004. The patient records were reviewed retrospectively. RESULTS: The study group (41 females, 43 males; average age, 41.4 +/- 10.5 y) included 46 cavernous hemangiomas, 27 focal nodular hyperplasias, 5 hepatic adenomas, and 6 liver cysts. The indications for resection were inability to rule out malignancy (50 [59.5%]), symptoms (33 [39.3%]), and others (1 [1.2%]). Postoperatively, 28 of the 33 patients had resolution of symptoms. Twenty-nine patients (34.5%) had chronic hepatitis B infection. CONCLUSIONS: Liver resection for benign liver tumor is safe, but indications for intervention must be evaluated carefully. The presence of chronic parenchymal liver disease does not increase morbidity in these patients.     

腹腔镜肝切除术

目的展示应用腹腔镜肝切除手术治疗肝脏左外叶肿瘤的1个病例。方法该患者为41岁女性,肝左外叶肿瘤直径为5．5cm,肝功能检测为Child—PughA级,吲哚氰绿15min潴留率（ICG15）为8．9％。术前手术方案评估表明为腹腔镜肝切除手术的适应证。患者术中采用仰卧位,共应用5个troear（即5个穿刺孔）。手术的初始操作为游离肝周韧带,肝实质的离断应用超声刀和可吸收血管夹来完成。结果手术时间为115min,出血量为110ml,除了常规进行预存式自体输血外,无需额外输血。病理结果提示为肝脏囊腺瘤。患者术后恢复良好,无手术并发症发生,术后第8天出院。结论对于具备肝胆手术以及腹腔镜手术操作经验的外科医生而言,腹腔镜肝切除手术是治疗肝脏外科疾病的一种安全、有效的方法。     

手辅式腹腔镜左半肝切除术的安全性及有效性研究

目的观察手辅式腹腔镜左半肝切除术应用的安全性及有效性。方法回顾分析在行手辅式腹腔镜左半肝切除术的患者20例，并与同期行开腹左半肝切除术的患者24例进行比较，对比两组的手术安全性、术后恢复情况。结果两组均无术中术后严重并发症和手术死亡病例，手辅式腹腔镜组无一例中转开腹；手辅式腹腔镜组手术时间与开腹组相比差异无统计学意义（P〉0．05）；手辅式腹腔镜组术中出血量少、术后体温恢复快、排气快、下床活动早，术后住院时间短，术后并发症少。与开腹组相比差异有统计学意义（P〈0．01）。结论运用手辅式腹腔镜技术能集中开放和腹腔镜手术的优势完成复杂的手术，手辅式腹腔镜左半肝切除术是一种安全、有效的手术方式，有较高的临床应用价值。     

Adult living donor liver transplantation: living donation of the right liver lobe

Background Adult living donor liver transplantation (LDLT) has become a routine treatment option for patients waiting for liver transplantation. In European and North American countries, LDLT for adult recipients is mainly performed with right lobe grafts. Indications, when compared to deceased donor liver transplantation, are controversial. Materials and methods In our institution, patients suffering from hepatocellular carcinoma in cirrhosis, non-resectable hilar cholangiocarcinoma, viral hepatitis associated cirrhosis, as well as cholestatic liver and biliary disease are considered good candidates for LDLT. Results In this overview, donor evaluation, graft selection, and the donor operation with special regard to operative techniques and strategies are discussed. For visualization, a 5-min video sequence of the standard donor operation as performed in our institution is attached. Conclusion Given the ongoing shortage of donor organs, adult LDLT has become a routine treatment option for patients waiting for liver transplantation. The associated inevitable risk for the healthy donor, however, remains ethically controversial. Electronic supplementary material The online version of this article (doi:) contains supplementary material, which is available to authorized users.     

Liver resection without hilus preparation and with selective intrahepatic hilus stapling for benign tumors and liver metastasis

Background Nowadays, liver resection is a routine operative procedure in surgical centers, and strategies must be aimed at avoiding additional risk factors. Extrahepatic isolation of portal vein, hepatic artery and hepatic duct, as well as lymphadenectomy of the liver hilum are generally accepted steps of liver resection, even for metastatic and benign indications. Our primary aim was to analyze the feasibility, blood loss, blood transfusion requirements, incidence of complications, and outcome using the approach for intrahepatic devascularization leaving the extrahepatic hilus untouched. Materials and methods Thirty-eight consecutive patients with resection for metastases and benign liver tumors were selected. After hilar examination, the extrahepatic structures remain intact, and during parenchyma dissection, the whole right or left or the appropriate bi-segmental pedicle is isolated intrahepatically and then transected using a stapler device. Results The used technique was feasible in all cases, and no intra- or postoperative surgical complications were observed. To date, no tumor recurrence was found in the hilum during the follow-up period. Conclusion The intrahepatic pedicle stapling technique appears to be feasible and safe in liver resection. Hilar dissection can, thus, be avoided in liver metastasis and benign liver tumors.     

腹腔镜左侧结肠良恶性肿瘤手术的临床分析

目的:探讨腹腔镜左侧结肠肿瘤切除术的临床应用价值。方法:回顾性分析2008年3月至2009年12月新华医院肛肠外科收治之54例腹腔镜下左侧结肠的良恶性肿瘤切除的临床资料。结果:全部病例均顺利完成手术,无重大术中并发症发生。平均手术时间(160±35)min;术后并发症8例,其中切口感染6例,淋巴漏1例,性功能障碍1例。病人平均住院天数为9.5 d。所有病例随访至今,无切口种植,无局部复发,无远处转移及死亡病例。结论:腹腔镜左侧结肠肿瘤切除是临床上较安全可靠的手术方式。