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Laparoscopic segment 7 resection with extracorporeal Pringle maneuver on a cirrhotic liver
This is the case of a 73-year-old man presenting with a 33mm hepatocellular carcinoma arising on a Hepatitis C virus-related well-compensated cirrhosis without portal hypertension. A laparoscopic segment 7 atypical resection was decided upon. Five ports are placed. The procedure begins with complete abdominal exploration and intraoperative liver ultrasonography. The right triangular and coronary ligaments are divided in order to mobilize the right lobe and gain access to liver segment 7. The hepatic hilum is encircled with an umbilical tape. The tape is passed percutaneously through a 24 French chest tube used as Rommel’s tourniquet to allow for a safe and fast extracorporeal Pringle maneuver. The transection plane is controlled using ultrasound. The first part of parenchymal transection is performed using Thunderbeat™ while an ultrasonic dissector (CUSA™) is used more deeply. Hemostasis is controlled with irrigated bipolar forceps and clips on major vessels. To allow for a bloodless parenchymal transection and a more precise isolation and clipping of the vessels, the hepatic hilum is clamped for 10 minutes. The chest tube is pushed towards the hilum and clamped extracorporeally. After 10 minutes, the Pringle maneuver is released for 5 minutes and then repeated for another 10 minutes until parenchymal transection is complete. No drains are placed. Operative time took 180 minutes and total blood loss was 50mL. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology confirmed a 3cm hepatocellular carcinoma without microvascular invasion. Resection margins were negative for tumor invasion.
D Citterio, C Battiston, C Sposito, M Altomare, A Benedetti, V Mazzaferro
Surgical intervention
5 months ago
1515 views
12 likes
2 comments
10:10
Laparoscopic segment 7 resection with extracorporeal Pringle maneuver on a cirrhotic liver
This is the case of a 73-year-old man presenting with a 33mm hepatocellular carcinoma arising on a Hepatitis C virus-related well-compensated cirrhosis without portal hypertension. A laparoscopic segment 7 atypical resection was decided upon. Five ports are placed. The procedure begins with complete abdominal exploration and intraoperative liver ultrasonography. The right triangular and coronary ligaments are divided in order to mobilize the right lobe and gain access to liver segment 7. The hepatic hilum is encircled with an umbilical tape. The tape is passed percutaneously through a 24 French chest tube used as Rommel’s tourniquet to allow for a safe and fast extracorporeal Pringle maneuver. The transection plane is controlled using ultrasound. The first part of parenchymal transection is performed using Thunderbeat™ while an ultrasonic dissector (CUSA™) is used more deeply. Hemostasis is controlled with irrigated bipolar forceps and clips on major vessels. To allow for a bloodless parenchymal transection and a more precise isolation and clipping of the vessels, the hepatic hilum is clamped for 10 minutes. The chest tube is pushed towards the hilum and clamped extracorporeally. After 10 minutes, the Pringle maneuver is released for 5 minutes and then repeated for another 10 minutes until parenchymal transection is complete. No drains are placed. Operative time took 180 minutes and total blood loss was 50mL. The postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology confirmed a 3cm hepatocellular carcinoma without microvascular invasion. Resection margins were negative for tumor invasion.
Laparoscopic living donor right hepatectomy (LLDH) fully exposing the right hepatic vein (conventional approach)
Introduction:
Laparoscopic living donor hepatectomy (LLDH) has gradually become a widespread technique in high volume transplant centers over the last decade.
Right LLDH is considered as a procedure which requires an expert level in both living donor liver transplantation and laparoscopic liver resection.
In order to fully expose and encircle the right hepatic vein before parenchymal transection implies the full mobilization of the right liver lobe as well as the clipping and cutting of the short hepatic veins in a same way as in a conventional open approach, using the hanging maneuver.
This approach could be more applicable as an initial experience in centers introducing the right LLDH.
Method: Right LLDH was demonstrated in a 31-year-old woman with standard liver anatomy. The procedure was performed using five ports with the patient placed in the French position. The graft was transplanted to a 10-year-old girl with Wilson’s disease (PELD score of 19).
Result: Operating time was 420 min. Blood loss was 120mL. Donor and recipient were discharged on postoperative day 6 and 28 respectively without any complications.
Conclusion: Right LLDH is a feasible procedure. The technique shown is reproducible.
A Monakhov, K Semash, K Khizroev, M Voskanov, SV Gautier
Surgical intervention
5 months ago
1283 views
14 likes
3 comments
10:38
Laparoscopic living donor right hepatectomy (LLDH) fully exposing the right hepatic vein (conventional approach)
Introduction:
Laparoscopic living donor hepatectomy (LLDH) has gradually become a widespread technique in high volume transplant centers over the last decade.
Right LLDH is considered as a procedure which requires an expert level in both living donor liver transplantation and laparoscopic liver resection.
In order to fully expose and encircle the right hepatic vein before parenchymal transection implies the full mobilization of the right liver lobe as well as the clipping and cutting of the short hepatic veins in a same way as in a conventional open approach, using the hanging maneuver.
This approach could be more applicable as an initial experience in centers introducing the right LLDH.
Method: Right LLDH was demonstrated in a 31-year-old woman with standard liver anatomy. The procedure was performed using five ports with the patient placed in the French position. The graft was transplanted to a 10-year-old girl with Wilson’s disease (PELD score of 19).
Result: Operating time was 420 min. Blood loss was 120mL. Donor and recipient were discharged on postoperative day 6 and 28 respectively without any complications.
Conclusion: Right LLDH is a feasible procedure. The technique shown is reproducible.
Laparoscopic central hepatectomy for hepatoma using a Glissonian approach
Introduction: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic central hepatectomy remains a challenging and technically demanding procedure because it requires two transection planes. This video illustrates a useful technique for laparoscopic central hepatectomy, which was successfully performed in a cirrhotic patient with hepatoma. Method: We demonstrated a total laparoscopic central hepatectomy which was performed in a 65-year-old woman who had a centrally located hepatoma, and this tumor was in contact with the middle hepatic vein. The operative procedure was performed by using five ports with the patient placed in a low lithotomy position. Results: The technique was successfully performed without any complications. The operative time was 380 min. Intraoperative blood loss was 60mL. The length of hospital stay was 5 days. The pathological report was well-differentiated HCC and free surgical margins. Conclusions: Laparoscopic central hepatectomy for hepatoma by using a Glissonian approach is feasible and safe.
R Chanwat, C Bunchaliew
Surgical intervention
8 months ago
5347 views
37 likes
6 comments
10:01
Laparoscopic central hepatectomy for hepatoma using a Glissonian approach
Introduction: Although laparoscopic liver resection has been widely adopted, performing a total laparoscopic central hepatectomy remains a challenging and technically demanding procedure because it requires two transection planes. This video illustrates a useful technique for laparoscopic central hepatectomy, which was successfully performed in a cirrhotic patient with hepatoma. Method: We demonstrated a total laparoscopic central hepatectomy which was performed in a 65-year-old woman who had a centrally located hepatoma, and this tumor was in contact with the middle hepatic vein. The operative procedure was performed by using five ports with the patient placed in a low lithotomy position. Results: The technique was successfully performed without any complications. The operative time was 380 min. Intraoperative blood loss was 60mL. The length of hospital stay was 5 days. The pathological report was well-differentiated HCC and free surgical margins. Conclusions: Laparoscopic central hepatectomy for hepatoma by using a Glissonian approach is feasible and safe.
Laparoscopic Beger procedure with Roux-en-Y hepaticojejunostomy
This is the case of a 49-year-old male patient presenting with recurrent intractable abdominal pain. The patient had a history of obstructive jaundice and underwent biliary decompression provided by a percutaneous cholecystostomy. CT-scan showed signs of chronic pancreatitis, multiple stones in the pancreatic parenchyma, a compressed portal vein and biliary obstruction. The patient underwent a laparoscopic duodenum-preserving pancreatic head resection (DPPHR) – a technique known as the Beger procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain, combined with portal and biliary compression caused by severe chronic pancreatitis. The surgical procedure preserves the stomach, the duodenum, and the biliary tree unlike standard duodenopancreatectomy (Whipple procedure), which is the other option for these patients. As Beger himself stated: “Preservation of the duodenum and the biliary system has major advantages for patients regarding short- and long-term outcome as compared to the Kausch-Whipple resection and pylorus-preserving resection”.
In this case, after completing the pancreatic head resection and fashioning the distal and proximal pancreaticojejunal anastomosis, a hepaticojejunostomy was performed. It was necessary due to the stenosis of the intrapancreatic segment of the common bile duct.
The purpose of this video is to demonstrate that the laparoscopic Beger procedure is safe and feasible, and provides all the well-known advantages of the minimally invasive approach, particularly lower postoperative pain, earlier functional recovery, and shorter hospital stay.
P Agami, A Andrianov, M Baychorov, R Izrailov
Surgical intervention
8 months ago
2496 views
16 likes
3 comments
17:23
Laparoscopic Beger procedure with Roux-en-Y hepaticojejunostomy
This is the case of a 49-year-old male patient presenting with recurrent intractable abdominal pain. The patient had a history of obstructive jaundice and underwent biliary decompression provided by a percutaneous cholecystostomy. CT-scan showed signs of chronic pancreatitis, multiple stones in the pancreatic parenchyma, a compressed portal vein and biliary obstruction. The patient underwent a laparoscopic duodenum-preserving pancreatic head resection (DPPHR) – a technique known as the Beger procedure. It is recognized as an effective therapeutic option for the surgical treatment of patients with persistent pain, combined with portal and biliary compression caused by severe chronic pancreatitis. The surgical procedure preserves the stomach, the duodenum, and the biliary tree unlike standard duodenopancreatectomy (Whipple procedure), which is the other option for these patients. As Beger himself stated: “Preservation of the duodenum and the biliary system has major advantages for patients regarding short- and long-term outcome as compared to the Kausch-Whipple resection and pylorus-preserving resection”.
In this case, after completing the pancreatic head resection and fashioning the distal and proximal pancreaticojejunal anastomosis, a hepaticojejunostomy was performed. It was necessary due to the stenosis of the intrapancreatic segment of the common bile duct.
The purpose of this video is to demonstrate that the laparoscopic Beger procedure is safe and feasible, and provides all the well-known advantages of the minimally invasive approach, particularly lower postoperative pain, earlier functional recovery, and shorter hospital stay.
Laparoscopic partial liver resection for hepatocellular adenoma
We report a laparoscopic partial liver resection for a large hepatocellular adenoma. This is the case of a 34-year-old patient with several small hepatic nodules. One out of three nodules was a 13cm hepatocellular adenoma, which was found to be located in Couinaud’s segments V and VI. After clamping via blood flow occlusion, parenchymal transection was performed along the outer edge of the tumor using a Sonicision™ Cordless Ultrasonic Dissection Device and an Endo GIA™ linear stapler. After liver resection, cholecystectomy was performed. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of an inflammatory type of hepatocellular adenoma.
P Pessaux, T Urade, T Wakabayashi, D Mutter, J Marescaux
Surgical intervention
1 year ago
2081 views
6 likes
0 comments
05:51
Laparoscopic partial liver resection for hepatocellular adenoma
We report a laparoscopic partial liver resection for a large hepatocellular adenoma. This is the case of a 34-year-old patient with several small hepatic nodules. One out of three nodules was a 13cm hepatocellular adenoma, which was found to be located in Couinaud’s segments V and VI. After clamping via blood flow occlusion, parenchymal transection was performed along the outer edge of the tumor using a Sonicision™ Cordless Ultrasonic Dissection Device and an Endo GIA™ linear stapler. After liver resection, cholecystectomy was performed. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of an inflammatory type of hepatocellular adenoma.
Laparoscopic left lateral sectionectomy for hepatocarcinoma in a cirrhotic patient
This video demonstrates a laparoscopic left lateral sectionectomy for hepatocellular carcinoma (HCC) in a cirrhotic liver with hemochromatosis. This is the case of a 77-year-old patient who presented with a 40mm HCC located in Couinaud’s liver segment II and III. After left liver mobilization, parenchymal transection was initiated along the left side of the falciform ligament, mainly using the cavitron ultrasonic surgical aspirator (CUSA®). Tissue Select mode was used during the exposure of the vascular structure. The Glissonian pedicles of segments III and II were encircled and transected, and finally the suprahepatic vein was divided using an Endo GIA™ linear stapler. The specimen was extracted with a short suprapubic incision. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of a well-differentiated HCC.
P Pessaux, T Urade, T Wakabayashi, E Felli, A Mazzotta, Z Cherkaoui, D Mutter, J Marescaux
Surgical intervention
1 year ago
2565 views
12 likes
1 comment
07:22
Laparoscopic left lateral sectionectomy for hepatocarcinoma in a cirrhotic patient
This video demonstrates a laparoscopic left lateral sectionectomy for hepatocellular carcinoma (HCC) in a cirrhotic liver with hemochromatosis. This is the case of a 77-year-old patient who presented with a 40mm HCC located in Couinaud’s liver segment II and III. After left liver mobilization, parenchymal transection was initiated along the left side of the falciform ligament, mainly using the cavitron ultrasonic surgical aspirator (CUSA®). Tissue Select mode was used during the exposure of the vascular structure. The Glissonian pedicles of segments III and II were encircled and transected, and finally the suprahepatic vein was divided using an Endo GIA™ linear stapler. The specimen was extracted with a short suprapubic incision. The postoperative outcome was uneventful. Final pathological findings confirmed the diagnosis of a well-differentiated HCC.
Laparoscopic left hepatectomy for a suspected biliary cystadenoma
This is the case of a 69-year-old male patient presenting to the emergency department for abdominal pain and fever. After CT-scan and liver MRI, a biliary cystadenoma was suspected. CEA and CA 19-9 were normal. Hydatid cyst serology was negative. Considering the localization and the size of the tumor, a left laparoscopic hepatectomy was indicated. The patient’s surgical history included laparoscopic sigmoidectomy, intestinal occlusion for internal hernia, appendectomy, and bilateral inguinal hernia repair. Dissection of adhesions and cholecystectomy were performed first. After transection of the left hepatic artery and the left portal vein, parenchymal transection was performed by exposing the middle hepatic vein under intermittent clamping using blood flow occlusion. During parenchymal transection, the left hepatic duct and the left hepatic vein were divided. The specimen was extracted through a suprapubic incision. The postoperative outcome was uneventful. Pathological findings showed the presence of a biliary cyst communicating with the biliary system, without any malignant characteristics.
O Soubrane, P Pessaux, E Felli, T Urade, T Wakabayashi, D Mutter, J Marescaux
Surgical intervention
1 year ago
2597 views
5 likes
0 comments
34:11
Laparoscopic left hepatectomy for a suspected biliary cystadenoma
This is the case of a 69-year-old male patient presenting to the emergency department for abdominal pain and fever. After CT-scan and liver MRI, a biliary cystadenoma was suspected. CEA and CA 19-9 were normal. Hydatid cyst serology was negative. Considering the localization and the size of the tumor, a left laparoscopic hepatectomy was indicated. The patient’s surgical history included laparoscopic sigmoidectomy, intestinal occlusion for internal hernia, appendectomy, and bilateral inguinal hernia repair. Dissection of adhesions and cholecystectomy were performed first. After transection of the left hepatic artery and the left portal vein, parenchymal transection was performed by exposing the middle hepatic vein under intermittent clamping using blood flow occlusion. During parenchymal transection, the left hepatic duct and the left hepatic vein were divided. The specimen was extracted through a suprapubic incision. The postoperative outcome was uneventful. Pathological findings showed the presence of a biliary cyst communicating with the biliary system, without any malignant characteristics.
Laparoscopic central hepatectomy using a Glissonian approach for hepatocellular adenoma
A 32-year-old asymptomatic female patient presented an incidental finding of a liver mass during pregnancy. The mass grew during pregnancy, and a biopsy confirmed the diagnosis of hepatocellular adenoma. On MRI, a hypodense 7 by 6.1cm mass with adipose infiltration was identified. Previously, it was a 5.8 by 5.1cm mass, located in liver segments IV, V, and VIII inferiorly.
The cystic duct and its artery were ligated. However, the gallbladder was kept in place for traction. After dissection of the anterior pedicle, a linear stapler was applied. The right lobe was mobilized and the right transection line was made according to the ischemia line of the anterior sector.
During the liver transection of segment IVB, the pedicle was identified, and linear stapling helped to control it. The parenchymal transection was performed with an ultrasonic scalpel and bipolar cautery. The liver surface of the anterior sector was demarcated and transected. Both the left and the right plane of transection were inferiorly joined. The middle and right hepatic vein branches were stapled.
The specimen was mobilized. Argon beam and bipolar forceps provided the hemostasis. The specimen was removed via a Pfannenstiel’s incision and a drain was placed. The duration of the procedure was 345 minutes. The estimated blood loss was 1200mL.
The patient was discharged from the intensive care unit on postoperative day 1 and from hospital on postoperative day 4. No complication was noted in 90 days. Pathological findings showed a mass of 10.7 by 8.4 by 4.8cm. The lesion represented a hepatocellular adenoma with negative margins.
R Araujo, D Burgardt, V Vazquez, F Felippe, MA Sanctis, D Wohnrath
Surgical intervention
1 year ago
1127 views
5 likes
0 comments
09:00
Laparoscopic central hepatectomy using a Glissonian approach for hepatocellular adenoma
A 32-year-old asymptomatic female patient presented an incidental finding of a liver mass during pregnancy. The mass grew during pregnancy, and a biopsy confirmed the diagnosis of hepatocellular adenoma. On MRI, a hypodense 7 by 6.1cm mass with adipose infiltration was identified. Previously, it was a 5.8 by 5.1cm mass, located in liver segments IV, V, and VIII inferiorly.
The cystic duct and its artery were ligated. However, the gallbladder was kept in place for traction. After dissection of the anterior pedicle, a linear stapler was applied. The right lobe was mobilized and the right transection line was made according to the ischemia line of the anterior sector.
During the liver transection of segment IVB, the pedicle was identified, and linear stapling helped to control it. The parenchymal transection was performed with an ultrasonic scalpel and bipolar cautery. The liver surface of the anterior sector was demarcated and transected. Both the left and the right plane of transection were inferiorly joined. The middle and right hepatic vein branches were stapled.
The specimen was mobilized. Argon beam and bipolar forceps provided the hemostasis. The specimen was removed via a Pfannenstiel’s incision and a drain was placed. The duration of the procedure was 345 minutes. The estimated blood loss was 1200mL.
The patient was discharged from the intensive care unit on postoperative day 1 and from hospital on postoperative day 4. No complication was noted in 90 days. Pathological findings showed a mass of 10.7 by 8.4 by 4.8cm. The lesion represented a hepatocellular adenoma with negative margins.
Laparoscopic left hepatectomy with extrahepatic inflow and outflow exclusion
This is the case of a 72-year-old woman presenting with a 5cm intrahepatic cholangiocarcinoma arising on an HCV-related well-compensated chronic liver disease without portal hypertension. Laparoscopic left hepatectomy (liver segments 2, 3, and 4) was decided upon. Four ports were placed. The procedure began with a complete abdominal exploration and intraoperative liver ultrasonography, which allowed to identify the tumor between liver segments 2 and 4a in close contact with the left hepatic vein.
Hilar dissection was performed with lymphadenectomy of the common hepatic artery and left hepatic artery.
Before parenchymal transection, both inflow and outflow of the left liver were interrupted. The left hepatic artery and the left portal vein were isolated and divided between clips. The left hepatic vein was isolated after division of the Arantius’ ligament and clamped by means of a laparoscopic vascular clamp. Parenchymal transection was carried out using an ultrasonic dissector (CUSA™), and hemostasis was controlled with a radiofrequency bipolar hemostatic sealer (Aquamantys™) and clips. The biliary duct and the left hepatic vein were managed with vascular staplers. At the end of the operation, a tubular drain was placed. Operative time accounted for 240 minutes and total blood loss was 100mL.
The postoperative course was uneventful and the patient was discharged on postoperative day 6.
The pathology confirmed a 5cm G3 cholangiocarcinoma with invasion of the left hepatic vein and of segment 2 portal branch. Resection margins were negative for tumor invasion and for all lymph nodes retrieved.
C Sposito, D Citterio, C Battiston, V Mazzaferro
Surgical intervention
1 year ago
3159 views
12 likes
2 comments
10:57
Laparoscopic left hepatectomy with extrahepatic inflow and outflow exclusion
This is the case of a 72-year-old woman presenting with a 5cm intrahepatic cholangiocarcinoma arising on an HCV-related well-compensated chronic liver disease without portal hypertension. Laparoscopic left hepatectomy (liver segments 2, 3, and 4) was decided upon. Four ports were placed. The procedure began with a complete abdominal exploration and intraoperative liver ultrasonography, which allowed to identify the tumor between liver segments 2 and 4a in close contact with the left hepatic vein.
Hilar dissection was performed with lymphadenectomy of the common hepatic artery and left hepatic artery.
Before parenchymal transection, both inflow and outflow of the left liver were interrupted. The left hepatic artery and the left portal vein were isolated and divided between clips. The left hepatic vein was isolated after division of the Arantius’ ligament and clamped by means of a laparoscopic vascular clamp. Parenchymal transection was carried out using an ultrasonic dissector (CUSA™), and hemostasis was controlled with a radiofrequency bipolar hemostatic sealer (Aquamantys™) and clips. The biliary duct and the left hepatic vein were managed with vascular staplers. At the end of the operation, a tubular drain was placed. Operative time accounted for 240 minutes and total blood loss was 100mL.
The postoperative course was uneventful and the patient was discharged on postoperative day 6.
The pathology confirmed a 5cm G3 cholangiocarcinoma with invasion of the left hepatic vein and of segment 2 portal branch. Resection margins were negative for tumor invasion and for all lymph nodes retrieved.
Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
P Pessaux, R Memeo, J Hallet, Z Cherkaoui, D Mutter, J Marescaux
Surgical intervention
2 years ago
7801 views
944 likes
0 comments
32:12
Laparoscopic right hemihepatectomy
A laparoscopic right hemihepatectomy was performed for a gastric liver metastasis. After the dissection of the anatomical structure of the hepatic pedicle and an ultrasound examination, the right portal vein and the right branch of the hepatic artery were clamped, hence allowing to skeletonize the demarcation between the right liver and the left liver. The devascularization line was subsequently marked by means of electrocautery. The right hepatic branch and the right branch of the portal vein were divided between locked clips. The hepatotomy was started. The first very superficial centimeters were dissected using the Sonicision® Cordless Ultrasonic Dissection Device. No pedicular clamping was performed. The dissection followed the ischemic demarcation line between the right liver and the left liver. Hemostasis and biliostasis were completed using the Aquamantys® Bipolar Sealers. Once the first centimeters had been dissected, dissection was carried on using the CUSA™ ultrasonic dissector (Cavitron Ultrasonic Surgical Aspirator). Liver segment I was divided in order to open the posterior aspect of the hilar plate. The dissection was performed on the right border of the vena cava. The hilar plate was dissected, making it possible to control the right branch of the biliary tract intraparenchymally. The right hepatic vein was dissected and divided with an Endo GIA™ linear stapler. Makuuchi’s ligament was subsequently dissected and divided by means of a firing of the Endo GIA™ linear stapler, white cartridge. Mobilization of the right liver was completed by dividing the triangular ligament’s attachments at the level of the diaphragm. The right hepatectomy specimen was introduced into a bag, which was extracted through a suprapubic Pfannenstiel’s incision. Pneumoperitoneum pressure was diminished in order to control hemostasis and biliostasis.
LIVE INTERACTIVE SURGERY: laparoscopic right hepatectomy in a patient with hepatocellular carcinoma (HCC) and metabolic syndrome
In this live interactive video, Professor Luc Soler provided a brief introduction of 3D reconstruction and modeling for precise tumor localization and future liver remnant before and after chemoembolization and right portal vein embolization. Dr. Soubrane briefly described the main principles, key steps, and preoperative planning in a 62-year-old male patient with hepatocellular carcinoma (HCC) and metabolic syndrome. He demonstrated the main technical aspects of port placement, hepatic pedicle dissection, exploration and dissection of vessels, and transection of liver parenchyma.
O Soubrane, P Pessaux, R Memeo, L Soler, D Mutter, J Marescaux
Surgical intervention
2 years ago
5200 views
571 likes
0 comments
51:19
LIVE INTERACTIVE SURGERY: laparoscopic right hepatectomy in a patient with hepatocellular carcinoma (HCC) and metabolic syndrome
In this live interactive video, Professor Luc Soler provided a brief introduction of 3D reconstruction and modeling for precise tumor localization and future liver remnant before and after chemoembolization and right portal vein embolization. Dr. Soubrane briefly described the main principles, key steps, and preoperative planning in a 62-year-old male patient with hepatocellular carcinoma (HCC) and metabolic syndrome. He demonstrated the main technical aspects of port placement, hepatic pedicle dissection, exploration and dissection of vessels, and transection of liver parenchyma.
Robotic left lateral sectionectomy in cirrhotic liver
Background: Laparoscopy for cirrhotic patients can reduce intraoperative bleeding and postoperative morbidity when compared to open surgery. Liver robotic surgery remains a work in progress and only few series reported this approach for cirrhotic patients.
Methods: This is the case of a 62-year-old man with hepatitis C virus and alcoholic cirrhosis (MELD score 10, Child-Pugh score A6) with a single lesion in liver segment III and close to its pedicle.
Results: Intraoperative ultrasound was used to confirm findings on preoperative imaging.
Parenchymal transection was made with an ultrasonic scalpel, monopolar and bipolar cautery with no Pringle’s maneuver. Linear staplers were used to control left lobe inflow and outflow. The specimen was removed through a Pfannenstiel incision. The estimated blood loss was 100mL, and the postoperative course was uneventful. Pathological findings confirmed a 2.5cm hepatocellular carcinoma, with negative margins, and a cirrhotic parenchyma.
Conclusion: Robotic left lateral sectionectomy seems to be as feasible as the conventional laparoscopic approach in selected cirrhotic patients.
R Araujo, LA de Castro, F Felippe, D Burgardt, D Wohnrath
Surgical intervention
2 years ago
1798 views
165 likes
0 comments
07:47
Robotic left lateral sectionectomy in cirrhotic liver
Background: Laparoscopy for cirrhotic patients can reduce intraoperative bleeding and postoperative morbidity when compared to open surgery. Liver robotic surgery remains a work in progress and only few series reported this approach for cirrhotic patients.
Methods: This is the case of a 62-year-old man with hepatitis C virus and alcoholic cirrhosis (MELD score 10, Child-Pugh score A6) with a single lesion in liver segment III and close to its pedicle.
Results: Intraoperative ultrasound was used to confirm findings on preoperative imaging.
Parenchymal transection was made with an ultrasonic scalpel, monopolar and bipolar cautery with no Pringle’s maneuver. Linear staplers were used to control left lobe inflow and outflow. The specimen was removed through a Pfannenstiel incision. The estimated blood loss was 100mL, and the postoperative course was uneventful. Pathological findings confirmed a 2.5cm hepatocellular carcinoma, with negative margins, and a cirrhotic parenchyma.
Conclusion: Robotic left lateral sectionectomy seems to be as feasible as the conventional laparoscopic approach in selected cirrhotic patients.