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Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences 6/2009

01.11.2009 | Topics

Laparoscopic major hepato-biliary-pancreatic surgery: formidable challenge to standardization

verfasst von: Akihiro Cho, Hiroshi Yamamoto, Matsuo Nagata, Nobuhiro Takiguchi, Hideaki Shimada, Osamu Kainuma, Hiroaki Souda, Hisashi Gunji, Akinari Miyazaki, Atsushi Ikeda, Tomoko Tohma, Ikuko Matsumoto

Erschienen in: Journal of Hepato-Biliary-Pancreatic Sciences | Ausgabe 6/2009

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Abstract

Introduction

Although laparoscopic colorectal or gastric surgery has become widely accepted as a superior alternative to conventional open surgery, the surgical management of hepato-biliary-pancreatic disease has traditionally involved open surgery. Recently, many reports have described laparoscopic partial liver resection, lateral segmentectomy, and distal pancreatectomy. However, laparoscopic major hepato-biliary-pancreatic surgery, such as hepatic lobectomy and pancreaticoduodenectomy, has not been widely developed because of technical difficulties.

Methods

We describe our experience with laparoscopic major hepato-biliary-pancreatic surgery, including right hepatectomy using hilar Glissonean pedicle transaction, and pylorus-preserving pancreaticoduodenectomy.

Conclusion

Although our experience is limited, and randomized study is necessary to elucidate the appropriate indications for and effects of the present procedures, we believe that laparoscopic major hepato-biliary-pancreatic surgery can be feasible, safe, and effective in highly selected patients, and that it will be one of the standard therapeutic options for carefully selected patients with hepato-biliary-pancreatic disease.
Literatur
1.
Zurück zum Zitat Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363:1187–92.CrossRefPubMed Leung KL, Kwok SP, Lam SC, Lee JF, Yiu RY, Ng SS, et al. Laparoscopic resection of rectosigmoid carcinoma: prospective randomised trial. Lancet. 2004;363:1187–92.CrossRefPubMed
2.
Zurück zum Zitat Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.CrossRefPubMed Guillou PJ, Quirke P, Thorpe H, Walker J, Jayne DG, Smith AM, et al. Short-term endpoints of conventional versus laparoscopic-assisted surgery in patients with colorectal cancer (MRC CLASICC trial): multicentre, randomised controlled trial. Lancet. 2005;365:1718–26.CrossRefPubMed
3.
Zurück zum Zitat Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.CrossRefPubMed Veldkamp R, Kuhry E, Hop WC, Jeekel J, Kazemier G, Bonjer HJ, et al. Laparoscopic surgery versus open surgery for colon cancer: short-term outcomes of a randomised trial. Lancet Oncol. 2005;6:477–84.CrossRefPubMed
4.
Zurück zum Zitat Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg. 2008;248:728–38.CrossRefPubMed Hewett PJ, Allardyce RA, Bagshaw PF, Frampton CM, Frizelle FA, Rieger NA, et al. Short-term outcomes of the Australasian randomized clinical study comparing laparoscopic and conventional open surgical treatments for colon cancer: the ALCCaS trial. Ann Surg. 2008;248:728–38.CrossRefPubMed
5.
Zurück zum Zitat Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.CrossRefPubMed Kim YW, Baik YH, Yun YH, Nam BH, Kim DH, Choi IJ, et al. Improved quality of life outcomes after laparoscopy-assisted distal gastrectomy for early gastric cancer: results of a prospective randomized clinical trial. Ann Surg. 2008;248:721–7.CrossRefPubMed
6.
Zurück zum Zitat Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol. 2008;15:2418–25.CrossRefPubMed Ng SS, Leung KL, Lee JF, Yiu RY, Li JC, Teoh AY, et al. Laparoscopic-assisted versus open abdominoperineal resection for low rectal cancer: a prospective randomized trial. Ann Surg Oncol. 2008;15:2418–25.CrossRefPubMed
7.
Zurück zum Zitat Memon MA, Khan S, Yunus RM, Barr R, Memon B. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc. 2008;22:1781–9.CrossRefPubMed Memon MA, Khan S, Yunus RM, Barr R, Memon B. Meta-analysis of laparoscopic and open distal gastrectomy for gastric carcinoma. Surg Endosc. 2008;22:1781–9.CrossRefPubMed
8.
Zurück zum Zitat Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: 5-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.CrossRefPubMed Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: 5-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.CrossRefPubMed
9.
Zurück zum Zitat Kaneko H, Takagi S, Shiba T. Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery. 1996;120:468–75.CrossRefPubMed Kaneko H, Takagi S, Shiba T. Laparoscopic partial hepatectomy and left lateral segmentectomy: technique and results of a clinical series. Surgery. 1996;120:468–75.CrossRefPubMed
10.
Zurück zum Zitat Cherqui D, Husson E, Hammoud R, Malassagne B, Stéphan F, Bensaid S, et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg. 2000;232:753–62.CrossRefPubMed Cherqui D, Husson E, Hammoud R, Malassagne B, Stéphan F, Bensaid S, et al. Laparoscopic liver resections: a feasibility study in 30 patients. Ann Surg. 2000;232:753–62.CrossRefPubMed
11.
Zurück zum Zitat Hashizume M, Shimada M, Sugimachi K. Laparoscopic hepatectomy: new approach for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2000;7:270–5.CrossRefPubMed Hashizume M, Shimada M, Sugimachi K. Laparoscopic hepatectomy: new approach for hepatocellular carcinoma. J Hepatobiliary Pancreat Surg. 2000;7:270–5.CrossRefPubMed
12.
Zurück zum Zitat Shimada M, Hashizume M, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc. 2001;15:541–4.CrossRefPubMed Shimada M, Hashizume M, Maehara S, Tsujita E, Rikimaru T, Yamashita Y, et al. Laparoscopic hepatectomy for hepatocellular carcinoma. Surg Endosc. 2001;15:541–4.CrossRefPubMed
13.
Zurück zum Zitat Kamiyama T, Kurauchi N, Nakagawa T, Nakanishi K, Kamachi H, Matsushita M, et al. Laparoscopic hepatectomy with the hook blade of ultrasonic coagulating shears and bipolar cautery with a saline irrigation system. J Hepatobiliary Pancreat Surg. 2005;12:49–54.CrossRefPubMed Kamiyama T, Kurauchi N, Nakagawa T, Nakanishi K, Kamachi H, Matsushita M, et al. Laparoscopic hepatectomy with the hook blade of ultrasonic coagulating shears and bipolar cautery with a saline irrigation system. J Hepatobiliary Pancreat Surg. 2005;12:49–54.CrossRefPubMed
14.
Zurück zum Zitat Kaneko H. Laparoscopic hepatectomy: indications and outcomes. J Hepatobiliary Pancreat Surg. 2005;12:438–43.CrossRefPubMed Kaneko H. Laparoscopic hepatectomy: indications and outcomes. J Hepatobiliary Pancreat Surg. 2005;12:438–43.CrossRefPubMed
15.
Zurück zum Zitat Mala T, Edwin B, Rosseland AR, Gladhaug I, Fosse E, Mathisen O. Laparoscopic liver resection: experience of 53 procedures at a single center. J Hepatobiliary Pancreat Surg. 2005;12:298–303.CrossRefPubMed Mala T, Edwin B, Rosseland AR, Gladhaug I, Fosse E, Mathisen O. Laparoscopic liver resection: experience of 53 procedures at a single center. J Hepatobiliary Pancreat Surg. 2005;12:298–303.CrossRefPubMed
16.
Zurück zum Zitat Takaori K, Tanigawa N. Laparoscopic pancreatic resection: the past, present, and future. Surg Today. 2007;37:535–45.CrossRefPubMed Takaori K, Tanigawa N. Laparoscopic pancreatic resection: the past, present, and future. Surg Today. 2007;37:535–45.CrossRefPubMed
17.
Zurück zum Zitat Ayav A, Bresler L, Brunaud L, Boissel P. Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg. 2005;390:134–40.CrossRefPubMed Ayav A, Bresler L, Brunaud L, Boissel P. Laparoscopic approach for solitary insulinoma: a multicentre study. Langenbecks Arch Surg. 2005;390:134–40.CrossRefPubMed
18.
Zurück zum Zitat Velanovich V. Case–control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg. 2006;10:95–8.CrossRefPubMed Velanovich V. Case–control comparison of laparoscopic versus open distal pancreatectomy. J Gastrointest Surg. 2006;10:95–8.CrossRefPubMed
19.
Zurück zum Zitat Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B. A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg. 2008;143:289–95.CrossRefPubMed Sa Cunha A, Rault A, Beau C, Laurent C, Collet D, Masson B. A single-institution prospective study of laparoscopic pancreatic resection. Arch Surg. 2008;143:289–95.CrossRefPubMed
20.
Zurück zum Zitat Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado MA, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11:1607–21.CrossRefPubMed Fernández-Cruz L, Cosa R, Blanco L, Levi S, López-Boado MA, Navarro S. Curative laparoscopic resection for pancreatic neoplasms: a critical analysis from a single institution. J Gastrointest Surg. 2007;11:1607–21.CrossRefPubMed
21.
Zurück zum Zitat Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005;137:597–605.CrossRefPubMed Mabrut JY, Fernandez-Cruz L, Azagra JS, Bassi C, Delvaux G, Weerts J, et al. Laparoscopic pancreatic resection: results of a multicenter European study of 127 patients. Surgery. 2005;137:597–605.CrossRefPubMed
22.
Zurück zum Zitat Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc. 2005;19:1028–34.CrossRefPubMed Dulucq JL, Wintringer P, Stabilini C, Feryn T, Perissat J, Mahajna A. Are major laparoscopic pancreatic resections worthwhile? A prospective study of 32 patients in a single institution. Surg Endosc. 2005;19:1028–34.CrossRefPubMed
23.
Zurück zum Zitat O’Rourke N, Fielding G. Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg. 2004;8:213–6.CrossRefPubMed O’Rourke N, Fielding G. Laparoscopic right hepatectomy: surgical technique. J Gastrointest Surg. 2004;8:213–6.CrossRefPubMed
24.
Zurück zum Zitat Eguchi D, Nishizaki T, Ohta M, Ishizaki Y, Hanaki N, Okita K, et al. Laparoscopy-assisted right hepatic lobectomy using a wall-lifting procedure. Surg Endosc. 2006;20:1326–8.CrossRefPubMed Eguchi D, Nishizaki T, Ohta M, Ishizaki Y, Hanaki N, Okita K, et al. Laparoscopy-assisted right hepatic lobectomy using a wall-lifting procedure. Surg Endosc. 2006;20:1326–8.CrossRefPubMed
25.
Zurück zum Zitat Dagher I, Caillard C, Proske JM, Carloni A, Lainas P, Franco D. Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg. 2008;206:756–60.PubMed Dagher I, Caillard C, Proske JM, Carloni A, Lainas P, Franco D. Laparoscopic right hepatectomy: original technique and results. J Am Coll Surg. 2008;206:756–60.PubMed
26.
Zurück zum Zitat Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, et al. Totally laparoscopic right hepatectomy. Am J Surg. 2007;194:685–9.CrossRefPubMed Gayet B, Cavaliere D, Vibert E, Perniceni T, Levard H, Denet C, et al. Totally laparoscopic right hepatectomy. Am J Surg. 2007;194:685–9.CrossRefPubMed
27.
Zurück zum Zitat Cho A, Asano T, Yamamoto H, Nagata M, Takiguchi N, Kainuma O. Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection. Surg Endosc. 2007;21:1466–8.CrossRefPubMed Cho A, Asano T, Yamamoto H, Nagata M, Takiguchi N, Kainuma O. Laparoscopy-assisted hepatic lobectomy using hilar Glissonean pedicle transection. Surg Endosc. 2007;21:1466–8.CrossRefPubMed
28.
Zurück zum Zitat Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.CrossRefPubMed Gagner M, Pomp A. Laparoscopic pylorus-preserving pancreatoduodenectomy. Surg Endosc. 1994;8:408–10.CrossRefPubMed
29.
Zurück zum Zitat Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20:1045–50.CrossRefPubMed Dulucq JL, Wintringer P, Mahajna A. Laparoscopic pancreaticoduodenectomy for benign and malignant diseases. Surg Endosc. 2006;20:1045–50.CrossRefPubMed
30.
Zurück zum Zitat Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205:222–30.CrossRefPubMed Palanivelu C, Jani K, Senthilnathan P, Parthasarathi R, Rajapandian S, Madhankumar MV. Laparoscopic pancreaticoduodenectomy: technique and outcomes. J Am Coll Surg. 2007;205:222–30.CrossRefPubMed
31.
Zurück zum Zitat Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech. 2008;18:13–8.CrossRefPubMed Pugliese R, Scandroglio I, Sansonna F, Maggioni D, Costanzi A, Citterio D, et al. Laparoscopic pancreaticoduodenectomy: a retrospective review of 19 cases. Surg Laparosc Endosc Percutan Tech. 2008;18:13–8.CrossRefPubMed
32.
Zurück zum Zitat Menon KV, Hayden JD, Prasad KR, Verbeke CS. Total laparoscopic pancreaticoduodenectomy and reconstruction for a cholangiocarcinoma of the bile duct. J Laparoendosc Adv Surg Tech A. 2007;17:775–80.CrossRefPubMed Menon KV, Hayden JD, Prasad KR, Verbeke CS. Total laparoscopic pancreaticoduodenectomy and reconstruction for a cholangiocarcinoma of the bile duct. J Laparoendosc Adv Surg Tech A. 2007;17:775–80.CrossRefPubMed
33.
Zurück zum Zitat Azagra JS, Goergen M, Gilbart E, Jacobs D. Laparoscopic anatomical (hepatic) left lateral segmentectomy—technical aspects. Surg Endosc. 1996;10:758–61.PubMed Azagra JS, Goergen M, Gilbart E, Jacobs D. Laparoscopic anatomical (hepatic) left lateral segmentectomy—technical aspects. Surg Endosc. 1996;10:758–61.PubMed
34.
Zurück zum Zitat Takasaki K, Kobayashi S, Tanaka S, Saito A, Yamamoto M, Hanyu F. Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg. 1990;75:73–7.PubMed Takasaki K, Kobayashi S, Tanaka S, Saito A, Yamamoto M, Hanyu F. Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg. 1990;75:73–7.PubMed
35.
Zurück zum Zitat Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg. 1998;5:286–91.CrossRefPubMed Takasaki K. Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg. 1998;5:286–91.CrossRefPubMed
36.
Zurück zum Zitat Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193:109–11.CrossRefPubMed Belghiti J, Guevara OA, Noun R, Saldinger PF, Kianmanesh R. Liver hanging maneuver: a safe approach to right hepatectomy without liver mobilization. J Am Coll Surg. 2001;193:109–11.CrossRefPubMed
37.
Zurück zum Zitat Ishida H, Furukawa Y, Kuroda H, Kobayashi M, Tsuneoka K. Laparoscopic observation and biopsy of the pancreas. Endoscopy 1981;13:68–73.CrossRefPubMed Ishida H, Furukawa Y, Kuroda H, Kobayashi M, Tsuneoka K. Laparoscopic observation and biopsy of the pancreas. Endoscopy 1981;13:68–73.CrossRefPubMed
38.
Zurück zum Zitat Warshaw AL, Gu ZY, Wittenberg J, Waltman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg. 1990;125:230–3.PubMed Warshaw AL, Gu ZY, Wittenberg J, Waltman AC. Preoperative staging and assessment of resectability of pancreatic cancer. Arch Surg. 1990;125:230–3.PubMed
39.
Zurück zum Zitat Cho A, Yamamoto H, Kainuma O, Miyazaki A, Ikeda A, Ryu M. Laparoscopy-assisted pylorus-preserving pancreaticodoudenectomy (in Japanese). Operation. 2008;62:1427–31. Cho A, Yamamoto H, Kainuma O, Miyazaki A, Ikeda A, Ryu M. Laparoscopy-assisted pylorus-preserving pancreaticodoudenectomy (in Japanese). Operation. 2008;62:1427–31.
40.
Zurück zum Zitat Imaizumi T, Hatori T, Tobita K, Fukuda A, Takasaki K, Makuuchi H. Pancreaticojejunostomy using duct-to-mucosa anastomosis without a stenting tube. J Hepatobiliary Pancreat Surg. 2006;13:194–201.CrossRefPubMed Imaizumi T, Hatori T, Tobita K, Fukuda A, Takasaki K, Makuuchi H. Pancreaticojejunostomy using duct-to-mucosa anastomosis without a stenting tube. J Hepatobiliary Pancreat Surg. 2006;13:194–201.CrossRefPubMed
41.
Zurück zum Zitat Imaizumi T, Harada N, Hatori T, Fukuda A, Takasaki K. Stenting is unnecessary in duct-to-mucosa pancreaticojejunostomy even in the normal pancreas. Pancreatology. 2002;2:116–21.CrossRefPubMed Imaizumi T, Harada N, Hatori T, Fukuda A, Takasaki K. Stenting is unnecessary in duct-to-mucosa pancreaticojejunostomy even in the normal pancreas. Pancreatology. 2002;2:116–21.CrossRefPubMed
42.
Zurück zum Zitat Dixon E, Vollmer CM Jr, Bathe OF, Sutherland F. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg. 2005;190:75–86.CrossRefPubMed Dixon E, Vollmer CM Jr, Bathe OF, Sutherland F. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg. 2005;190:75–86.CrossRefPubMed
43.
Zurück zum Zitat Smyrniotis V, Farantos C, Kostopanagiotou G, Arkadopoulos N. Vascular control during hepatectomy: review of methods and results. World J Surg. 2005;29:1384–96.CrossRefPubMed Smyrniotis V, Farantos C, Kostopanagiotou G, Arkadopoulos N. Vascular control during hepatectomy: review of methods and results. World J Surg. 2005;29:1384–96.CrossRefPubMed
44.
Zurück zum Zitat Maehara S, Adachi E, Shimada M, Taketomi A, Shirabe K, Tanaka S, et al. Clinical usefulness of biliary scope for Pringle’s maneuver in laparoscopic hepatectomy. J Am Coll Surg. 2007;205:816–8.CrossRefPubMed Maehara S, Adachi E, Shimada M, Taketomi A, Shirabe K, Tanaka S, et al. Clinical usefulness of biliary scope for Pringle’s maneuver in laparoscopic hepatectomy. J Am Coll Surg. 2007;205:816–8.CrossRefPubMed
45.
Zurück zum Zitat Rumstadt B, Schwab M, Korth P, Samman M, Trede M. Hemorrhage after pancreatoduodenectomy. Ann Surg. 1998;227:236–41.CrossRefPubMed Rumstadt B, Schwab M, Korth P, Samman M, Trede M. Hemorrhage after pancreatoduodenectomy. Ann Surg. 1998;227:236–41.CrossRefPubMed
46.
Zurück zum Zitat Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg. 1994;168:295–8.CrossRefPubMed Cullen JJ, Sarr MG, Ilstrup DM. Pancreatic anastomotic leak after pancreaticoduodenectomy: incidence, significance, and management. Am J Surg. 1994;168:295–8.CrossRefPubMed
Metadaten
Titel
Laparoscopic major hepato-biliary-pancreatic surgery: formidable challenge to standardization
verfasst von
Akihiro Cho
Hiroshi Yamamoto
Matsuo Nagata
Nobuhiro Takiguchi
Hideaki Shimada
Osamu Kainuma
Hiroaki Souda
Hisashi Gunji
Akinari Miyazaki
Atsushi Ikeda
Tomoko Tohma
Ikuko Matsumoto
Publikationsdatum
01.11.2009
Verlag
Springer Japan
Erschienen in
Journal of Hepato-Biliary-Pancreatic Sciences / Ausgabe 6/2009
Print ISSN: 1868-6974
Elektronische ISSN: 1868-6982
DOI
https://doi.org/10.1007/s00534-009-0144-0

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