Skip to main content
Erschienen in: Surgical Endoscopy 1/2021

28.01.2020 | Liver Resection

Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes

verfasst von: Jun Cao, Wen-da Li, Rui Zhou, Chang-zhen Shang, Lei Zhang, Hong-wei Zhang, Wan Yee Lau, Ya-jin Chen

Erschienen in: Surgical Endoscopy | Ausgabe 1/2021

Einloggen, um Zugang zu erhalten

Abstract

Background

The traditional open or laparoscopic segmentectomy of liver segment 7 (S7) requires exposing and controlling the root of the right hepatic vein(RHV)after full mobilization and lifting up of the right liver before liver transection. This approach violates the “no-touch” principle for malignant tumors, and makes laparoscopic resection technically challenging. So reports on isolated totally laparoscopic anatomic S7 segmentectomy have rarely been reported. This study describes our experience in laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes of the liver. To our knowledge, this is the first description of this novel approach.

Methods

From September 2017 to May 2019, patients who underwent laparoscopic anatomic S7 segmentectomy for hepatocellular carcinoma at the HPB Surgery Department, Sun Yat-Sen Memorial Hospital entered into this retrospective study. This in situ split approach was designed using main vessels as the plane markers of right intersectoral and intersegmental planes, along which liver transection was carried out. There was no need to mobilize the right liver and control the root of RHV.

Results

There were 9 women and 15 men. The average diameter of the tumors on preoperative CT/MR was 3.4 cm (range 2–6 cm). All the procedures were successfully carried out laparoscopically. There was no perioperative death. The average operative time was 216.5 min (range 180–310 min). The average blood loss was 320 ml (range 120–620 ml). Pathological study showed all the operations to be R0 resections.

Conclusion

Laparoscopic anatomic S7 segmentectomy using the in situ split approach resulted in R0 liver resection in all our patients with primary liver cancer. The operation was technically feasible and it provided a better view and increased maneuverability in the cramped operative space compared with the traditional open/laparoscopic approach. The approach also better complies with the “no-touch” principle for malignant tumors. Its long-term oncological outcomes require further studies.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
1.
Zurück zum Zitat Lim C, Ishizawa T, Miyata A et al (2016) Surgical indications and procedures for resection of hepatic malignancies confined to segment VII. Ann Surg 263:529–537CrossRef Lim C, Ishizawa T, Miyata A et al (2016) Surgical indications and procedures for resection of hepatic malignancies confined to segment VII. Ann Surg 263:529–537CrossRef
2.
Zurück zum Zitat Ishizawa T, Gumbs AA, Kokudo N et al (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRef Ishizawa T, Gumbs AA, Kokudo N et al (2012) Laparoscopic segmentectomy of the liver: from segment I to VIII. Ann Surg 256:959–964CrossRef
3.
Zurück zum Zitat Xiao L, Li J-W, Zheng S-G (2016) Laparoscopic anatomical segmentectomy of liver segments VII and VIII with the hepatic veins exposed from the head side (with videos). J Surg Oncol 114:752–756CrossRef Xiao L, Li J-W, Zheng S-G (2016) Laparoscopic anatomical segmentectomy of liver segments VII and VIII with the hepatic veins exposed from the head side (with videos). J Surg Oncol 114:752–756CrossRef
4.
Zurück zum Zitat Li W, Zhou X, Huang Z et al (2015) Laparoscopic surgery minimizes the release of circulating tumor cells compared to open surgery for hepatocellular carcinoma. Surg Endosc 29:3146–3153CrossRef Li W, Zhou X, Huang Z et al (2015) Laparoscopic surgery minimizes the release of circulating tumor cells compared to open surgery for hepatocellular carcinoma. Surg Endosc 29:3146–3153CrossRef
5.
Zurück zum Zitat Guerra F, Bonapasta SA, Annecchiarico M et al (2017) Liver malignancies in segment VII: the role of robot-assisted surgery. Ann Surg 265(6):E80CrossRef Guerra F, Bonapasta SA, Annecchiarico M et al (2017) Liver malignancies in segment VII: the role of robot-assisted surgery. Ann Surg 265(6):E80CrossRef
6.
Zurück zum Zitat Ichida H, Ishizawa T, Tanaka M et al (2017) Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors. Surg Endosc 31(3):1280–1286CrossRef Ichida H, Ishizawa T, Tanaka M et al (2017) Use of intercostal trocars for laparoscopic resection of subphrenic hepatic tumors. Surg Endosc 31(3):1280–1286CrossRef
7.
Zurück zum Zitat Lee W, Han H-S, Yoon Y-S et al (2014) Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8. J Hepatobiliary Pancreat Sci 21(8):E65–E68CrossRef Lee W, Han H-S, Yoon Y-S et al (2014) Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8. J Hepatobiliary Pancreat Sci 21(8):E65–E68CrossRef
8.
Zurück zum Zitat Li J, Ren H, Du G et al (2018) A systematic surgical procedure: The '7+3' approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52 patients with liver tumors. Oncol Lett 15(5):7846–7854PubMedPubMedCentral Li J, Ren H, Du G et al (2018) A systematic surgical procedure: The '7+3' approach to laparoscopic right partial hepatectomy [deep segment (S) VI, S VII or S VIII] in 52 patients with liver tumors. Oncol Lett 15(5):7846–7854PubMedPubMedCentral
9.
Zurück zum Zitat Okuda Y, Honda G, Kurata M et al (2015) A safe and valid procedure for pure laparoscopic partial hepatectomy of the most posterosuperior area: the top of segment 7. J Am Coll Surg 220(3):e17–21CrossRef Okuda Y, Honda G, Kurata M et al (2015) A safe and valid procedure for pure laparoscopic partial hepatectomy of the most posterosuperior area: the top of segment 7. J Am Coll Surg 220(3):e17–21CrossRef
10.
Zurück zum Zitat Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259CrossRef Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259CrossRef
12.
Zurück zum Zitat Figueroa R, Laurenzi A, Laurent A et al (2018) Perihilar glissonian approach for anatomical parenchymal sparing liver resections: technical aspects: the taping game. Ann Surg 267:537–543CrossRef Figueroa R, Laurenzi A, Laurent A et al (2018) Perihilar glissonian approach for anatomical parenchymal sparing liver resections: technical aspects: the taping game. Ann Surg 267:537–543CrossRef
13.
Zurück zum Zitat Inoue Y, Arita J, Sakamoto T et al (2015) Anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging. Ann Surg 262:105–111CrossRef Inoue Y, Arita J, Sakamoto T et al (2015) Anatomical liver resections guided by 3-dimensional parenchymal staining using fusion indocyanine green fluorescence imaging. Ann Surg 262:105–111CrossRef
14.
Zurück zum Zitat Cheng KC, Yeung YP, Hui J et al (2011) Multimedia manuscript: laparoscopic resection of hepatocellular carcinoma at segment 7: the posterior approach to anatomic resection. Surg Endosc 25(10):3437CrossRef Cheng KC, Yeung YP, Hui J et al (2011) Multimedia manuscript: laparoscopic resection of hepatocellular carcinoma at segment 7: the posterior approach to anatomic resection. Surg Endosc 25(10):3437CrossRef
15.
Zurück zum Zitat Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250:825–830CrossRef Buell JF, Cherqui D, Geller DA et al (2009) The international position on laparoscopic liver surgery: the Louisville statement, 2008. Ann Surg 250:825–830CrossRef
16.
Zurück zum Zitat Li W, Zhou X, Huang Z et al (2017) Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center. Hepatol Res 47:650–657CrossRef Li W, Zhou X, Huang Z et al (2017) Short-term and long-term outcomes of laparoscopic hepatectomy, microwave ablation, and open hepatectomy for small hepatocellular carcinoma: a 5-year experience in a single center. Hepatol Res 47:650–657CrossRef
17.
Zurück zum Zitat Cao J, Li G-L, Wei J-X et al (2019) Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc 33:633–638CrossRef Cao J, Li G-L, Wei J-X et al (2019) Laparoscopic duodenum-preserving total pancreatic head resection: a novel surgical approach for benign or low-grade malignant tumors. Surg Endosc 33:633–638CrossRef
18.
Zurück zum Zitat Kang W-H, Kim K-H, Jung D-H et al (2018) Long-term results of laparoscopic liver resection for the primary treatment of hepatocellular carcinoma: role of the surgeon in anatomical resection. Surg Endosc 32:4481–4490CrossRef Kang W-H, Kim K-H, Jung D-H et al (2018) Long-term results of laparoscopic liver resection for the primary treatment of hepatocellular carcinoma: role of the surgeon in anatomical resection. Surg Endosc 32:4481–4490CrossRef
19.
Zurück zum Zitat Kawaguchi Y, Fuks D, Kokudo N et al (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17CrossRef Kawaguchi Y, Fuks D, Kokudo N et al (2018) Difficulty of laparoscopic liver resection: proposal for a new classification. Ann Surg 267:13–17CrossRef
Metadaten
Titel
Totally laparoscopic anatomic S7 segmentectomy using in situ split along the right intersectoral and intersegmental planes
verfasst von
Jun Cao
Wen-da Li
Rui Zhou
Chang-zhen Shang
Lei Zhang
Hong-wei Zhang
Wan Yee Lau
Ya-jin Chen
Publikationsdatum
28.01.2020
Verlag
Springer US
Erschienen in
Surgical Endoscopy / Ausgabe 1/2021
Print ISSN: 0930-2794
Elektronische ISSN: 1432-2218
DOI
https://doi.org/10.1007/s00464-020-07376-z

Weitere Artikel der Ausgabe 1/2021

Surgical Endoscopy 1/2021 Zur Ausgabe

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.