Liver resection for hepatocellular carcinoma(HCC)is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-li...Liver resection for hepatocellular carcinoma(HCC)is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis.The aim of this review is to assess current indications,advantages and limits of laparoscopic surgery for HCC resections.We also discussed the possible evolution of this surgical approach in parallel with new technologies.展开更多
Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic c...Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy(SILC), minilaparoscopic cholecystectomy(MLC) and natural orifice transluminal endoscopic surgery(NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.展开更多
Hepatic resection is the gold standard for patients affected by primary or metastatic liver tumors but is hampered by the risk of post-hepatectomy liver failure.Despite recent impro-vements,liver surgery still require...Hepatic resection is the gold standard for patients affected by primary or metastatic liver tumors but is hampered by the risk of post-hepatectomy liver failure.Despite recent impro-vements,liver surgery still requires excellent clinical judgement in selecting patients for surgery and,above all,efficient pre-operative strategies to provide adequate future liver remnant.The aim of this article is to review the literature on the rational,the preliminary assessment,the advantages as well as the limits of each existing technique for preparing the liver for major hepatectomy.展开更多
To the Editor:Melanoma is an aggressive malignant tumor that arises from melanocytic cells. It usually originates from the epithelial tissues of the skin, retina and anorectal canal. Melanoma is characterized by early...To the Editor:Melanoma is an aggressive malignant tumor that arises from melanocytic cells. It usually originates from the epithelial tissues of the skin, retina and anorectal canal. Melanoma is characterized by early metastases, even from thin primary tumors. The most common sites of distant metastasis are: skin, lung, brain, liver, bone and intestine. Liver involvement occurs in 14% to 20% of cases [1] , but the diagnosis is usually performed incidentally on imaging studies, since these lesions are seldom symptomatic. Rarely, metastatic hepatic melanoma can manifest as an acute condition of massive bleeding due to spontaneous rupture of one or more hepatic lesions, with disastrous outcomes for patients in most cases. In the current literature, very few cases of spontaneous rupture of metastatic hepatic melanoma have been reported, all with fatal outcomes [2–5] . Indeed, when such a condition occurs, prompt management and bleeding control strategies are essential for long-term survival of these patients.展开更多
文摘Liver resection for hepatocellular carcinoma(HCC)is currently known to be a safer procedure than it was before because of technical advances and improvement in postoperative patient management and remains the first-line treatment for HCC in compensated cirrhosis.The aim of this review is to assess current indications,advantages and limits of laparoscopic surgery for HCC resections.We also discussed the possible evolution of this surgical approach in parallel with new technologies.
文摘Laparoscopic cholecystectomy is the most commonlyperformed abdominal intervention in Western countries. In an attempt to reduce the invasiveness of the procedure, surgeons have developed single-incision laparoscopic cholecystectomy(SILC), minilaparoscopic cholecystectomy(MLC) and natural orifice transluminal endoscopic surgery(NOTES). The aim of this review was to determine the role of these new minimally invasive approaches for elective laparoscopic cholecystectomy in the treatment of gallstone related disease. Current literature remains insufficient for the correct assessment of emerging techniques for laparoscopic cholecystectomy. None of these procedures has demonstrated clear benefits over conventional laparoscopic cholecystectomy. SILC cannot be currently recommended as it can be associated with an increased risk of bile duct injury and incisional hernia incidence. NOTES cholecystectomy is still experimental, although hybrid transvaginal cholecystectomy is gaining popularity in clinical practice. As it is standardized and almost identical to the standard laparoscopic technique, MLC could lead to limited benefits without exposing patients to increased postoperative complications, being therefore adoptable for routine elective cholecystectomy. Technical challenges of SILC and NOTES cholecystectomy could be addressed with the evolution of new surgical tools that need to catch up with the innovative minds of surgeons. Regardless the place of these approaches in the future, robotization may be necessary to impose them as standard treatment.
文摘Hepatic resection is the gold standard for patients affected by primary or metastatic liver tumors but is hampered by the risk of post-hepatectomy liver failure.Despite recent impro-vements,liver surgery still requires excellent clinical judgement in selecting patients for surgery and,above all,efficient pre-operative strategies to provide adequate future liver remnant.The aim of this article is to review the literature on the rational,the preliminary assessment,the advantages as well as the limits of each existing technique for preparing the liver for major hepatectomy.
文摘To the Editor:Melanoma is an aggressive malignant tumor that arises from melanocytic cells. It usually originates from the epithelial tissues of the skin, retina and anorectal canal. Melanoma is characterized by early metastases, even from thin primary tumors. The most common sites of distant metastasis are: skin, lung, brain, liver, bone and intestine. Liver involvement occurs in 14% to 20% of cases [1] , but the diagnosis is usually performed incidentally on imaging studies, since these lesions are seldom symptomatic. Rarely, metastatic hepatic melanoma can manifest as an acute condition of massive bleeding due to spontaneous rupture of one or more hepatic lesions, with disastrous outcomes for patients in most cases. In the current literature, very few cases of spontaneous rupture of metastatic hepatic melanoma have been reported, all with fatal outcomes [2–5] . Indeed, when such a condition occurs, prompt management and bleeding control strategies are essential for long-term survival of these patients.
