AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put i...AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.展开更多
BACKGROUND Hepatic epithelioid hemangioendothelioma(HEHE)is a rare malignant vascular liver tumor diagnosed by histopathological evaluation.Standardized treatment is challenging because of its rarity;hepatectomy is pr...BACKGROUND Hepatic epithelioid hemangioendothelioma(HEHE)is a rare malignant vascular liver tumor diagnosed by histopathological evaluation.Standardized treatment is challenging because of its rarity;hepatectomy is preferred for solitary lesions and multiple transplantations.There is no consensus on the optimal treatment for HEHE;however,surgical excision is often considered effective.This report presents a case of initially suspected cholangiocarcinoma or renal cell carcinoma(RCC)metastasis,which was later confirmed as HEHE,with no recurrence during follow-up.CASE SUMMARY A 52-year-old man with a history of left nephrectomy for RCC presented with an incidentally detected liver mass and nonspecific abdominal discomfort.Imaging revealed a 3-cm centripetal enhancing lesion in the right hepatic dome with indeterminate malignant potential.The patient underwent a laparoscopic right anterior sectionectomy and remained recurrence-free without complications during the 3-year follow-up period.CONCLUSION Managing HEHE is challenging.Accurate diagnosis and surgical options,such as resection or transplantation,are essential with tailored multidisciplinary followup.The authors have read the CARE Checklist(2016)and the manuscript was prepared and revised according to the CARE Checklist(2016).展开更多
INTRODUCTION In 2002, Cherqui et al. reported the first purely laparoscopic living-donor left lateral sectionectomy （LDLLS）Yl This technique has now become a standardized procedure and has significantly shortened do...INTRODUCTION In 2002, Cherqui et al. reported the first purely laparoscopic living-donor left lateral sectionectomy （LDLLS）Yl This technique has now become a standardized procedure and has significantly shortened donor hospitalization.lZl The da Vinci robotic surgical system was introduced into the field of liver surgery more than 10 years ago. Its flexible mechanical ＂wrist＂ and stable three-dimensional （3D） visual field help minimize risks from complicated procedures.展开更多
Right umbilical portion(RUP) is a rare congenital anomaly associated with anomalous ramifications of the hepatic vessels and biliary system. As such, major hepatectomy requires a careful approach. We describe the usef...Right umbilical portion(RUP) is a rare congenital anomaly associated with anomalous ramifications of the hepatic vessels and biliary system. As such, major hepatectomy requires a careful approach. We describe the usefulness of the Glissonean approach in two patients with vessel anomalies, such as RUP. The first patient underwent a right anterior sectionectomy for intrahepatic cholangiocarcinoma. We encircled several Glissonean pedicles that entered the right anterior section along the right side of the RUP. We temporarily clamped each pedicle, confirmed the demarcation area, and finally cut them. The operation was performed safely and was successful. The second patient underwent a left trisectionectomy for perihilar cholangiocarcinoma. We secured the right posterior Glissonean pedicle. The vessels in the pedicle were preserved, and the other vessels and contents were resected. Identifying the vessels for preservation facilitated the safe lymphadenectomy and dissection of the vessels to be resected. We successfully performed the operation.展开更多
文摘AIM:To study our novel caudal approach laparoscopic posterior-sectionectomy with parenchymal transection prior to mobilization under laparoscopy-specific view.METHODS:Points of the procedure are:(1) Patients are put in left lateral position and posterior sector is not mobilized;(2) Glissonian pedicle of the sector is encircled and clamped extra-hepatically and divided afterward during the transection;(3) Dissection of inferior vena cava(IVC) anterior wall behind the liver is started from caudal.Simultaneously,liver transection is performed to search right hepatic vein(RHV) from caudal;(4) Liver transection proceeds to the bifurcation of the vessels from caudal to cranial,exposing the surfaces of IVC and RHV.Since the remnant liver sinks down,the cutting surface is well-opend;and(5) After the completion of transection,dissection of the resected liver from retroperitoneum is easily performed using the gravity.This approach was performed for a 63 years old woman with liver metastasis close to RHV.RESULTS:RHV exposure is required for R0 resection of the lesion.Although the cutting plane is horizontal in supine position and the gravity obstructs the exposure in the small subphrenic space,the use of specific characteristics of laparoscopic hepatectomy,such as the good vision for the dorsal part of the liver and IVC and facilitated dissection using the gravity with the patient positioning,made the complete RHV exposure during the liver transection easy to perform.The operation time was 341 min and operative blood loss was 1356 mL.Her postoperative hospital stay was uneventfull and she is well without any signs of recurrences 14 mo after surgery.CONCLUSION:The new procedure is feasible and useful for the patients with tumors close to RHV and the need of the exposure of RHV.
文摘BACKGROUND Hepatic epithelioid hemangioendothelioma(HEHE)is a rare malignant vascular liver tumor diagnosed by histopathological evaluation.Standardized treatment is challenging because of its rarity;hepatectomy is preferred for solitary lesions and multiple transplantations.There is no consensus on the optimal treatment for HEHE;however,surgical excision is often considered effective.This report presents a case of initially suspected cholangiocarcinoma or renal cell carcinoma(RCC)metastasis,which was later confirmed as HEHE,with no recurrence during follow-up.CASE SUMMARY A 52-year-old man with a history of left nephrectomy for RCC presented with an incidentally detected liver mass and nonspecific abdominal discomfort.Imaging revealed a 3-cm centripetal enhancing lesion in the right hepatic dome with indeterminate malignant potential.The patient underwent a laparoscopic right anterior sectionectomy and remained recurrence-free without complications during the 3-year follow-up period.CONCLUSION Managing HEHE is challenging.Accurate diagnosis and surgical options,such as resection or transplantation,are essential with tailored multidisciplinary followup.The authors have read the CARE Checklist(2016)and the manuscript was prepared and revised according to the CARE Checklist(2016).
文摘INTRODUCTION In 2002, Cherqui et al. reported the first purely laparoscopic living-donor left lateral sectionectomy （LDLLS）Yl This technique has now become a standardized procedure and has significantly shortened donor hospitalization.lZl The da Vinci robotic surgical system was introduced into the field of liver surgery more than 10 years ago. Its flexible mechanical ＂wrist＂ and stable three-dimensional （3D） visual field help minimize risks from complicated procedures.
文摘Right umbilical portion(RUP) is a rare congenital anomaly associated with anomalous ramifications of the hepatic vessels and biliary system. As such, major hepatectomy requires a careful approach. We describe the usefulness of the Glissonean approach in two patients with vessel anomalies, such as RUP. The first patient underwent a right anterior sectionectomy for intrahepatic cholangiocarcinoma. We encircled several Glissonean pedicles that entered the right anterior section along the right side of the RUP. We temporarily clamped each pedicle, confirmed the demarcation area, and finally cut them. The operation was performed safely and was successful. The second patient underwent a left trisectionectomy for perihilar cholangiocarcinoma. We secured the right posterior Glissonean pedicle. The vessels in the pedicle were preserved, and the other vessels and contents were resected. Identifying the vessels for preservation facilitated the safe lymphadenectomy and dissection of the vessels to be resected. We successfully performed the operation.
