A new strategy of laparoscopic anatomical hemihepatectomy guided by the middle hepatic vein combined with transhepatic duct lithotomy for complex hemihepatolithiasis: A propensity score matching study

Liao, Cheng-Yu; Wang, Danfeng; Huang, Long; Bai, Yan; Yan, Mao-Lin; Zhou, Songqiang; Qiu, Funan; Lai, Zhide; Yaodong, Wang; Tian, Yuan; Zheng, Xiaochun; Chen, Shi

doi:10.1016/j.surg.2020.12.043

Cited by 9 publications

(2 citation statements)

References 46 publications

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“…However, compared to NAR, AR is associated with the adverse features of major liver resection, longer operating time, increased blood loss, and wider surgical margins, and is generally regarded as a more technically demanding operation [ 17 ]. Laparoscopic AR is even more challenging, especially for lesions located close to the main hepatic vein, portal vein, or inferior vena cava [ 18 , 19 ]. In this study, we applied 3DP models and ICG fluorescence imaging technology to LH for the treatment of complex liver lesions, and facilitated the procedures both safely and effectively.…”

Section: Discussionmentioning

confidence: 99%

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Cheng

Wang²,

Liu³

et al. 2022

PLoS ONE

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Background Laparoscopic hepatectomy (LH) has achieved rapid progress over the last decade. However, it is still challenging to apply laparoscopy to lesions located in segments I, VII, VIII, and IVa and the hepatic hilar region due to difficulty operating around complex anatomical structures. In this study, we applied three-dimensional printing (3DP) and indocyanine green (ICG) fluorescence imaging technology to complex laparoscopic hepatectomy (CLH) to explore the effects and value of the modified procedure. Materials and methods From January 2019 to January 2021, 54 patients with complex hepatobiliary diseases underwent LH at our center. Clinical data were collected from these patients and retrospectively analyzed. Results A total of 30 patients underwent CLH using the conventional approach, whereas 24 cases received CLH with 3DP technology and ICG fluorescent navigation. Preoperative data were compared between the two groups. In the 3DP group, we modified the surgical strategy of four patients (4/24, 16.7%) due to real-time intraoperative navigation with 3DP and ICG fluorescent imaging technology. We did not modify the surgical strategy for any patient in the non-3DP group (P = 0.02). There were no significant differences between the non-3DP and 3DP groups regarding operating time (297.7±104.1 min vs. 328.8±110.9 min, P = 0.15), estimated blood loss (400±263.8 ml vs. 345.8±356.1 ml, P = 0.52), rate of conversion to laparotomy (3/30 vs. 2/24, P = 0.79), or pathological outcomes including the incidence of microscopical R0 margins (28/30 vs. 24/24, P = 0.57). Additionally, there were no significant differences in postoperative complications or recovery conditions between the two groups. No instances of 30- or 90-day mortality were observed. Conclusion The optimal surgical strategy for CLH can be chosen with the help of 3DP technology and ICG fluorescent navigation. This modified procedure is both safe and effective, but without improvement of intraoperative and short-term outcomes.

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Section: Discussionmentioning

confidence: 99%

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Cheng

Wang²,

Liu³

et al. 2022

PLoS ONE

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“…First, we only included patients with advanced-stage ICC, all of whom received LND because of preoperative suspicious LNs. Second, our center is the largest hepato-biliary-pancreatic center in Southeast China, and has extensive experience in laparoscopic liver resection and LND [ 56 , 57 ]. Third, at a technical level, removal of the lesion improves the visual field when there is no occlusion by LNs.…”

Section: Discussionmentioning

confidence: 99%

Optimization of a laparoscopic procedure for advanced intrahepatic cholangiocarcinoma based on the concept of “waiting time”: a preliminary report

et al. 2022

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Introduction Clinicians increasingly perform laparoscopic surgery for intrahepatic cholangiocarcinoma (ICC). However, this surgery can be difficult in patients with advanced-stage ICC because of the complicated procedures and difficulty in achieving high-quality results. We compared the effects of a three-step optimized procedure with a traditional procedure for patients with advanced-stage ICC. Methods Forty-two patients with advanced-stage ICC who received optimized laparoscopic hemihepatectomy with lymph node dissection (LND, optimized group) and 84 propensity score-matched patients who received traditional laparoscopic hemihepatectomy plus LND (traditional group) were analyzed. Surgical quality, disease-free survival (DFS), and overall survival (OS) were compared. Results The optimized group had a lower surgical bleeding score (P = 0.038) and a higher surgeon satisfaction score (P = 0.001). Blood loss during hepatectomy was less in the optimized group (190 vs. 295 mL, P < 0.001). The optimized group had more harvested LNs (12.0 vs. 8.0, P < 0.001) and more positive LNs (8.0 vs. 5.0, P < 0.001), and a similar rate of adequate LND (88.1% vs. 77.4%, P = 0.149). The optimized group had longer median DFS (9.0 vs. 7.0 months, P = 0.018) and median OS (15.0 vs. 13.0 months, P = 0.046). In addition, the optimized group also had a shorter total operation time (P = 0.001), shorter liver resection time (P = 0.001), shorter LND time (P < 0.001), shorter hospital stay (P < 0.001), and lower incidence of total morbidities (14.3% vs. 36.9%, P = 0.009). Conclusions Our optimization of a three-step laparoscopic procedure for advanced ICC was feasible, improved the quality of liver resection and LND, prolonged survival, and led to better intraoperative and postoperative outcomes.

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A hemodynamic study of the relationship between the left and right liver volumes and the blood flow distribution in portal vein branches

Xie,

Sun,

Huang

et al. 2024

Medical Physics

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BackgroundCirrhosis patients often exhibit clinical symptoms such as right liver atrophy, portal hypertension, spleen enlargement and increased blood supply, which exhibit considerable variation between the left and right liver sections. These differences are hypothesized to stem from disparities in blood flow within the left and right portal vein (PV) branches. However, rigorous quantitative evidence remains scarce.PurposeWe mainly aim at quantitatively revealing the relationship between the blood flow rates of two PV branches and liver volumes, and providing quantitative evidence and theoretical support for the diagnosis and treatment of cirrhosis from the perspective of hemodynamics.MethodsFive cirrhotic patients and two healthy volunteers from Beijing Friendship Hospital are investigated. Their PV blood flow models are established based on computed tomography (CT) images and finite volume simulations. The volume of the left and right liver lobes are measured in 3‐matic. The distributions of blood source in the PV branches are tracked by streamline analysis. The blood flow rates are quantitatively counted by integrating the blood source velocities. Linear analysis is performed to build the relationship between liver volumes and PV blood flow distributions.ResultsStreamline analysis reveals significant differences in blood distribution between the left and right PV branches. The majority of blood from the superior mesenteric vein (SMV) flowed into the right portal vein (RPV), while most blood from the splenic vein (SV) entered the left portal vein (LPV). The main PV pressure drop linearly increases with the SV blood velocity for all PV structures of patients and healthy volunteers. The flow rate ratio QRPV/QLPV demonstrates an increase in tandem with the volume ratio VR/VL, exhibiting a linear correlation with the Pearson correlation coefficient being 0.93.ConclusionThe differences in the blood distributions are consistent with the clinicians’ knowledge and validate our simulations. We demonstrated a linear increase in PV pressure with elevated SV blood velocity. Additionally, the volumes of the left and right hepatic lobes exhibited a positive correlation with blood flow rates in the corresponding PV branches.

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A new strategy of laparoscopic anatomical hemihepatectomy guided by the middle hepatic vein combined with transhepatic duct lithotomy for complex hemihepatolithiasis: A propensity score matching study

Cited by 9 publications

References 46 publications

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Value of 3D printing technology combined with indocyanine green fluorescent navigation in complex laparoscopic hepatectomy

Optimization of a laparoscopic procedure for advanced intrahepatic cholangiocarcinoma based on the concept of “waiting time”: a preliminary report

A hemodynamic study of the relationship between the left and right liver volumes and the blood flow distribution in portal vein branches

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