Modified Thoracoscopic Hepatectomy For Segment VIII

Li, Hongyu; Yue, Wei; Li, Bo; Peng, Bing

doi:10.1097/md.0000000000003801

Cited by 4 publications

(3 citation statements)

References 8 publications

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“…Sufficient and proper exposure of the surgical field and effective use of laparoscopic instruments are essential to avoid bleeding, diaphragmatic injury, and inadvertent open conversion [7]. Experts have introduced several techniques such as the left semi-decubitus, left full-decubitus, semiprone, and the French positions, or a combination of different approaches [5,[9][10][11][12][13][14][15][16][17][18][19]. Most of the authors insert an additional one to three intercostal trocars to facilitate liver resection.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic Minor Liver Resections for Hepatocellular Carcinoma in the Posterosuperior Segments Using the Rubber Band Technique

et al. 2022

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Background Although laparoscopic minor liver resections (LLR) of posterosuperior (PS) segments are technically challenging, several expert centers are increasingly performing this procedure. In the present study, we introduced novel techniques, including the rubber band traction method and positional changes, and compared surgical outcomes of LLR for hepatocellular carcinoma (HCC) located in PS segments with open minor liver resection (OLR). Methods From January 2008 to August 2019, 113 patients underwent laparoscopic (n = 55) or open (n = 58) minor liver resections for single small HCCs (\5 cm) located in PS segments. Propensity score matching in a 1:1 ratio was conducted to minimize preoperative selection bias, and surgical outcomes were compared between the two groups. Results There was no intraoperative mortality or reoperation in either group. One conversion to open surgery was necessary due to severe post-operative adhesions. The matched LLR group compared to OLR had significantly shorter operative time (215.16 vs. 251.41 min, P = 0.025), lesser blood loss (218.11 vs. 358.92 mL, P = 0.046), lower complication rate (8.1% vs. 29.7%, P = 0.018), and shorter hospital stay (7.03 vs. 11.78 days, P = 0.001). Intraoperative transfusion, R0 resection, resection margin, 5-year disease-free survival and 5-year overall survival were comparable. Conclusion Our standardized LLR provided improved short-term outcomes and similar long-term outcomes, when compared with OLR. With advanced techniques and accumulated surgical experience, LLR can be the first option for HCC in PS segments at expert centers.

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Section: Discussionmentioning

confidence: 99%

Laparoscopic Minor Liver Resections for Hepatocellular Carcinoma in the Posterosuperior Segments Using the Rubber Band Technique

et al. 2022

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“…Trans-thoracic trans-diaphragmatic surgical approach has also been described for lesions in the dome of the liver [12,[47][48][49] . This technique involves port placements into the thoracic cavity followed by trans-A B Figure 11.…”

Section: Trans-diaphragmatic Thoracoscopic Approachmentioning

confidence: 99%

“…A pure thoracoscopic approach may be particularly useful in patients with multiple previous abdominal surgeries so as to avoid difficult adhesiolysis in the scarred abdomen [49] . However, if there is a need to access the porta hepatis and hepatoduodenal ligament for the Pringle manoeuvre as well as survey the left lobe of the liver with intra-operative ultrasound, the surgery can be modified to involve two steps with an anterior trans-abdominal approach in the supine position followed by left lateral positioning with transthoracic approach [47] . In this approach, the pneumoperitoneum is evacuated prior to transthoracic port placement and diaphragmatic incision.…”

Section: Trans-diaphragmatic Thoracoscopic Approachmentioning

confidence: 99%

Patient and port positioning in laparoscopic liver resections

Thiruchelvam¹,

Lee²,

Chiow³

2021

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Currently, laparoscopic liver resections are routinely performed at an increasing number of centres and has extended to include major liver resections as well as more challenging segments of the liver. We believe that patient positioning and port placement is a critical yet under described component of successful laparoscopic liver resection to achieve optimal visualisation and allow for an ergonomic and safe dissection. In this article, we describe the advantages of various types of patient positioning as well as provide illustrations for an array of trocar configurations previously described in literature. Whilst there is no universally accepted standardization of port placement for various resection types, this descriptive article can serve as a guide for the various possibilities of port configurations that can be individually adapted by surgeons based on their preference as well as the patient's physique and anatomy.

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