Pure laparoscopic hepatectomy for hepatocellular carcinoma patients with severe liver cirrhosis

Morise, Zenichi; Sugioka, Atsushi; Kawabe, Norihiko; Umemoto, Shunji; Nagata, Hidetoshi; Ohshima, Hisanori; Kawase, Jin; Arakawa, Satoshi; Yoshida, Rie

doi:10.1111/j.1758-5910.2011.00081.x

Cited by 45 publications

(36 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…A key aim of our LLR is to carry out minimum dissection of the attachments and adhesions around the liver, in order to minimize the risk of damage to the environment around the liver. Most of our LLR patients have HCC/CLD and, occasionally, severe CLD patients undergo LLR[35]; this is partially due to the well-recognized situation in Japan involving a shortage of cadaver donors. Damage to the proximal environment associated with liver resection, such as dissection-related destruction of collateral venous/lymphatic flows, can easily lead to massive ascites and liver failure.…”

Section: Our Approach: Caudal Approach With Postural Changesmentioning

confidence: 99%

Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach

Morise¹

2016

WJG

View full text Add to dashboard Cite

Laparoscopic liver resection (LLR) for tumors in the posterosuperior liver [segment (S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space (rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed via the caudal approach with postural changes. The left lateral position is used for posterior sectionectomy and the semi-prone position is used for S7 segmentectomy and partial resections of S7 and deep S6 without combined intercostal ports insertion. Although the movement of instruments is restricted in the caudal approach, compared to the lateral approach, port placement in the para-vertebra area makes the manipulation feasible and stable, with minimum damage to the environment around the liver.

show abstract

Section: Our Approach: Caudal Approach With Postural Changesmentioning

confidence: 99%

Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach

Morise¹

2016

WJG

View full text Add to dashboard Cite

show abstract

“…We also experienced that the perioperative course of HCC patients with severe liver cirrhosis (Child-Pugh class B/C and ICG R15 of ≥ 40%) who underwent pure laparoscopic hepatectomy was favorable and comparable to that of the other HCC patients with mild/moderate liver cirrhosis [40] . As of 2012, 40 patients with HCC and chronic liver disease underwent pure laparoscopic hepatectomy in our hospital.…”

Section: Introductionmentioning

confidence: 99%

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Morise¹,

Kawabe

Kawase

et al. 2013

WJH

View full text Add to dashboard Cite

Pure laparoscopic hepatectomy is a less invasive procedure than conventional open hepatectomy for the resection of hepatic lesions. Increases in experiences with the technique, in combination with advances in technology, have promoted the popularity of pure laparoscopic hepatectomy. However, indications for usage and potential contraindications of the procedure remain unresolved. The characteristics and specific advantages of the procedure, especially for hepatocellular carcinoma (HCC) patients with chronic liver diseases, are reviewed and discussed in this paper. For cirrhotic patients with liver tumors, pure laparoscopic hepatectomy minimizes destruction of the collateral blood and lymphatic flow from laparotomy and mobilization, and mesenchymal injury from compression. Therefore, pure laparoscopic hepatectomy has the specific advantage of minimal postoperative ascites production that leads to lowering the risk of disturbance in water or electrolyte balance and hypoproteinemia. It minimizes complications that routinely trigger postoperative serious liver failure. Under adequate patient positioning and port arrangement, the partial resection of the liver in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated in pure laparoscopic surgery by providing good vision and manipulation in the small operative field. Furthermore, the features of reduced post-operative adhesion, good vision, and manipulation within the small area between the adhesions make this procedure safer in the context of repeat hepatectomy procedures. These improved features are especially advantageous for patients with liver cirrhosis and multicentric and/or metachronous HCCs. Key words: Laparoscopic hepatectomy; Hepatocellular carcinoma; Liver cirrhosis; Chronic liver disease; Liver Tumor; Liver resection; Repeat hepatectomy; Bridging therapy to transplantation; Ascites; Postoperative liver failure Core tip: For cirrhotic patients with liver tumor, pure laparoscopic hepatectomy minimizes destruction of the collateral blood/lymphatic flow from laparotomy and mobilization, and has advantage of minimal postoperative ascites. It restrains the complications, which trigger the postoperative liver failure. The partial resection in the area of subphrenic space, peri-inferior vena cava area or next to the attachment of retro-peritoneum is facilitated with good vision and manipulation in the small operative field. Furthermore, repeat pure laparoscopic hepatectomy for patients with multicentric/ metachronous hepatocellular carcinomas was feasible and safe with the advantages of less post-operative adhesion and good vision and manipulation between the adhesions.

show abstract

“…[31,32] Thus, LLR limits the occurrence of complications, such as massive ascites, which can lead to postoperative liver failure. [3] We also reported that the smaller working space required for LLR necessitated less adhesiolysis, with a direct approach to the region affected by the tumor being possible in repeat LLR.…”

Section: Discussionmentioning

confidence: 99%

“…[31,32] The deterioration of liver function should be minimized with the reduced adhesiolysis and dissection required during a laparoscopic approach. In addition, LLR better prepared patients both physically and psychologically for a subsequent repeat LR, illustrated by a shortened hospital stay for the patient reported here.…”

Section: Discussionmentioning

confidence: 99%

Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

Morise¹,

Isetani²,

Kawabe³

et al. 2016

View full text Add to dashboard Cite

A 73-year-old woman with liver cirrhosis caused by hepatitis C virus (HCV) underwent treatment of three hepatocellular carcinomas (HCCs) in liver segment 4, following three previous laparoscopic liver resections (LLRs) over 73 months. Contrast-enhanced computed tomography showed three 0.5-1.2 cm HCCs deep within the portal territories of subsegments 4a and 4b. The patient underwent laparoscopic resection of 4a and 4b, with the preservation of the portal branch to 4c, after minimal adhesiolysis around segment 4. The operation lasted 284 min, there was 50 mL of intra-operative bleeding and her recovery was uneventful. She was well, had experienced no recurrence and was HCV-negative, after taking oral anti-HCV therapy, 21 months later. LLR is associated with fewer adhesions after surgery and requires less adhesiolysis, because the laparoscope and forceps can be used in the small spaces between adhesions. The present patient underwent four LLRs over 6 years without severe deterioration of liver functional reserve. LLR is a useful localized therapy, which can be performed repeatedly and may prolong the survival of patients with multicentric metachronous HCCs. Key words:Laparoscopic liver resection, repeat liver resection, hepatocellular carcinoma, liver cirrhosis, anatomical liver resection, subsegmentectomy ABSTRACT Article history:

show abstract

Pure laparoscopic hepatectomy for hepatocellular carcinoma patients with severe liver cirrhosis

Cited by 45 publications

References 16 publications

Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach

Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach

Pure laparoscopic hepatectomy for hepatocellular carcinoma with chronic liver disease

Case report of the fourth laparoscopic liver resection and review of repeat laparoscopic resection for recurrent hepatocellular carcinoma in cirrhotic liver

Contact Info

Product

Resources

About