Home About us Contact
|
Home About us Contact | ||
|
|
||
Laparoscopic Liver Resection (laparoscopic + liver_resection)
Selected AbstractsINLINE RADIOFREQUENCY ABLATION-ASSISTED LAPAROSCOPIC LIVER RESECTION: FIRST EXPERIMENT WITH STAPLING DEVICEANZ JOURNAL OF SURGERY, Issue 6 2007Peng Yao Background: In liver surgery, the increase in advancement of laparoscopic equipment has allowed the feasibility and safety of complex laparoscopic liver resection. However, blood loss and the potential risk of gas embolism seem to be the main obstacles. In this study, we successfully used the InLine radiofrquency ablation (RFA) device to carry out laparoscopic hand-assisted liver resection in pigs. Methods: Under general anaesthesia with tracheal intubation, pigs underwent InLine RFA-assisted laparoscopic liver resection. After installation of Hand Port and trocars, the InLine RFA device was introduced through Hand Port system and inserted into the premarked resection line. Then the generator was turned on and the power was applied according to the power setting. The resection was finally carried out using diathermy or stapler. For the control group, resection was simply carried out by diathermy or stapler. Results: Eight Landrace pigs underwent 23 liver resections. Blood loss was reduced significantly in the InLine group (P < 0.001) when compared with control group in both surgical methods (diathermy and stapler). Conclusion: In this study, we successfully carried out InLine RFA-assisted laparoscopic liver resection in both stapled and diathermy group. We showed that there was a highly significant difference between InLine and other liver resection techniques laparoscopically. [source] Open liver resection for colorectal metastases: better short- and long-term outcomes in patients potentially suitable for laparoscopic liver resectionHPB, Issue 6 2010Fenella Welsh No abstract is available for this article. [source] Open versus laparoscopic resection for liver tumoursHPB, Issue 6 2009Thomas Van Gulik Abstract Background:, The issue under debate is whether laparoscopic liver resections for malignant tumours produce outcomes which are comparable with conventional, open liver resections. Methods:, Literature review on liver resection and laparoscopy. Results:, There are no randomized controlled trials (RCTs) published that provide any evidence for the benefits of laparoscopic liver resections for liver tumours. In case,control series reporting short-term outcomes, laparoscopic liver resection has been shown to have the advantage of a reduced length of hospital stay. There are as yet, however, no adequate long-term survival studies demonstrating that laparoscopic liver resection is oncologically equivalent to open resection. Discussion:, The challenge for the near future is to test the oncological integrity of laparoscopic liver resection in controlled trials in the same way that we have learned from the RCTs carried out in laparoscopic resection for colorectal cancer. It is likely that laparoscopic liver resection will then have to compete with fast-track, open liver resection. Already, concerns have been raised regarding the learning curve required to master the techniques of laparoscopic liver resection. [source] The use of water-jet dissection in open and laparoscopic liver resectionHPB, Issue 4 2008H. G. RAU Abstract Background. We intend to give an overview of our experiences with the implementation of a new dissection technique in open and laparoscopic surgery. Methods. Our database comprises a total of 950 patients who underwent liver resection. Three hundred and fifty of them were performed exceptionally with the water-jet dissector. Forty-one laparoscopic partial liver resections were accomplished. Results. Using the water-jet dissection technique it was possible to reduce the blood loss, the Pringle- and resection time in comparison to CUSA® and blunt dissection. In the last five years we could reduce the Pringle-rate from 48 to 6% and the last 110 liver resections were performed without any Pringle's manoeuvre. At the same time, the transfusion-rate decreased from 1.86 to 0.46 EC/patient. In oncological resections, the used dissection technique had no influence on long-time survival. Conclusions. The water-jet dissection technique is fast, feasible, oncologically safe and can be used in open and in laparoscopic liver surgery. [source] Current techniques of liver transectionHPB, Issue 3 2007RONNIE T.P. POON The operative mortality rate of liver resection has decreased from 10% to 20% before the 1980s to <5% in most specialized hepatobiliary centers nowadays. The most important factor for better outcome is reduced blood loss due to improvement in surgical techniques. Liver transection is the most challenging part of liver resection, associated with a risk of massive hemorrhage. Understanding the segmental anatomy of the liver and delineation of the proper transection plane using intraoperative ultrasound are prerequisites to safe liver transection. Clamp crushing and ultrasonic dissection are the two most widely used transection techniques. In recent years, new instruments using different types of energy for coagulation or sealing of vessels have been developed for liver transection. These include radiofrequency devices, Harmonic Scalpel, Ligasure and TissueLink dissecting sealer. Whether these new instruments, used alone or in combination with clamp crushing or ultrasonic dissection, improve the safety of liver transection has not been clearly demonstrated. The use of the vascular stapler for transection of major intrahepatic vascular trunks is also gaining popularity. These new instruments are particularly useful in liver transection during laparoscopic liver resection. Adjunctive measures such as intermittent Pringle maneuver and low central venous pressure anesthesia are also useful measures to reduce the risk of hemorrhage. This article reviews the safety and efficacy of different techniques of liver transection, with particular attention to evidence from randomized controlled trials available in the literature. [source] LAPAROSCOPIC HEPATECTOMY, A SYSTEMATIC REVIEWANZ JOURNAL OF SURGERY, Issue 11 2007Jerome M. Laurence This systematic review was undertaken to assess the published evidence for the safety, feasibility and reproducibility of laparoscopic liver resection. A computerized search of the Medline and Embase databases identified 28 non-duplicated studies including 703 patients in whom laparoscopic hepatectomy was attempted. Pooled data were examined for information on the patients, lesions, complications and outcome. The most common procedures were wedge resection (35.1%), segmentectomy (21.7%) and left lateral segmentectomy (20.9%). Formal right hepatectomy constituted less than 4% of the reported resections. The conversion and complication rates were 8.1% and 17.6%, respectively. The mortality rate over all these studies was 0.8% and the median (range) hospital stay 7.8 days (2,15.3 days). Eight case,control studies were analysed and although some identified significant reductions in-hospital stay, time to first ambulation after surgery and blood loss, none showed a reduction in complication or mortality rate for laparoscopically carried out resections. It is clear that certain types of laparoscopic resection are feasible and safe when carried out by appropriately skilled surgeons. Further work is needed to determine whether these conclusions can be generalized to include formal right hepatectomy. [source] INLINE RADIOFREQUENCY ABLATION-ASSISTED LAPAROSCOPIC LIVER RESECTION: FIRST EXPERIMENT WITH STAPLING DEVICEANZ JOURNAL OF SURGERY, Issue 6 2007Peng Yao Background: In liver surgery, the increase in advancement of laparoscopic equipment has allowed the feasibility and safety of complex laparoscopic liver resection. However, blood loss and the potential risk of gas embolism seem to be the main obstacles. In this study, we successfully used the InLine radiofrquency ablation (RFA) device to carry out laparoscopic hand-assisted liver resection in pigs. Methods: Under general anaesthesia with tracheal intubation, pigs underwent InLine RFA-assisted laparoscopic liver resection. After installation of Hand Port and trocars, the InLine RFA device was introduced through Hand Port system and inserted into the premarked resection line. Then the generator was turned on and the power was applied according to the power setting. The resection was finally carried out using diathermy or stapler. For the control group, resection was simply carried out by diathermy or stapler. Results: Eight Landrace pigs underwent 23 liver resections. Blood loss was reduced significantly in the InLine group (P < 0.001) when compared with control group in both surgical methods (diathermy and stapler). Conclusion: In this study, we successfully carried out InLine RFA-assisted laparoscopic liver resection in both stapled and diathermy group. We showed that there was a highly significant difference between InLine and other liver resection techniques laparoscopically. [source] Ten-year experience of totally laparoscopic liver resection in a single institutionBRITISH JOURNAL OF SURGERY (NOW INCLUDES EUROPEAN JOURNAL OF SURGERY), Issue 3 2009A. Sasaki Background: Recent developments in liver surgery include the introduction of laparoscopic liver resection. The aim of the present study was to review a single institution's 10-year experience of totally laparoscopic liver resection (TLLR). Methods: Between May 1997 and April 2008, 82 patients underwent TLLR for hepatocellular carcinoma (HCC) (37 patients), liver metastases (39) and benign liver lesions (six). Operations included 69 laparoscopic wedge resections, 11 laparoscopic left lateral sectionectomies and two thoracoscopic wedge resections. Nine patients underwent simultaneous laparoscopic resection of colorectal primary cancer and synchronous liver metastases. Results: Median operating time was 177 (range 70,430) min and blood loss 64 (range 1,917) ml. Median tumour size and surgical margin were 25 (range 15,85) and 6 (range 0,40) mm respectively. One procedure was converted to a laparoscopically assisted hepatectomy. Three patients developed complications. Median postoperative stay was 9 (range 3,37) days. The overall 5-year survival rate after surgery for HCC and colorectal metastases was 53 and 64 per cent respectively. Conclusion: TLLR can be performed safely for a variety of primary and secondary liver tumours, and seems to offer at least short-term benefits in selected patients. Copyright © 2009 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd. [source] Open versus laparoscopic resection for liver tumoursHPB, Issue 6 2009Thomas Van Gulik Abstract Background:, The issue under debate is whether laparoscopic liver resections for malignant tumours produce outcomes which are comparable with conventional, open liver resections. Methods:, Literature review on liver resection and laparoscopy. Results:, There are no randomized controlled trials (RCTs) published that provide any evidence for the benefits of laparoscopic liver resections for liver tumours. In case,control series reporting short-term outcomes, laparoscopic liver resection has been shown to have the advantage of a reduced length of hospital stay. There are as yet, however, no adequate long-term survival studies demonstrating that laparoscopic liver resection is oncologically equivalent to open resection. Discussion:, The challenge for the near future is to test the oncological integrity of laparoscopic liver resection in controlled trials in the same way that we have learned from the RCTs carried out in laparoscopic resection for colorectal cancer. It is likely that laparoscopic liver resection will then have to compete with fast-track, open liver resection. Already, concerns have been raised regarding the learning curve required to master the techniques of laparoscopic liver resection. [source] Laparoscopic management of benign liver diseases: where are we?HPB, Issue 4 2004Jean-François Gigot Background The role of laparoscopic surgery in the management of benign cystic and solid liver tumours appears to differ according to each tumour type. As regards congenital liver cysts, laparoscopic treatment is now the gold standard for treating selected, huge, accessible, highly symptomatic or complicated cysts. In contrast, the laparoscopic approach is not useful for patients suffering from adult polycystic liver disease (PLD), except for type I PLD with large multiple hepatic cysts. For benign hepatocellular tumours, the surgical management has recently benefited from a better knowledge of the natural history of each type of tumour and from the improvement of imaging techniques in assuring a precise diagnosis of tumour nature. Thus the general tendency has led to a progressive restriction and tailoring of indications for resection in benign liver tumours, selecting only patients with huge, specifically symptomatic or compressive benign tumours or patients suffering from liver cell adenoma. Despite the enthusiastic use of the laparoscopic approach, selective indications for resection of benign liver tumours should indeed remain unchanged. For all types of benign liver tumours, the best indication remains small, superficial lesions, located in the anterior or the lateral segments of the liver. Deep, centrally located lesions or tumours in contact with major vascular or biliary trunks are not ideal candidates for laparoscopic liver resections. When performed by expert liver and laparoscopic surgeons using an adequate surgical technique, the laparoscopic approach is safe for performing minor liver resections and is accompanied by the usual postoperative benefits of laparoscopic surgery. When applied in selected patients and tumours, laparoscopic management of benign liver diseases appears to be a promising technique for hepatobiliary surgeons. [source] | ||||||||||