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Hepatobiliary Surgeons (hepatobiliary + surgeon)

Distribution by Scientific Domains

Medical Sciences	75%

Selected Abstracts

Laparoscopic liver surgery: parenchymal transection using saline-enhanced electrosurgery

HPB, Issue 4 2008
A. J. KOFFRON
Abstract Minimally invasive liver resection (MILR) has evolved considerably in the past decade. Safe hepatic parenchymal transection, has been one of the technical hurdles that has become evident during the growth of MILR. Advances in technology have now made safe liver transection a reality allowing resections of greater magnitude. In this review, the precoagulation approach is described in both methodology and technique. Using this method of liver transection, we have been able to perform MILR of all varieties and magnitudes, with favorable patient outcomes. A detailed description of one particular device will be highlighted to disseminate our experience and thus broaden the technical options for hepatobiliary surgeons wishing to offer their patients a minimally invasive .therapy. [source]

Laparoscopic management of benign liver diseases: where are we?

HPB, Issue 4 2004
Jean-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]

Management of bile duct injury after laparoscopic cholecystectomy: a review

ANZ JOURNAL OF SURGERY, Issue 1-2 2010
Wan Yee Lau
Abstract Background:, Bile duct injury following cholecystectomy is an iatrogenic catastrophe which is associated with significant perioperative morbidity and mortality, reduced long-term survival and quality of life, and high rates of subsequent litigation. The aim of this article was to review the management of bile duct injury after cholecystectomy. Methods:, Medline and PubMed database search was undertaken to identify articles in English from 1970 to 2008 using the key words ,bile duct injury', ,cholecystectomy' and ,classification'. Additional papers were identified by a manual search of the references from the key articles. Case report was excluded. Results:, Early recognition of bile duct injury is of paramount importance. Only 25%,32.4% of injuries are recognized during operation. The majority of patients present initially with non-specific symptoms. Management depends on the timing of recognition, the type, extent and level of the injury. Immediate recognition and repair are associated with improved outcome, and the minimum standard of care after recognition of bile duct injury is immediate referral to a surgeon experienced in bile duct injury repair. There is a growing body of literature supporting the importance of early referral to a tertiary care hospital which can provide a multidisciplinary approach to treat bile duct injury. Inadequate management may lead to severe complications. Conclusions:, None of the classification system is universally accepted as each has its own limitation. The optimal management depends on the timing of recognition of injury, the extent of bile duct injury, the patient's condition and the availability of experienced hepatobiliary surgeons. [source]

Variant anatomy of the cystic artery in adult Kenyans

CLINICAL ANATOMY, Issue 8 2007
Hassan Saidi
Abstract Knowledge of the variant vascular anatomy of the subhepatic region is important for hepatobiliary surgeons in limiting operative complications due to unexpected bleeding. The pattern of arterial blood supply of 102 gallbladders was studied by gross dissection. The cystic artery originated from the right hepatic artery in 92.2% of cases. The rest were aberrant and originated from the proper hepatic artery. Accessory arteries were observed to originate from proper hepatic artery (n = 5), left hepatic artery (n = 2), and right hepatic artery (n = 1). Most of the arteries approached the gallbladder in relation to the common hepatic duct (anterior 45.1%, posterior, 46.1%). The other vessels passed anterior to common bile duct (2.9%), posterior to common bile duct (3.9%), or were given off in Calot's triangle. Cystic arteries in this data set show wide variations in terms of relationship to the duct systems. In about one tenth of patients, an accessory cystic artery may need to be ligated or clipped during cholecystectomy. Clin. Anat. 20:943,945, 2007. © 2007 Wiley-Liss, Inc. [source]