Name: transradial access chemoembolization for hepatocellular carcinoma patients
Uploaded: 2020-09-20T13:00:00.000+00:00
Duration: 5 min 31 s
Description: Watch this Scientific Journal Video about Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients at JoVE.com

这项工作得到了复旦大学中山医院临床研究专项基金（2016ZSLC17）的支持。作者非常感谢复旦大学中山医院胡祥林博士对英语写作的专业建议。

这项单中心回顾性研究得到了复旦大学中山医院地方机构评审委员会的批准。
1. 获得知情同意
<ol><li>在TRA干预之前，请介入放射科医生（IRs）向患者解释TRA的好处和潜在的并发症。</li>
</ol>2. 患者评价
<ol><li>在获得知情同意后，评估 RA 的穿刺和罐装的可行性。</li>
	<li>全面回顾患者的病史。确认患者是否患有严重的血管结肠炎、严重的周围血管疾病、透析的膀胱或 RA 透析手术的准备。这些是接受TRA干预的患者的相对禁忌症。</li>
	<li>评估 RA 的可见性。<ol>
<li>使用脉冲氧化测量进行巴博测试，以评估干预11之前手部辅助动脉的可见度。巴博 D 波形被认为是 RA 罐装的绝对禁忌。</li>
		<li>对于测试为 Barbeau C 波形的患者，应用多普勒超声波检查，以提供有关前臂和手部附带循环量的更可靠的信息。内径小于 2 毫米被视为禁忌症。 注:在病史评估和RA评估后，禁忌症患者应避免通过ipsilaterAL进行穿刺。如果通过 Barbeau 测试评估发现该 RA 是专利，则反向 RA 可能会成为理想的供应。左 RA 最初被选为首选访问路线。如果发现左 RA 不合适，右 RA 可能会作为替代选择。</li>
	</ol>
</li>
</ol>3. 径向动脉通道
<ol><li>将患者置于血管造影表的上位。然后，将左臂与患者的身体平行，靠近左腰，方便放置导管和导线，使操作员的定位与 TFA 相媲美。</li>
	<li>按触觉标记脱位RA脉冲。用 10% 的 povidone 碘手术磨砂溶液清洁皮肤表面，并允许溶液使空气干燥。用手术窗帘盖住左臂。<ol>
<li>如果潜在的左 RA 穿刺失败，请通过消毒和拖曳右臂或右侧内侧区域来准备替代访问路线。</li>
	</ol>
</li>
	<li>应用局部麻醉（即利多卡因1 mL 2%）沿着左 RA 最强大的脉动轴线的样式过程近似。</li>
	<li>延长手腕，使用改良的塞尔丁格技术用 20 G 针刺穿 RA。当脉动动脉血液返回被观察到时，引入一条0.025英寸的亲水导线。<ol>
<li>如果遇到阻力，请收回导线并重新调整针头。不要强制插入导线。在数字减法血管造影术 （DSA） 的帮助下，注入约 1 到 2 mL 的对比度，以突出 RA 并帮助插入亲水导线。</li>
	</ol>
</li>
	<li>一旦获得访问，取出针头，并引入一个4-法国亲水护套与导线。插入护套后，用注射器轻轻泵回少量动脉血，以确认护套尖端在容器内。</li>
</ol>4. 抗凝和血管扩散
<ol><li>准备 10 mL 的血管化鸡尾酒溶液（3，000 IU 未受破坏的肝素、0.1 毫克硝化甘油和 20 毫克利多卡因）。</li>
	<li>以 0.5 mL/s 的速度通过护套管理 8 mL 的血管化鸡尾酒解决方案（图 1）。 注意:减少或停止中度或高出血风险患者的肝素剂量。</li>
</ol>5. 导管选择
<ol><li>使用 4-French，125 厘米普通导管和标准 0.035 英寸 x 180 厘米亲水线穿过亚克拉维安动脉，并接合下降的主动脉。使用 DSA 荧光镜在手臂内导航期间可视化近轴动脉，以避免动脉环或血管侵权的潜在病变。 注:亚克拉维安动脉有许多动脉分支。血管学导管可防止导管导管在逆行导管过程中进入辅助容器。少数情况下径向动脉有动脉环。如果标准电线无法通过环路，建议使用微型信箱和角度为 0.016 英寸或 0.018 英寸的微线。</li>
	<li>使用 4-French，125 厘米普通导管与标准 0.035 英寸导线组合，协商横向拱门，将导线引导到下降的主动脉。 注:如果主动脉和左亚克拉维安动脉之间的角度非常尖锐，建议使用眼镜蛇 2 形导管（如西蒙斯 I 或西蒙斯 II 导管）来完成此转弯。</li>
	<li>下降主动脉导管后，通过同轴技术更换普通导管。一旦将公用导管插入下降的主动脉，在 DSA 荧光镜检查的指导下，将导管尖直通，进行腹腔躯干导管。在大多数情况下，很容易导管和进行血管造影的腹腔树干，肝动脉，和优越的中动脉。 注意:如果腹腔动脉和下降主动脉之间的角度非常尖锐，请使用眼镜蛇导管完成手术。</li>
	<li>对于肝栓塞程序，使用同轴技术进行超选择性导管和化疗，并将一个2.8-French 150cm的微导管放入喂养肿瘤的肝动脉靶向分支（图2）。根据疾病负担和患者偏好执行 TACE。</li>
	<li>使用高压喷油器通过普通导管进行血管造影，以确认足够的栓塞。导管尖端通常位于常见的肝动脉中。以每秒 3-4 mL 的速度注入 9-12 mL 的对比剂，荧镜检查时间为 15 秒。然后，在导管上取下导管，以避免对 RA 造成损坏。</li>
</ol>6. 径向动脉血吸虫病
注:非包容性血吸虫使用特殊的旅行服进行，以保持RA的父权（图3）。
<ol><li>通过 RA 护套管理剩余的 2 mL 血管化鸡尾酒解决方案（第 4 节）。紧接着，取回约5厘米的护套。</li>
	<li>在左手腕的径向通道上放置一个旅游通道，并使用随附的注射器用空气充分充气。然后完全取下护套，慢慢放气袋。在访问站点观察到泄漏时，将 1 mL 的空气重新添加到袖口中。通常，在气囊中加入 10-15 mL 的空气以保持血吸。</li>
	<li>确认没有出血或泄漏。同时，确保断端径向动脉脉搏在血吸期间明显。使用脉冲氧化计波形来确认左拇指上的动脉波形。</li>
	<li>以每2小时~2 mL的速度慢慢充气，不超过6小时。再次确认，一旦手术后6小时切除导体，就会完成止血。 注意:如果在通缩期间观察到穿刺部位出血或泄漏，空气会重新添加到空气囊中 30 分钟，并重复这个过程。</li>
	<li>出院前，进行巴博测试，以确认RA的性格，并记录患者的径向动脉闭塞和密切跟踪。</li>
</ol>7. 跟进
<ol><li>干预约1个月后，给TRA患者进行彻底的身体检查，包括检查左手腕和脉搏检查。对于可能被遮挡的 RA 患者，使用前臂多普勒超声波或脉搏氧化术对手部血液供应进行后续评估。</li>
	<li>在 TACE 之后密切跟踪所有患者。如果新的肿瘤结节在CT扫描中明显，并且初始病变似乎重新血管化，则执行另一种 TACE 治疗。</li>
</ol>

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L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+Approach+for+Hepatic+Radioembolization:+Initial+Results+and+Technique.">Transradial Approach for Hepatic Radioembolization: Initial Results and Technique.</a> AJR: American Journal of Roentgenology. 207 (5), 1112-1121 (2016).</li><li>Bernat, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ST-segment+elevation+myocardial+infarction+treated+by+radial+or+femoral+approach+in+a+multicenter+randomized+clinical+trial:+the+STEMI-RADIAL+trial.">ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial.</a> Journal of the American College of Cardiology. 63 (10), 964-972 (2014).</li></ol>

研究WZ和ZPY的概念和设计;通过ND、ZHZ和MJY获取数据;由ZPY获得资金。提交人没有相关的财务披露。

近年来，TRA介入疗法在全球显著增长，特别是在诊断和介入心脏病学程序12。此外，人们越来越重视外周血管疾病干预。在不影响程序成功率的情况下，TRA到心脏干预可以有效地降低出血率和血管并发症相比，TFA13，14。与 TFA 相比，TRA 在多个能力方面都更胜一筹，包括手术后的监测时间、消沉时间以及更高的患者总体满意度 15、16、17?...

肝细胞癌（HCC）是一种非常常见的恶性肿瘤，发病率居世界第六位。这也是全球癌症死亡率的第二大原因。因为只有5%-20%的患者可以接受治疗，跨动脉化疗（TACE）是HCC2患者最流行的姑息治疗。TACE 已被公认为中度3期 HCC 患者最常用和最有效的治疗方法。跨女性获取 （TFA） 化疗是 TACE4最常见的方法。然而，有与TFA干预相关的风险，包括进入现场出血和主要血管并发症5。这些并发症导致长期住院和增加费用。此外，TFA 要求固定至少 6 小时，这增加了患者的不适和不满。
跨径向访问 （TRA） 是一种替代方法，已用于皮下冠状动脉干预 （PCI） 超过20年 5，6。TRA PCI有几个优点:增加手术舒适性，减少接触部位相关的出血，减少主要血管并发症，降低死亡率7，8。径向动脉（RA）是很容易访问和穿刺，因为它的表面位置7。血吸虫病易于干预后进行，没有严格的熏蒸9。尽管在心脏导管治疗方面有令人鼓舞的 TRA 干预证据，但迄今为止，只有少数研究在周围疾病干预中使用了 TRA。恶性肝肿瘤的TRA干预更为罕见。分析了TRA肝栓塞的临床可行性和安全性。还介绍了一个机构在提供分步 TRA 协议方面的经验。

<table><tbody><tr><td>&lt;strong&gt;Reagents&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Embosphere</td><td>Merit</td><td>20173776165</td><td></td></tr><tr><td>Gelfoam</td><td>Alicon</td><td>20143771056</td><td></td></tr><tr><td>Heparin</td><td>Hepatunn</td><td>H51021209</td><td></td></tr><tr><td>Injection syringe</td><td>KDL</td><td>20163150518</td><td></td></tr><tr><td>Iodinated oil</td><td>Yantai Luyin Pharmaceutical Co.Ltd</td><td>H37022398</td><td></td></tr><tr><td>Lidocaine</td><td>Shandong Hualu Pharmaceutical Co.Ltd</td><td>H37022147</td><td></td></tr><tr><td>Lobaplatin</td><td>Hainan Changan International Pharmaceutical Co.Ltd</td><td>H20050308</td><td></td></tr><tr><td>Nitroglycerin</td><td>Brijing Yimin Pharmaceutical Co.Ltd</td><td>H11020289</td><td></td></tr><tr><td>Normal saline</td><td>Anhui Shuanghe Pharmaceutical Co.Ltd</td><td>H34023609</td><td></td></tr><tr><td>Pharmorubicin</td><td>Pfizer</td><td>H20000496</td><td></td></tr><tr><td>Ultravist 370</td><td>Bayer</td><td>H20171333</td><td></td></tr><tr><td>&lt;strong&gt;Material&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Hydrophilic Guide Wire</td><td>Merit</td><td>LWSTDA38180</td><td></td></tr><tr><td>Injection syringe</td><td>KDL</td><td>20163150518</td><td></td></tr><tr><td>Maestro Microcatheter</td><td>Merit</td><td>28MC24150SN</td><td></td></tr><tr><td>MPA1 (I) catheter</td><td>Cordis</td><td>451-406P0</td><td></td></tr><tr><td>Sheath Introducer</td><td>Merit</td><td>PSI-4F-11-035</td><td></td></tr><tr><td>Steerable Guidewire</td><td>Merit</td><td>TNR2411</td><td></td></tr><tr><td>TR Band</td><td>Terumo</td><td>XX*RF06</td><td></td></tr><tr><td>&lt;strong&gt;Equipment&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>DSA</td><td>Toshiba</td><td>INFX-9000V</td><td></td></tr><tr><td>Ultrasonic machine</td><td>SonoScape</td><td>20172231180</td><td></td></tr></tbody></table>

transradial access chemoembolization for hepatocellular carcinoma patients

跨动脉化疗 （TACE） 是治疗中间阶段肝细胞癌 （HCC） 的最常见方式。TACE 通常通过跨性别访问 （TFA） 执行。然而，由于并发症和死亡率的降低，冠状动脉干预中优先使用横向通道 （TRA）。TRA 的优势是否可以应用于 TACE 需要调查。
在单个中心接受TRA TACE的患者被追溯性地注册学习。对程序细节、技术成功、径向动脉闭塞率（RAO）和访问部位相关的出血并发症进行了评估。从 2017 年 10 月到 2018 年 10 月，112 名患者接受了 160 例 TRA TACE 手术。总体技术成功率为95.0%（152/160）。从特拉到 Tfa 的交叉率为 1.9%。在任何情况下均未发现与访问站点相关的出血并发症。无症状RA闭塞发生在三个患者（2.7%）。与 TFA 相比，TRA 可提高安全性和患者满意度，同时减少与访问部位相关的出血并发症。此外，TRA 干预措施可使老年、肥胖或出血并发症的高危患者受益。

2017年10月至2018年10月，112名患者接受了160例TRA TACE手术，总体技术成功率为95.0%（152/160）。有8个案件出现技术故障。其中5例是由左RA穿刺失败引起的，随后在右RA访问下成功进行了TACE。其他三个病例是由禁食失败引起的，随后通过交叉到右足总访问成功干预。RA 访问 FA 访问的交叉率仅为 1.9%。在任何病例中均未发现与出入部位相关的出血并发症。
比较了技术成功或技术故障?...

Watch this Scientific Journal Video about Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients at JoVE.com

Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

跨动脉化疗 （TACE） 是治疗肝细胞癌中间阶段患者的标准疗法，通常通过股动脉进行。与跨性别接触相比，跨径接触（TRA）可以降低出血并发症的发生率，提高患者的耐受性。这里介绍了一种通过径向动脉访问进行跨动脉化疗的方法。

肝细胞癌患者的跨径向获取化疗

Transarterial chemoembolization (TACE) is the most common modality for treatment of hepatocellular carcinoma (HCC) at the intermediate stage. TACE is ...

transradial-access-chemoembolization-for-hepatocellular-carcinoma

Research

JoVE Journal

Cancer Research

5.4K 次观看.  Fudan University. 跨动脉化疗 （TACE） 是治疗肝细胞癌中间阶段患者的标准疗法，通常通过股动脉进行。与跨性别接触相比，跨径接触（TRA）可以降低出血并发症的发生率，提高患者的耐受性。这里介绍了一种通过径向动脉访问进行跨动脉化疗的方法。

视频: Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional&#160;(3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.

Dual-phase cone-beam computed tomography (DP-CBCT) is a useful intraprocedural imaging technique for transarterial chemo-embolization treatment with drug-eluting beads of hepatocellular carcinoma. DP-CBCT has been used to perform three major steps in oncologic interventional radiology: tumor localization (see), navigation and intraprocedural catheter guidance (reach), and intraprocedural evaluation of treatment success (treat).

双相位锥束CT看看，到达，并在药物洗脱珠Transarterial化疗栓塞治疗原发性肝癌

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

科研

医学

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when there are tumors adjacent to the cystic bed, surgeons cannot palpate the surgical margins through the laparoscopic approach, which leads to uncertainty about R0 resection. Conventionally, the gallbladder is resected first, and the hepatic lobes or segments are resected second. However, tumor tissues can be disseminated in the above cases. To address this issue, based on the recognition of the porta hepatis and intrahepatic anatomy, we propose a unique approach to hepatectomy combined with gallbladder resection by en bloc anatomic resection in situ. Firstly, after dissecting the cystic duct, without cutting the gallbladder primarily, the porta hepatis is pre-occluded by the single lumen ureter; secondly, the left hepatic pedicle is made free by the gap of the Laennec membrane and Hilar plate; thirdly, the assistant is asked to drag the fundus of the gallbladder, and the liver parenchyma tissue is resected using a harmonic scalpel along the ischemia line on the liver surface and intraoperative ultrasound. The whole middle hepatic vein (MHV) and its tributaries appear completely; lastly, the left hepatic vein (LHV) is disconnected, and the specimen is taken out from the abdominal cavity. The tumor, gallbladder, and other surrounding tissues are resected en bloc, which meets the tumor-free criterion, and a wide incisal margin and R0 resection are achieved. Therefore, the laparoscopic hepatectomy with the combination of the en bloc concept and anatomic resection is a safe, effective, and radical method with low postoperative recurrence and metastasis.

Numerous studies have demonstrated the advantages of anatomic resection. Nonetheless, whether anatomic resection can increase R0 resection rates remains controversial. Consequently, the present study describes an innovative procedure involving the en bloc concept combined with anatomic resection in laparoscopic hepatectomy, which can reduce postoperative recurrence and metastasis.

整体概念联合解剖切除在腹腔镜肝切除术中的应用

Laparoscopic hepatectomy has been reported in many studies, and it is the mainstream method of liver resection. In some particular cases, such as when ...

癌症研究

Right Hemihepatectomy by Suprahilar Intrahepatic Transection of the Right Hemipedicle using a Vascular Stapler

Successful hepatic resection requires profound anatomical knowledge and delicate surgical technique. Hemihepatectomies are mostly performed after preparing the extrahepatic hilar structures within the hepatoduodenal ligament, even in benign tumours or liver metastasis.1-5. Regional extrahepatic lymphadenectomy is an oncological standard in hilar cholangiocarcinoma, intrahepatic cholangio-cellular carcinoma and hepatocellular carcinoma, whereas lymph node metastases in the hepatic hilus in patients with liver metastasis are rarely occult. Major disadvantages of these procedures are the complex preparation of the hilus with the risk of injuring contralateral structures and the possibility of bleeding from portal vein side-branches or impaired perfusion of bile ducts. We developed a technique of right hemihepatectomy or resection of the left lateral segments with intrahepatic transection of the pedicle that leaves the hepatoduodenal ligament completely untouched. 6 However, if intraoperative visualization or palpation of the ligament is suspicious for tumor infiltration or lymph node metastasis, the hilus should be explored and a lymphadenectomy performed.

This video describes a right hemihepatectomy with intrahepatic transection of the right hemipedicle leaving the hepatoduodenal ligament completely untouched.

右右Hemipedicle Suprahilar肝内血管吻合器横断Hemihepatectomy

Successful hepatic resection requires profound anatomical knowledge and delicate surgical technique. Hemihepatectomies are mostly performed after ...

生物学

Transarterial Administration of Oncolytic Viruses for Locoregional Therapy of Orthotopic HCC in Rats

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis. In recent years, oncolytic virotherapies have proven themselves to be potentially powerful tools to fight malignancy. Due to the unique dual blood supply in the liver, it is possible to apply therapies locally to orthotopic liver tumors, which are predominantly fed by arterial blood flow. We have previously demonstrated that hepatic arterial delivery of oncolytic viruses results in safe and efficient transduction efficiency of multifocal HCC lesions, resulting in significant prolongation of survival in immune competent rats. This procedure closely mimics the application of transarterial embolization in patients, which is the standard palliative care provided to many HCC patients. The ability to administer tumor therapies through the hepatic artery in rats allows for a highly sophisticated preclinical model for evaluating novel viral vectors under development. Here we describe the detailed protocol for microdissection of the hepatic artery for infusion of oncolytic virus vectors to treat orthotopic HCC.

Oncolytic virotherapies are under development as novel therapeutics for the treatment of hepatocellular carcinoma (HCC). Here we describe a method for locoregional therapy of HCC via hepatic arterial administration of oncolytic virus.

溶瘤病毒的Transarterial管理局大鼠原位肝癌的局部治疗

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis.  In recent years, oncolytic virotherapies have proven ...

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

In this manuscript, we describe percutaneous isolated hepatic perfusion with simultaneous chemofiltration as treatment for unresectable liver metastases. This procedure is performed under general anaesthesia in the angiosuite by an experienced team, consisting of an interventional radiologist, a clinical perfusionist and anaesthesiologist.

经皮肝脏灌注（PHP）与美法仑作为囿于肝脏不能手术切除转移的治疗

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

Robotic Taj Mahal Hepatectomy for Hilar Cholangiocarcinoma

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In this study, a 32-year-old male patient with Bismuth Type IVa hilar cholangiocarcinoma underwent radical robotic resection of hepatic S4b, S5, and S1 (Taj Mahal hepatectomy) combined with regional lymphadenectomy, hilar bile duct reconstruction, and hepaticojejunostomy by the robotic surgical system. Postoperative pathological examination showed moderately-differentiated adenocarcinoma of the hilar bile duct. The surgical margins of the liver and bile ducts were negative. Recovery was smooth and the patient was discharged on the 17th postoperative day. The robotic surgical system and associated multiple instruments along with flexible and precise movements is suitable for the local hepatectomy around the porta hepatis, and delicate reconstruction of the hilar bile duct with a smaller diameter. This first clinical application study found that robotic Taj Mahal hepatectomy for hilar cholangiocarcinoma is safe and feasible and needs more experience for the evaluation of its long-term outcomes.

Robotic resection of hepatic S4b, S5, and S1 using the Taj Mahal procedure is feasible and safe for selected patients with hilar cholangiocarcinoma. The step-by-step details for this surgery are presented here.

机器人泰姬陵肝切除术治疗肺门胆管癌

Hilar cholangiocarcinoma is the most common malignant tumor of the biliary tract. Radical surgical resection is the only effective treatment option. In ...

Y-90 TARE and PD-1 Inhibition as Bridging Therapy in Hepatocellular Carcinoma

Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 transarterial radioembolization (TARE) and Programmed Cell Death-1 (PD-1) inhibitors as neoadjuvant therapy. Highlighted through a case report, it offers a step-by-step reference for similar therapeutic interventions. A retrospective analysis was conducted on a patient who underwent hepatectomy following Y-90 TARE and PD-1 inhibitor treatment. Key demographic and clinical details were recorded at admission to guide therapy selection. Y-90 TARE suitability and dosage calculation were based on Technetium-99m (Tc-99m) macroaggregated albumin (MAA) perfusion mapping tests. Lesion coverage by Y-90 microspheres was confirmed through single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging, and adverse reactions and follow-up outcomes were meticulously documented. The patient, with a 7.2 cm HCC in the right hepatic lobe (T1bN0M0, BCLC A, CNLC Ib) and an initial alpha-fetoprotein (AFP) level of 66,840 ng/mL, opted for Y-90 TARE due to high recurrence risk and initial surgery refusal. The therapy's parameters, including the lung shunting fraction (LSF) and non-tumor ratio (TNR), were within therapeutic limits. A total of 1.36 GBq Y-90 was administered. At 1 month post-therapy, the tumor shrank to 6 cm with partial necrosis, and AFP levels dropped to 21,155 ng/mL, remaining stable for 3 months. After 3 months, PD-1 inhibitor treatment led to further tumor reduction to 4 cm and AFP decrease to 1.84 ng/mL. The patient then underwent hepatectomy; histopathology confirmed complete tumor necrosis. At 12 months post-surgery, no tumor recurrence or metastasis was observed in follow-up sessions. This protocol demonstrates the effective combination of Y-90 TARE and PD-1 inhibitor as a bridging strategy to surgery for HCC patients at high recurrence risk, providing a practical guide for implementing this approach.

This study illustrates the methodological potential of combining Yttrium-90 Trans-Arterial Radioembolization (Y-90 TARE) with an anti-PD-1 monoclonal antibody as an effective neoadjuvant strategy leading to hepatectomy in hepatocellular carcinoma (HCC) patients with a high initial recurrence risk. It emphasizes the safety, feasibility, and step-by-step procedural guidance of this approach.

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 ...

Complete Laparoscopic Radical Resection of Perihilar Cholangiocarcinoma Type IIIb

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With continuous advancements in laparoscopic techniques and instruments, laparoscopic radical surgery for pCCA is now considered technically safe and feasible. However, due to the high complexity of the surgery and the lack of evidence-based clinical support, laparoscopic radical surgery for type IIIb pCCA is performed only in a few large hepatobiliary centers. Current guidelines recommend left hemihepatectomy combined with total caudate lobectomy and standardized lymphadenectomy for resectable type IIIb pCCA. Therefore, in this article, we provide a detailed description of the surgical steps and technical points of complete laparoscopic left hemihepatectomy combined with total caudate lobectomy, regional lymphadenectomy, and right hepatic duct-jejunal Roux-en-Y anastomosis in patients with type IIIb pCCA, using fluorescence navigation technology to enhance surgical precision and safety. By adhering to standardized surgical procedures and precise intraoperative techniques, we offer an effective means to improve patient outcomes.

IIIb 型肺门周围胆管癌的完全腹腔镜根治性切除术

Perihilar cholangiocarcinoma (pCCA) is a highly malignant and aggressive tumor, with radical resection being the only curative treatment available. With ...

Trans-Arterial Indocyanine Green Staining for Precise Anatomical Hepatectomy of Liver Segments VII and VIII

Anatomical hepatectomy for resectable hepatocellular carcinoma (HCC) is performed with precision using the Glissonean system, ultrasound imaging, and indocyanine green (ICG) fluorescence staining to define liver segments, enhancing surgical radicality and preserving liver volume. However, laparoscopic clamping and ultrasound-guided ICG staining for deep-seated tumors in liver segments VII and VIII pose challenges due to the depth of the Glissonean ducts and other technical limitations. This study aimed to overcome these obstacles by exploring a protocol using trans-arterial ICG staining, a technique specifically tailored for complex anatomical hepatectomy of liver segments VII and VIII. In this method, an interventionalist accessed the right femoral artery and advanced to the celiac trunk for arteriography, followed by strategic placement of a microcatheter into the tumor's blood supply vessel to facilitate surgical resection. During the operation, ICG was injected through the microcatheter to fluorescently label the tumor's liver segment, enabling precise anatomical resection under fluorescence guidance. This trans-arterial ICG staining approach allows for the accurate identification of tumor subsegments, facilitates complete resection, and optimizes liver function preservation, ultimately improving oncological outcomes without increasing surgical complication rates.

Laparoscopic anatomical hepatectomy has gained global recognition in liver surgery. However, delineating tumor boundaries in liver segments VII and VIII presents distinct technical challenges. This protocol utilizes trans-arterial indocyanine green (ICG) staining to accurately identify liver subsegments, facilitating complete tumor resection while preserving functional liver volume.

经动脉吲哚菁绿染色用于肝段 VII 和 VIII 的精确解剖肝切除术

Anatomical hepatectomy for resectable hepatocellular carcinoma (HCC) is performed with precision using the Glissonean system, ultrasound imaging, and ...

Laparoscopic Left Hemihepatectomy Combined with Caudate Lobe Resection

Intrahepatic cholangiocarcinoma (ICC) is the common malignant tumor of the liver. Radical surgical resection is the mainstay of potentially curative treatment for ICC. Anatomical liver resection for ICC in the caudate lobe is one of the most difficult liver resections. Because the tumor is located deep and easily invades surrounding blood vessels, such as the left hepatic pedicle, right hepatic pedicle, and middle hepatic vein. Laparoscopic anatomic hepatectomy of the caudate lobe not only ensures a negative incision margin but also offers a more minimally invasive approach for patients. This technique is poised to become the preferred choice for radical surgery of the caudate lobe in the future. In this surgical protocol, a 65-year-old male patient with intrahepatic cholangiocarcinoma (sized about 3.2&#160;&#215; 1.9 cm2) located in the left caudal lobe underwent laparoscopic left hemihepatectomy combined with caudate lobe resection successfully without any postoperative complications. Postoperative pathological examination showed a cholangiocarcinoma with a tumor thrombus visible in the vasculature. The patient was discharged on the 14th postoperative day. Laparoscopic left hemihepatectomy combined with caudate lobectomy for the treatment of caudate lobe ICC can be performed safely and does not add significantly to the morbidity or mortality of the procedure.

Intrahepatic cholangiocarcinoma of the caudate lobe is a challenge for many surgeons due to its unique location. Here, we present a protocol to show the step-by-step details of laparoscopic left hemihepatectomy combined with caudate lobe resection for cholangiocarcinoma.

腹腔镜左半肝切除术联合尾状叶切除术

Intrahepatic cholangiocarcinoma (ICC) is the common malignant tumor of the liver. Radical surgical resection is the mainstay of potentially curative ...