<meta charset="utf8"></head><body>使用圆韧带进行腹腔镜切面切除术进行无血肝切除术

<ol>
	<li>Liu, X., 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=Laparoscopic+hepatectomy+produces+better+outcomes+for+hepatolithiasis+than+open+hepatectomy:+An+updated+systematic+review+and+meta-analysis.">Laparoscopic hepatectomy produces better outcomes for hepatolithiasis than open hepatectomy: An updated systematic review and meta-analysis.</a> Int J Surg. 51, 151-163 (2018).</li><li>Abu Hilal, M., Pearce, N. W. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+left+lateral+liver+sectionectomy:+a+safe,+efficient,+reproducible+technique.">Laparoscopic left lateral liver sectionectomy: a safe, efficient, reproducible technique.</a> Dig Surg. 25 (4), 305-308 (2008).</li><li>Montorsi, M., 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=Perspectives+and+drawbacks+of+minimally+invasive+surgery+for+hepatocellular+carcinoma.">Perspectives and drawbacks of minimally invasive surgery for hepatocellular carcinoma.</a> Hepatogastroenterology. 49, 56-61 (2002).</li><li>Zhang, X. L., Wang, W. J., Wang, W. J., Cao, N. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effectiveness+and+safety+of+controlled+venous+pressure+in+liver+surgery:+a+systematic+review+and+network+meta-analysis.">Effectiveness and safety of controlled venous pressure in liver surgery: a systematic review and network meta-analysis.</a> Biomed Res Int. 2015, 290234 (2015).</li><li>Ogiso, S., 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=Anatomy+of+the+middle+hepatic+vein+tributaries+to+promote+safer+hepatic+vein-guided+liver+resection.">Anatomy of the middle hepatic vein tributaries to promote safer hepatic vein-guided liver resection.</a> J Gastrointest Surg. 26 (1), 122-127 (2022).</li><li>Xie, K. L., Zeng, Y., Wu, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Hepatic+trisectionectomy+for+hepatocellular+carcinoma+using+the+Glisson+pedicle+method+combined+with+anterior+approach.">Hepatic trisectionectomy for hepatocellular carcinoma using the Glisson pedicle method combined with anterior approach.</a> World J Surg. 38 (9), 2358-2362 (2014).</li><li>Sugioka, A., Kato, Y., Tanahashi, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Systematic+extrahepatic+Glissonean+pedicle+isolation+for+anatomical+liver+resection+based+on+Laennec's+capsule:+proposal+of+a+novel+comprehensive+surgical+anatomy+of+the+liver.">Systematic extrahepatic Glissonean pedicle isolation for anatomical liver resection based on Laennec's capsule: proposal of a novel comprehensive surgical anatomy of the liver.</a> J Hepatobiliary Pancreat Sci. 24 (1), 17-23 (2017).</li><li>Wu, P. C., 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=Noninvasive+assessment+of+liver+function+reserve+with+fluorescent+dosimetry+of+indocyanine+green.">Noninvasive assessment of liver function reserve with fluorescent dosimetry of indocyanine green.</a> Biomed Opt Express. 13 (4), 1995-2005 (2022).</li><li>Piardi, T., Lhuaire, M., Memeo, R. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+Pringle+maneuver:+how+we+do+it.">Laparoscopic Pringle maneuver: how we do it.</a> Hepatobiliary Surg Nutr. 5 (4), 345-349 (2016).</li><li>Liu, T. S., 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=Application+of+controlled+low+central+venous+pressure+during+hepatectomy:+A+systematic+review+and+meta-analysis.">Application of controlled low central venous pressure during hepatectomy: A systematic review and meta-analysis.</a> J Clin Anesth. 75, 110467 (2021).</li><li>van der Poel, M. J., 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=International+multicenter+propensity+score+matched+study+on+laparoscopic+versus+open+left+lateral+sectionectomy.">International multicenter propensity score matched study on laparoscopic versus open left lateral sectionectomy.</a> HPB (Oxford). 23 (5), 707-714 (2021).</li><li>Darnis, B., 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=Long-term+abdominal+wall+benefits+of+the+laparoscopic+approach+in+liver+left+lateral+sectionectomy:+a+multicenter+comparative+study.">Long-term abdominal wall benefits of the laparoscopic approach in liver left lateral sectionectomy: a multicenter comparative study.</a> Surg Endosc. 35 (9), 5034-5042 (2021).</li><li>Chong, Y., 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=International+robotic+and+laparoscopic+liver+resection+study+group+investigators.+An+international+multicentre+propensity+score+matched+analysis+comparing+between+robotic+versus+laparoscopic+left+lateral+sectionectomy.">International robotic and laparoscopic liver resection study group investigators. An international multicentre propensity score matched analysis comparing between robotic versus laparoscopic left lateral sectionectomy.</a> Surg Endosc. 37 (5), 3439-3448 (2023).</li><li>Zheng, K., He, D., Liao, A., Wu, H., Yang, J., Jiang, L. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+segmentectomy+IV+using+hepatic+round+ligament+approach+combined+with+fluorescent+negative+staining+method.">Laparoscopic segmentectomy IV using hepatic round ligament approach combined with fluorescent negative staining method.</a> Ann Surg Oncol. 29 (5), 2980-2981 (2022).</li><li>Wu, H., Xie, K. L., Huang, J., Pan, G. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+effect+of+fissure+for+ligamentum+teres+hepatic+approach+in+hepatectomy.">Clinical effect of fissure for ligamentum teres hepatic approach in hepatectomy.</a> Chin J Dig Surg. 15 (1), 53-57 (2016).</li><li>Idrees, M., 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=Umbilical+fissure+vein,+anatomical+variation+and+potential+surgical+application.">Umbilical fissure vein, anatomical variation and potential surgical application.</a> ANZ J Surg. 91 (7-8), E479-E483 (2021).</li><li>Kobayashi, K., 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=Extended+segmentectomy+II+to+left+hepatic+vein:+Importance+of+preserving+umbilical+fissure+vein+to+avoid+congestion+of+segment+III.">Extended segmentectomy II to left hepatic vein: Importance of preserving umbilical fissure vein to avoid congestion of segment III.</a> J Am Coll Surg. 225 (3), e5-e11 (2017).</li><li>Zheng, K., 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=Laparoscopic+anatomic+bi-segmentectomy+(S3+and+S4b)+using+the+Glisson's+pedicle-first+and+intrahepatic+anatomic+markers+approach.">Laparoscopic anatomic bi-segmentectomy (S3 and S4b) using the Glisson's pedicle-first and intrahepatic anatomic markers approach.</a> Surg Endosc. 36 (10), 7859-7860 (2022).</li><li>Hobeika, C., 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=Impact+of+cirrhosis+in+patients+undergoing+laparoscopic+liver+resection+in+a+nationwide+multicentre+survey.">Impact of cirrhosis in patients undergoing laparoscopic liver resection in a nationwide multicentre survey.</a> Br J Surg. 107 (3), 268-277 (2020).</li></ol>

<table border="1" fo:keep-together.within-page="1" fo:keep-with-next.within-page="always">
	<tbody>
		<tr>
			<td>30&#176; high-definition laparoscopic device</td>
			<td>KARL STORZ,Germany</td>
			<td>26606BCA/ACA</td>
			<td>New 3D Electronic Laparoscope</td>
		</tr>
		<tr>
			<td>Bipolar electrocoagulation</td>
			<td>KANGJI, China</td>
			<td>KJ-XRH05Q</td>
			<td>Electrocoagulation for hemostasis</td>
		</tr>
		<tr>
			<td>Ceftazidime</td>
			<td>Zhejiang Jutai Pharmaceutical Co.,China</td>
			<td>(China) Drug Administration Code (DAC)H20033369</td>
			<td>usage: 1.0 g, intravenous drip</td>
		</tr>
		<tr>
			<td>Computed Tomography (CT)</td>
			<td>Siemens, Germany</td>
			<td>SOMATOM Force</td>
			<td>Force is a 96-row dual-source CT scanner that revolutionizes a series of imaging chains including the tube, high-voltage generator, detector, data acquisition system, and reconstruction system, opening up a new era of CT imaging and achieving faster, wider, thinner, more capable, and lower radiation dose.</td>
		</tr>
		<tr>
			<td>Echelon Flex Endopath Stapler</td>
			<td>Ethicon</td>
			<td>EC60A</td>
			<td>Manual stapler that compresses 
			tissue while it simultaneously lays 
			down a staple line and transects the 
			tissue, 60 mm Stapler (Standard), Size 60 mm, Length 34 cm</td>
		</tr>
		<tr>
			<td>Harmonic ACE+7 Shears</td>
			<td>Ethicon</td>
			<td>HARH36</td>
			<td>Curved tip, energy sealing and 
			dissecting, diameter 5 mm, length 36 cm</td>
		</tr>
		<tr>
			<td>Hem-o-lok Clips L</td>
			<td>Weck Surgical Instruments, Teleflex Medical, Durham, NC</td>
			<td>544240</td>
			<td>Vascular clip 5&#8211;13 mm Size Range</td>
		</tr>
		<tr>
			<td>Hem-o-lok Clips ML</td>
			<td>Weck Surgical Instruments, Teleflex 
			Medical, Durham, NC</td>
			<td>544230</td>
			<td>Vascular clip 3&#8211;10 mm Size Range</td>
		</tr>
		<tr>
			<td>Indocyanine Green(ICG)</td>
			<td>&#160;Dandong Medical Creation Pharmaceutical Co., Ltd.</td>
			<td>H20055881</td>
			<td>25 mg/vial, Detecting liver reserve function</td>
		</tr>
		<tr>
			<td>Liver function reserve analyzer</td>
			<td>Shanghai Optoelectronic Medical Electronic Instruments Co., Ltd</td>
			<td>DDG3300K</td>
			<td>A medical instrument that detects and analyzes indocyanine green (ICG) injected into the body based on spectroscopic analysis techniques.</td>
		</tr>
		<tr>
			<td>Magnetic resonance imaging (MRI)</td>
			<td>GE company,American</td>
			<td>Signa Hoxt 3.0T MRI,JB00988XC</td>
			<td>provides 360-degrees of coil coverage, RF technology, and a direct digital interface with more channels. Patient-friendly design maximizes comfort and system utility, accommodating all types of patients and sizes with feet-first imaging.</td>
		</tr>
	</tbody>
</table>

laparoscopic left lateral sectionectomy: guided by the ligamentum teres hepatis and the umbilical fissure vein

<meta charset="utf8"></head><body>作者聚焦:利用微创手术技术推进肝胆和胰腺肿瘤治疗

腹腔镜左侧切片切除术:在肝圆韧带和脐裂静脉的引导下

Laparoscopic left lateral sectionectomy (LLLS), a mainstream procedure in liver surgery, often utilizes controlled low central venous pressure (CLCVP) to ...

laparoscopic-left-lateral-sectionectomy-guided-ligamentum-teres

Research

JoVE Journal

Medicine

Laparoscopic Left Lateral Sectionectomy: Guided by the Ligamentum Teres Hepatis and the Umbilical Fissure Vein

667 次观看.  the Affiliated Nanchong Central Hospital of North Sichuan Medical College (University). 我的研究重点是肝胆和胰腺肿瘤的微创手术治疗。在肝圆韧带和脐裂静脉的引导下，这种腹腔镜左侧横切术可有效控制术中出血，即使在没有受控的低中心静脉压的情况下也是如此。这些属性为患有心血管或脑血管疾病的患者提供了潜在的益处。先进的成像方式，如吲哚菁绿荧光成像，可以提供胆道解剖结构的实时可视化，有助于手术计划和决...

视频: 作者聚焦:利用微创手术技术推进肝胆和胰腺肿瘤治疗

Nerve Stimulator-guided Injection of Autologous Stem Cells Near the Equine Left Recurrent Laryngeal Nerve

Recurrent laryngeal neuropathy (RLN) commonly affects horses and is characterized by abnormal respiratory sounds and exercise intolerance. The recurrent laryngeal nerve shows lesions of demyelination. The benefit of applying stem cells to demyelinated nerves has been demonstrated in various animal models. The aim of the study was to test the feasibility and safety of a peri-neuronal injection of autologous muscle-derived mesenchymal stem cells to the left recurrent laryngeal nerve in healthy horses by using an electrical nerve stimulator.
Muscle-derived stems cell are obtained from five healthy Standardbred horses by sampling 20 mg of muscle tissue with a semi-automatic 14 G biopsy needle from the triceps muscle. Movements of the larynx are monitored via upper-airway video endoscopy. The left recurrent laryngeal nerve is approached with an insulated nerve block needle. Nerve stimulation is applied, starting at 2 mA, and the successful abduction of the left arytenoid is monitored. The stimulation intensity is reduced progressively. When a loss of the motor response is observed at 0.5 mA, 107 autologous muscle-derived stem cells are injected. Two examiners, who are blinded to the time point, score the laryngeal function of the horses prior to the treatment and at day 1, day 7, and day 28 after the injection of the cells. In a sixth horse, 1 mL of 2% lidocaine is injected to further confirm the correct positioning of the needle. This leads to a temporary paralysis of the left arytenoid cartilage.
This study proves that the recurrent laryngeal nerve can be approached with the help of an electrical nerve stimulator and that the electrical stimulation of the nerve is well tolerated by the horses. No modification of the laryngeal function was observed in any of the horses after the injection of the stem cells. Further studies should be conducted to describe the effects of a peri-neuronal injection of autologous muscle-derived mesenchymal stem cells to horses suffering from RLN.

Here, we present a protocol to inject autologous muscle-derived stem cells in the proximity to the recurrent laryngeal nerve with the help of an electrical nerve stimulator. This novel technique may become useful for the treatment of equine recurrent laryngeal neuropathy.

神经刺激器引导注射自体干细胞近马左喉返神经

Recurrent laryngeal neuropathy (RLN) commonly affects horses and is characterized by abnormal respiratory sounds and exercise intolerance. The recurrent ...

科研

医学

Standardized Hemorrhagic Shock Induction Guided by Cerebral Oximetry and Extended Hemodynamic Monitoring in Pigs

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an insufficient oxygen supply and irreversible organ failure. The brain exerts only limited compensation capacities and is particularly at high risk of severe hypoxic damage.This article demonstrates the reproducible induction of life-threatening hemorrhagic shock in a porcine model by means of calculated blood withdrawal. We titrate shock induction guided by near-infrared spectroscopy&#160;and extended hemodynamic monitoring to display systemic circulatory failure, as well as cerebral microcirculatory oxygen depletion. In comparison to similar models that primarily focus on predefined removal volumes for shock induction, this approach highlights a titration by means of the resulting failure of macro- and microcirculation.

Hemorrhagic shock is a severe complication in seriously injured patients, which leads to life-threatening oxygen undersupply. We present a standardized method to induce hemorrhagic shock via blood withdrawal in pigs that is guided by hemodynamics and microcirculatory cerebral oxygenation.

由脑氧测量和猪期扩展血液动力学监测指导的标准化出血性休克诱导

Hemorrhagic shock ranks among the main reasons for severe injury-related death. The loss of circulatory volume and oxygen carriers can lead to an ...

Laparoscopic Radical Left Pancreatectomy for Pancreatic Cancer: Surgical Strategy and Technique Video

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological resection of left-sided pancreatic cancer. Several surgical techniques have been described in recent years, but few were specifically designed for minimally invasive approaches. This study describes and demonstrates a standardized and reproducible technique for an adequate oncological resection of pancreatic cancer: laparoscopic radical left pancreatectomy (LRLP).
A 61-year-old woman presented with an incidental finding of a 3 cm mass in the left pancreas suspect for malignancy. Imaging did not reveal distant metastases, central vascular involvement, or morbid obesity, hence the patient was suitable for LRLP. This study describes the main steps of LRLP for pancreatic cancer. First, the lesser sac is opened by transecting the gastrocolic ligament. The splenic flexure of the colon is mobilized and the inferior border of the pancreas including Gerota&#39;s fascia is dissected down to the inferior border of the spleen. The pancreas is tunneled and hung, including Gerota&#8217;s fascia with a vessel loop. At the pancreatic neck, a tunnel is created between the pancreas and the portal vein, likewise a vessel loop is passed. The pancreas is then transected using the graded compression technique with an endostapler. Both the splenic vein and artery are transected before completing the resection. The entire specimen is extracted in a retrieval bag via a small Pfannenstiel incision.
Duration of the surgery was 210 min with 250 mL blood loss. Pathology revealed a R0-resection (&#62;1 mm) of a well-to-moderately differentiated adenocarcinoma originating from an intraductal papillary mucinous neoplasm. A total of 15 tumor-negative lymph nodes were resected. This is a detailed description of LRLP for left-sided pancreatic cancer as is currently being used within the international, multicenter randomized DIPLOMA (Distal Pancreatectomy Minimally Invasive or Open for PDAC) trial.

Oncologically safe left pancreatectomy requires radical resection (R0), Gerota&#8217;s (perirenal) fascia resection, and adequate lymph node dissection. This study describes the technical details of laparoscopic radical left pancreatectomy (LRLP), used in the first international multicenter randomized trial comparing minimally invasive with open left pancreatectomy for pancreatic cancer, the DIPLOMA trial.

胰腺癌的腹腔镜根左造影切除术:手术策略与技术视频

Radical resection margins, resection of Gerota&#8217;s (perirenal) fascia, and adequate lymph node dissection are crucial for an adequate oncological ...

Laparoscopic Non-Mesh Cerclage Pectopexy for Pelvic Organ Prolapse

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore apical support for treating POP. Sacrocolpopexy and pectopexy are indicated for apical prolapse. Using a synthetic mesh in these techniques increases success by enhancing apical support. However, the implantation of synthetic mesh is associated with mesh-related complications. In addition, the exorbitant cost of synthetic mesh and lack of universal access limit the popularity of these procedures. The current study develops a unique technique known as laparoscopic non-mesh cerclage pectopexy (LNMCP), in which permanent cervical cerclage sutures are embedded in the round ligament until the iliopectineal ligament. The iliopectineal ligament was sutured, resulting in a firm cervical suspension. The procedure was successfully performed in 16 cases in the hospital. The surgical duration was 67.8 min &plusmn; 15.5 min, and the blood loss was 73.1 mL &plusmn; 51.1 mL. No procedural complications were seen. LNMCP is associated with an objective success rate of 100% and a subjective success rate of 93.8%. LNMCP for patients with apical prolapse obviates the need for a mesh, thereby avoiding complications associated with mesh erosion and reducing medical costs. In addition, it is easy to perform even in resource-poor areas without access to synthetic mesh.

The present pilot study describes the development of laparoscopic non-mesh cerclage pectopexy to treat pelvic organ prolapse. The procedure can be used to prevent any complications associated with the use of mesh.

腹腔镜非网片环扎胸肌固定术治疗盆腔器官脱垂

Pelvic organ prolapse (POP) is widespread among the female population and significantly impairs the patient's quality of life. It is important to restore ...

基于 ICE 的左心房和肺静脉 3D 重塑

Three-Dimensional Modeling of the Left Atrium and Pulmonary Veins with a Precise Intracardiac Echocardiography Approach

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left atrium (LA) anatomy and pulmonary vein structures. ICE is widely used to establish a three-dimensional (3D) left atrial structural model during ablation procedures. However, it is unclear whether using ICE in a precise 3D modeling method can provide a more accurate left atrial 3D model and the transseptal approach. This study proposes a protocol to model the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling. It evaluates the accuracy of the models produced using the two methods through observer scoring. We included 50 patients who underwent ICE-based 3D remodeling and 45 who underwent FAM 3D remodeling based on pulmonary vein isolation procedures. The pulmonary vein antrum remodeling is estimated by comparing the antrum area acquired by remodeling and left atrial computed tomography angiography (CTA). The observer scores for the modeling in the ICE and FAM groups were 3.40 &#177; 0.81 and 3.02 &#177; 0.72 (P &#60; 0.05), respectively. The pulmonary vein antrum area obtained using the ICE- and FAM-based methods showed a correlation with the area acquired by left atrium CT. However, the 95% confidence interval bias was narrower in ICE-acquired models than in FAM-acquired models (-238 cm2 to 323 cm2 Vs. -363 cm2 to 386 cm2, respectively) using Bland-Altman analysis. Therefore, precise ICE possesses high accuracy in estimating the left atrial structure, becoming a promising approach for future cardiac structure estimation.

作者聚焦:用于心房解剖评估的心内超声心动图的进展 

Accurate intracardiac echocardiography (ICE) shows significant accuracy in estimating the left atrial structure, a prospective and promising cardiac structure estimation method. Here we propose a protocol for three-dimensional modeling of the left atrium and pulmonary veins with ICE and fast anatomical mapping (FAM) catheter remodeling.

使用精确的心内超声心动图方法对左心房和肺静脉进行三维建模

Intracardiac echocardiography (ICE) is a novel tool for estimating cardiac anatomy during pulmonary vein isolation procedures, particularly the left ...

Advancing LRPS: Optimal Techniques for Challenging Liver Resections

Techniques of Laparoscopic Right Posterior Sectionectomy: Glissonian Approach and a Parenchymal Transection Technique

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver resections, including less blood loss, reduced wound pain, and shorter hospital stays with a comparable oncological outcome. However, laparoscopic resection of lesions in the right posterior section of the liver is challenging due to difficulties in bleeding control and visualizing the surgical field. In the past, laparoscopic right posterior sectionectomy (LRPS) was still in the exploration phase, with undefined risks in the Second International Consensus Conference on LLR in 2014. However, recent technological advancements and increased surgical experience have shown that LRPS can be safe and feasible. It has been found to reduce hospital stay and blood loss compared to open surgery. This manuscript aims to provide a detailed description of the steps involved in LRPS. The key factors contributing to our success in this challenging procedure include proper liver retraction and exposure, the use of an intrahepatic Glissonian approach for inflow control, a technique called the 'ultrasonic scalpel mimic Cavitron ultrasonic surgical aspirator (CUSA)' for parenchymal transection, early identification of the right hepatic vein, and meticulous bleeding control using bipolar diathermy.

Here, we present a protocol to perform laparoscopic right posterior sectionectomy, focusing on two key aspects: the intrahepatic Glissonian approach for inflow control and a parenchymal transection technique using an ultrasonic surgical aspirator.

腹腔镜右后切除术技术:Glissonian 入路和实质横断技术

Laparoscopic liver resections (LLR) have been widely accepted as a treatment option for liver tumors. They offer several advantages over open liver ...

Laparoscopic Posterior Radical Antegrade Modular Pancreatosplenectomy for Distal Pancreatic Carcinoma

Distal pancreatic carcinoma is a highly malignant tumor with strong invasiveness, often growing to the edge of the pancreas and penetrating the pancreatic capsule to infiltrate surrounding tissues. In conventional distal pancreatosplenectomy (DPS), tumor cells are prone to spread along the direction of blood and lymphatic reflux due to surgical compression. Additionally, inflammation makes it challenging to achieve R0 resection, leading to a lower patient survival rate. To address these limitations, radical antegrade modular pancreatosplenectomy (RAMPS) was developed, emphasizing deeper excision, including the left anterior renal fascia, the left anterior renal adipose sac, and even the left adrenal gland, to improve the R0 resection rate. With the advancement of minimally invasive surgical techniques, laparoscopic RAMPS (L-RAMPS) is being considered technically safe and feasible in oncology. However, due to technical difficulties and a lack of supporting evidence for clinical application, only a few institutions are currently conducting L-RAMPS. In this context, this article presents detailed techniques for laparoscopic posterior radical antegrade modular pancreatosplenectomy (L-pRAMPS), offering promise for future clinical applications.

Laparoscopic radical antegrade modular pancreatosplenectomy (L-RAMPS) is currently considered technically safe and feasible. However, due to technical challenges and a lack of supporting evidence for widespread clinical applications, only a limited number of institutions are currently conducting L-RAMPS. This article aims to provide detailed techniques for laparoscopic posterior radical antegrade modular pancreatosplenectomy.

腹腔镜后路根治性顺行模块化胰脾切除术治疗胰腺远端癌

Distal pancreatic carcinoma is a highly malignant tumor with strong invasiveness, often growing to the edge of the pancreas and penetrating the pancreatic ...

<meta charset="utf8"></head><body>在分期肝切除术动物模型中研究 ALLPS 的肝脏再生

A Mouse Model of the Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Procedure Aided by Microscopy

Hepatectomy is widely regarded as the primary treatment for hepatic malignancies; yet, postoperative liver failure remains a major cause of perioperative mortality, severely impacting patient outcomes. In a robust hepatic environment, the future liver remnant (FLR) must exceed 25%, and in cases of cirrhosis, this requirement increases to over 40%. The inadequacy of FLR is currently a major obstacle in the progression of hepatic surgery.
Traditional methods to enhance FLR hypertrophy mainly focus on portal vein embolization (PVE), but its effectiveness is considerably limited. In recent years, there have been numerous reports on a novel biphasic hepatectomy method involving hepatic partitioning and portal vein ligation, known as associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). ALPPS surpasses PVE in efficiently and considerably inducing FLR hypertrophy. However, the detailed mechanisms driving ALPPS-facilitated hepatic regeneration are not fully understood. Thus, replicating ALPPS in animal models is crucial to thoroughly investigate the molecular mechanisms of hepatic regeneration, offering valuable theoretical and practical insights.

<meta charset="utf8"></head><body>作者聚焦:通过 ALPPS 小鼠模型推进肝脏再生研究

Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy (ALPPS) has been shown to result in remarkable liver regeneration after several weeks post first-stage surgery. Animal models that have undergone ALPPS have been developed to explore potential liver regeneration ability and achieve favorable clinical outcomes.

显微镜辅助分期肝切除术的关联肝分区和门静脉结扎的小鼠模型

Hepatectomy is widely regarded as the primary treatment for hepatic malignancies; yet, postoperative liver failure remains a major cause of perioperative ...