Präoperative Workout <ol><li> In der Bauch-CT kann es leicht zu sehen, der Gallenwege (erscheint im Inneren des Leberparenchyms mit einer dunkleren Farbe) stark vergrößert auf der linken Seite der Leber .3 D Rekonstruktion zeigte das Vorhandensein einer rechten Leberarterie, die direkt aus der Aorta und keine weiteren Gefäßveränderungen. </li><li> Die Leber kann funktionell in 8 Segmente wie im Video gezeigt, und bedenkt, dass die Erweiterung zu Segment 2 und 3 (links Sektoren) war begrenzt, und eine laparoskopische links sectoriectomy geplant war aufgeteilt werden. </li></ol> Intraoperative Verfahren <ol><li> Der Patient wird in Rückenlage und der Arzt stand zwischen Patient die Beine gestellt. 5 Trokare verwendet werden und legte wie im Video gezeigt </li><li> Vascular Klammer ist auf dem Portal Dreiklang gelegt, um Blutungen zu verringern (Pringle Manöver) </li><li> Abteilung des Leberparenchyms erfolgt mit einer Kombination oder bipolare Elektrokauter und harmonische Skalpell entlang der Lig. falciforme zwischen Segment III und IV </li><li> Nachdem das Segment III Stiel ist vollständig seziert sie geteilt werden mit Hilfe eines 45mm Endo GIA mit einer vaskulären Patrone. </li><li> er Verfahren betreibt mit weiteren Teilung des Parenchyms bis zur Hauptkreuzung Pedikel zu segmentieren II erreicht ist, isoliert und schließlich geteilt mit einem 45mm endoGIA mit vaskulären Patrone </li><li> Das linke Lig. trianguläre ist jetzt unterteilt mit einem Elektrokauter und die linke Lebervene ist isoliert und getrennt mit vaskulären Hefter </li><li> Die Leber Oberfläche ist für Blutungen kontrolliert; Argon-Beamer ist auf die Leber Oberfläche aufgetragen und die vaskuläre Klammer entfernt. An dieser Stelle Fibrinkleber auf Reihenfolge angewendet, um das Risiko von postoperativen Galle Leckagen zu reduzieren. Die Probe wird in endobag platziert und entfernt </li></ol>

<ol>
	<li>Nguyen, K. T., Gamblin, T. C., Geller, D. A. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+liver+resection+for+cancer.">Laparoscopic liver resection for cancer.</a> Future Oncol. 4 (5), 661-670 (2008).</li><li>Gumbs, A. A., Gayet, B., Gagner, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Laparoscopic+liver+resection:+when+to+use+the+laparoscopic+stapler+device.">Laparoscopic liver resection: when to use the laparoscopic stapler device.</a> HPB (Oxford). 10 (4), 296-303 (2008).</li><li>Pulitan&#242;, C., Catena, M., Arru, M., Guzzetti, E., Comotti, L., Ferla, G., Aldrighetti, 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+liver+resection+without+portal+clamping:+a+prospective+evaluation.">Laparoscopic liver resection without portal clamping: a prospective evaluation.</a> Surg Endosc. 22 (10), 2196-2200 (2008).</li><li>Yonem, O., Bayraktar, Y. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Clinical+characteristics+of+Caroli's+disease.">Clinical characteristics of Caroli's disease.</a> World J Gastroenterol. 13 (13), 1934-1937 (2007).</li></ol>

Laparoskopische Chirurgie sicher durchgeführt auch für Leberresektion sowohl für gutartige und bösartige Erkrankungen. Reduzierung der chirurgischen Traumas unter Verwendung minimal-invasiver Ansatz erlaubt es, die Inzidenz von postoperativen Komplikationen und postoperative Krankenhausaufenthalt zu minimieren.

laparoscopic left liver sectoriectomy of caroli's disease limited to segment ii and iii

Caroli-Krankheit ist eine abnorme Erweiterung der intra-hepatica Gallengänge definiert: Die Inzidenz ist äußerst gering (1 in 1.000.000 Einwohner) und in den meisten Fällen die ganze Leber ist interessiert und Lebertransplantation ist die Therapie der Wahl. Im Falle der Erweiterung beschränkt auf den linken oder rechten Lappen, können Leberresektion durchgeführt werden. Für viele Jahre der Standard-Ansatz zur Leberresektion hat eine formale Laparotomie durch einen großen Schnitt des Bauches, die durch signifikante post-operatie Morbidität gekennzeichnet ist gewesen. In jüngerer Zeit hat minimal-invasive, laparoskopische Vorgehen wie möglich Operationstechnik zur Leberresektion sowohl für gutartige und bösartige Erkrankungen vorgeschlagen worden. Die wichtigsten Vorteile der minimal-invasiven Ansatz wird durch eine signifikante Reduktion des chirurgischen Traumas, dass eine schnellere Genesung weniger postoperative Komplikationen ermöglicht vertreten. Dieses Video zeigt einen Fall von Caroli-Krankheit aufgetreten ist in einem 58 Jahre alten männlichen an der Abteilung Gastroenterologie für plötzliche Auftreten von Bauchschmerzen mit Fieber verbunden zugelassen (&gt; 38C °), Übelkeit und Schüttelfrost. Abdominal Ultraschall zeigte eine signifikante Erweiterung der intra-hepatischen links gelegenen Gallengänge ohne Beweise Gallenblase oder Choledochus Steine. Solche Befunde wurden abdominale hochauflösende Computertomographie bestätigt. Laparoskopische links sectoriectomy geplant war. Fünf Trokare und 30 °-Optik verwendet wurde, zeigte Exploration der Bauchhöhle keine Verwachsungen oder Beweise für andere Krankheiten. Um Blutzufluss zur Leber-Steuerung-, Gefäß-Klemme an der Leber Pedikel (Pringle Manöver s) gelegt wurde, ist Parenchymale Division mit einem kombinierten Einsatz von 5 mm bipolaren Pinzetten und 5 mm Ultraschalldissektor durchgeführt. Eine stark dilatierten linken Ductus hepaticus wurde isoliert und getrennt mit einem 45mm endoskopische vaskulären Hefter. Leber-Dissektion wurde die Isolation der wichtigsten linken Portal Zweig, der dann mit einer weiteren Patrone von 45 mm vaskulären Hefter geteilt wurde fortgesetzt. An seiner Stelle der linken Leber verbunden bleibt nur die linke Lebervene: Teilung des Lig. trianguläre wurde mit monopolaren Haken und die Lebervene isoliert und die geteilte mit vaskulären Hefter. Blutstillung durch Anwendung von Argon-Beamer Koagulation verfeinert und keine Blutung war auch nach dem Entfernen des Gefäßklemme (insgesamt Pringle s Zeit 27 Minuten) ergab. Postoperative Verlauf war ereignislos, minimale Erhöhung der Leberwerte wurde im postoperativen Tag 1 aufgezeichnet, aber wieder normal zu entladen auf post-operative Tag 3.

Watch this Scientific Journal Video about Laparoscopic Left Liver Sectoriectomy of Caroli's Disease Limited to Segment II and III at JoVE.com

Laparoscopic Left Liver Sectoriectomy of Caroli's Disease Limited to Segment II and III

Dieses Video stellt einen Fall der laparoskopischen linken Leber sectoriectomy in ein 53 Jahre alter Mann litt Caroli-Krankheit begrenzt auf Segment II und III der Leber perfomed.

Laparoskopische Left Leber Sectoriectomy der Caroli-Krankheit zu Segment II und III Limited

Caroli's disease is defined as a abnormal dilatation of the intra-hepatica bile ducts: Its  incidence is extremely low  (1 in 1,000,000 population) and in ...

laparoscopic-left-liver-sectoriectomy-caroli-s-disease-limited-to

Research

JoVE Journal

Biology

14.1K Aufrufe.  University of Insubria. Dieses Video stellt einen Fall der laparoskopischen linken Leber sectoriectomy in ein 53 Jahre alter Mann litt Caroli-Krankheit begrenzt auf Segment II und III der Leber perfomed.

Serie: Laparoscopic Left Liver Sectoriectomy of Caroli's Disease Limited to Segment II and III

Application of Hemostatic Devices in Laparoscopic Hepatectomy

Laparoscopic hepatectomy is considered a conventional method for treating benign and malignant liver diseases because it is a minimally invasive method. Despite its non-invasive aspect, bleeding and bile leakage occur in liver parenchyma tissue resection during the operation or in the post-operation period, indicating the requirement for high-grade hemostatic devices, such as ultrasonic surgical aspiration, bipolar electrocoagulation, etc. The lack of availability of these high-grade hemostatic devices prevents laparoscopic hepatectomy from becoming a generalized procedure in basic medical organizations. In view of the situation mentioned above, a suite of simple and easy hemostatic devices is developed in this protocol, which includes a harmonic scalpel, monopole electrocoagulation, and a single lumen catheter, to innovatively perform liver parenchyma tissue resection. First of all, the porta hepatis or hepatic pedicle is occluded intermittently by a single lumen catheter, followed by clamping for 15 min and releasing for 5 min. Subsequently, using the harmonic scalpel, clamping and crushing of the liver are done to cut off the hepatic parenchyma tissue and to reveal the intrahepatic arteries, veins, and bile ducts. Lastly, the bleeding spots are coagulated by using monopole electrocoagulation at each spot. Intrahepatic pipeline structures are then visible by using these methods, which could stop bleeding easily, reduce the incidence rate of bile leakage, and improve the safety and feasibility of laparoscopic hepatectomy. Therefore, the simple and easy hemostatic devices shown here are suitable for conducting procedures in primary medical institutions.

High-grade hemostatic devices are essential for laparoscopic hepatectomy. However, these devices are not generalized in basic medical organizations. Therefore, a suite of simple and easy hemostatic devices is shown in this article, which can make the laparoscopic hepatectomy easier to perform.

Anwendung hämostatischer Geräte in der laparoskopischen Hepatektomie

Laparoscopic hepatectomy is considered a conventional method for treating benign and malignant liver diseases because it is a minimally invasive method. ...

Forschung

Krebsforschung

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.

Anwendung des En-Bloc-Konzepts in Kombination mit anatomischer Resektion in der laparoskopischen Hepatektomie

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

Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience

Laparoscopic anterior right hepatectomy (LARH) has been used in some hospitals. However, data on the feasibility and safety of this procedure are still limited, due to the demanding technical requirements. The primary objective of this study was to compare the clinical outcomes of LARH with those of laparoscopic conventional right hepatectomy (LCRH) in patients with large right hepatocellular carcinoma, as well as to confirm the safety and feasibility of LARH. Furthermore, the article presents a step-by-step description of the surgical procedures for LARH to help perform this surgery in the clinic. The principle of LARH is to first prioritize the hepatic inlet duct separation while separating the right hepatic perihepatic ligament after transecting the liver. From December 2015 to June 2022, 82 patients with large right hepatocellular carcinoma (maximum tumor diameter &#8805; 5 cm), were recruited for the study. In this cohort, 54 and 28 patients underwent LARH and LCRH, respectively. The perioperative clinical data and survival outcomes of the two groups were compared. Compared with LCRH, LARH exhibited the advantages of less contact and extrusion, thereby leading to the achievement of superior results. Thus, we propose that LARH is the optimal choice for patients with large right hepatocellular carcinoma.

Here we present a step-by-step protocol for conducting laparoscopic anterior right hepatectomy and compare its clinical effects and postoperative outcomes with those of conventional hepatectomies. Analysis of the data of 82 patients with hepatocellular carcinoma revealed that laparoscopic anterior right hepatectomy had better clinical outcomes and survival rates than the conventional hepatectomy.

Laparoskopische vordere rechte Hepatektomie: eine einzentrische Erfahrung

Laparoscopic anterior right hepatectomy (LARH) has been used in some hospitals. However, data on the feasibility and safety of this procedure are still ...

Verhalten

Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to the anatomical characteristics of the liver, with intraoperative hemorrhage being a primary concern. Intraoperative blood loss is the leading cause of conversion to open surgery; therefore, effective management of bleeding and hemostasis is crucial for a successful LAH.
The two-surgeon technique is proposed as an alternative to the traditional single-surgeon approach, with potential benefits in reducing intraoperative bleeding during laparoscopic hepatectomy. However, there remains a lack of evidence to determine which mode of the two-surgeon technique yields superior patient outcomes. Besides, to our knowledge, the LAH technique, which involves the use of a cavitron ultrasonic surgical aspirator (CUSA) by the primary surgeon while an ultrasonic dissector by the second surgeon, has been rarely reported before.
Herein, we present a modified, two-surgeon LAH technique, wherein one surgeon employs a CUSA while the other uses an ultrasonic dissector. This technique is combined with a simple extracorporeal Pringle maneuver and low central venous pressure (CVP) approach. In this modified technique, the primary and secondary surgeons utilize a laparoscopic CUSA and an ultrasonic dissectorconcurrently to achieve precise and expeditious hepatectomy. A simple extracorporeal Pringle maneuver, combined with the maintenance of low CVP, is employed to regulate the hepatic inflow and outflow in order to minimize intraoperative bleeding. This approach facilitates the attainment of a dry and clean operative field, which allows for the precise ligation and dissection of blood vessels and bile ducts. The modified LAH procedure is simpler and safer due to its effective control over bleeding as well as the seamless transition between the roles of primary and secondary surgeons. It holds great promise for future clinical applications.

Here, we present a protocol to perform a modified laparoscopic anatomic hepatectomy using improved techniques and instruments.

Modifizierte laparoskopische anatomische Hepatektomie: Zwei-Chirurgen-Technik kombiniert mit dem einfachen extrakorporalen Pringle-Manöver

Laparoscopic anatomic hepatectomy (LAH) has become increasingly prevalent worldwide in recent years. However, LAH remains a challenging procedure due to ...

Medizin

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.

Techniken der laparoskopischen rechten posterioren Sektionektomie: Glisson-Ansatz und eine parenchymale Durchtrennungstechnik

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

<meta charset="utf8"></head><body>Laparoskopische Sektionektomie mit Ligamentum teres zur unblutigen Hepatektomie

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

Laparoscopic left lateral sectionectomy (LLLS), a mainstream procedure in liver surgery, often utilizes controlled low central venous pressure (CLCVP) to reduce bleeding in the hepatic venous system. However, anesthesiologists may avoid the use of CLCVP in patients with concurrent cardiovascular and cerebrovascular diseases to prioritize the maintenance of vital organ perfusion. In this report, we present an LLLS guided by the ligamentum teres hepatis (LTH) for dissection of the Glissonian pedicles for segments 2/3 outside the liver, followed by hepatic parenchymal dissection along the falciform ligament and umbilical fissure vein (UFV) while approaching the left hepatic vein root. Guided by LTH and UFV, this LLLS procedure effectively controlled intraoperative bleeding, even in the absence of CLCVP. Additionally, hepatectomy guided by extrahepatic and intrahepatic anatomical landmarks prevents loss of direction during liver dissection and ensures precise hepatic resection. These attributes suggest that the potential benefits extend beyond patients with cardiovascular or cerebrovascular conditions, making it applicable in a wide range of LLLS cases.

<meta charset="utf8"></head><body>Autor im Rampenlicht: Weiterentwicklung der Behandlung von hepatobiliären und Pankreastumoren mit minimal-invasiven Operationstechniken

Laparoscopic left lateral sectionectomy guided by the ligamentum teres hepatis and umbilical fissure vein effectively controls intraoperative bleeding even without controlled low central venous pressure and prevents loss of direction during parenchymal dissection.

Laparoskopische Sektionektomie linkslateral: Geführt durch das Ligamentum teres hepatis und die Nabelfissurenvene

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

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.

Vollständige laparoskopische radikale Resektion des perihilären Cholangiokarzinoms Typ IIIb

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

Laparoscopic Left Approach Resection of the Caudate Lobe

Laparoscopic caudate lobectomy (LCL) is one of the most challenging types of laparoscopic liver resections. The main difficulty lies in the deep anatomical position of the caudate lobe, which is closely adjacent to the first and second hepatic ports and the inferior vena cava, increasing the risk of major bleeding during surgery. In addition to a thorough understanding of the anatomy of the caudate lobe tumor, comprehensive imaging assessment, and three-dimensional reconstruction, the flexible choice of surgical approach is also key to reducing surgical difficulty and improving safety. We perform laparoscopic caudate lobectomy using a left-sided approach, especially when the tumor is located in the area of the caudate lobe close to the inferior vena cava. This method avoids the step of splitting the liver substance to expose the field of view required by the traditional anterior approach, with the advantages of larger operating space and shorter operation time. At the same time, combined with preoperative three-dimensional reconstruction technology, we have significantly reduced the risk of damaging important blood vessels and increased the success rate of resection of tumors in the caudate lobe.

Here, we present a surgical protocol describing the laparoscopic resection of a tumor situated near the paracaval portion within the caudate lobe, utilizing a left-sided approach.

Laparoskopische Left Leber Sectoriectomy der Caroli-Krankheit zu Segment II und III Limited

Zusammenfassung

Weitere Videos entdecken

Kapitel in diesem Video

Anwendung hämostatischer Geräte in der laparoskopischen Hepatektomie

Anwendung des En-Bloc-Konzepts in Kombination mit anatomischer Resektion in der laparoskopischen Hepatektomie

Laparoskopische vordere rechte Hepatektomie: eine einzentrische Erfahrung

Modifizierte laparoskopische anatomische Hepatektomie: Zwei-Chirurgen-Technik kombiniert mit dem einfachen extrakorporalen Pringle-Manöver

Techniken der laparoskopischen rechten posterioren Sektionektomie: Glisson-Ansatz und eine parenchymale Durchtrennungstechnik

Laparoskopische Sektionektomie linkslateral: Geführt durch das Ligamentum teres hepatis und die Nabelfissurenvene

Laparoskopische Sektionektomie linkslateral: Geführt durch das Ligamentum teres hepatis und die Nabelfissurenvene

Laparoskopische Sektionektomie linkslateral: Geführt durch das Ligamentum teres hepatis und die Nabelfissurenvene

Vollständige laparoskopische radikale Resektion des perihilären Cholangiokarzinoms Typ IIIb

Laparoskopische Resektion des Kaudarmappens mit linksem Zugang