Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position.
Anatomical liver resection
Laennec's capsule
Laparoscopic liver resection
Journal
Surgical oncology
ISSN: 1879-3320
Titre abrégé: Surg Oncol
Pays: Netherlands
ID NLM: 9208188
Informations de publication
Date de publication:
Jun 2019
Jun 2019
Historique:
received:
07
02
2019
revised:
07
04
2019
accepted:
01
05
2019
entrez:
15
6
2019
pubmed:
15
6
2019
medline:
19
12
2019
Statut:
ppublish
Résumé
Among the laparoscopic anatomical liver resections, the right posterior sectionectomy is highly demanding [1, 2], particularly when exposing the right hepatic vein (RHV). To standardize the procedure, the inter-Laennec approach was developed based on the Laennec's capsule structure, composed of two layers surrounding the RHV. One is derived from the proper membrane (hepatic Laennec's capsule) and the other from the pericardium (cardiac Laennec's capsule) [3]. The inter-Laennec approach is a new strategy to expose the RHV by entering the space between the two layers. Herein, we present the concept and procedure of the inter-Laennec approach. The patient with 15-mm metastatic tumor close to the right posterior Glissonean pedicle and RHV was placed in left semi-prone position to obtain a good visual field [4]. After the isolation of the extrahepatic right posterior Glissonean pedicle and mobilization of the right liver, we transected the inferior vena cava ligament that facilitated entry into the inter-Laennec space between the hepatic and cardiac Laennec's capsules. We started the liver parenchyma transection between the right posterior section and caudate lobe, followed by cranio-caudal parenchymal dissection along the inter-Laennec space that safely facilitated the exposure of the RHV and confluences of the V7s. The operative time and estimated blood loss were 538 min and 250 mL, respectively. The surface of the RHV was completely exposed with a whitish and shiny appearance, suggesting it was covered by the cardiac Laennec's capsule. The inter-Laennec approach is a feasible procedure to standardize laparoscopic right posterior sectionectomy.
Sections du résumé
BACKGROUND
BACKGROUND
Among the laparoscopic anatomical liver resections, the right posterior sectionectomy is highly demanding [1, 2], particularly when exposing the right hepatic vein (RHV). To standardize the procedure, the inter-Laennec approach was developed based on the Laennec's capsule structure, composed of two layers surrounding the RHV. One is derived from the proper membrane (hepatic Laennec's capsule) and the other from the pericardium (cardiac Laennec's capsule) [3]. The inter-Laennec approach is a new strategy to expose the RHV by entering the space between the two layers. Herein, we present the concept and procedure of the inter-Laennec approach.
METHODS
METHODS
The patient with 15-mm metastatic tumor close to the right posterior Glissonean pedicle and RHV was placed in left semi-prone position to obtain a good visual field [4]. After the isolation of the extrahepatic right posterior Glissonean pedicle and mobilization of the right liver, we transected the inferior vena cava ligament that facilitated entry into the inter-Laennec space between the hepatic and cardiac Laennec's capsules. We started the liver parenchyma transection between the right posterior section and caudate lobe, followed by cranio-caudal parenchymal dissection along the inter-Laennec space that safely facilitated the exposure of the RHV and confluences of the V7s.
RESULTS
RESULTS
The operative time and estimated blood loss were 538 min and 250 mL, respectively. The surface of the RHV was completely exposed with a whitish and shiny appearance, suggesting it was covered by the cardiac Laennec's capsule.
CONCLUSION
CONCLUSIONS
The inter-Laennec approach is a feasible procedure to standardize laparoscopic right posterior sectionectomy.
Identifiants
pubmed: 31196479
pii: S0960-7404(19)30047-7
doi: 10.1016/j.suronc.2019.05.001
pii:
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
140-141Informations de copyright
Copyright © 2019. Published by Elsevier Ltd.