Pure Laparoscopic Right Upper Transversal Hepatectomy.
Journal
Annals of surgical oncology
ISSN: 1534-4681
Titre abrégé: Ann Surg Oncol
Pays: United States
ID NLM: 9420840
Informations de publication
Date de publication:
May 2022
May 2022
Historique:
received:
13
09
2021
accepted:
03
01
2022
pubmed:
24
1
2022
medline:
12
4
2022
entrez:
23
1
2022
Statut:
ppublish
Résumé
First proposed by Torzilli et al., A 36-year-old female with HBV-related hepatocellular carcinoma (HCC) was admitted to our institution. Abdominal CT showed a 5.5- × 5.0-cm mass located in deep S7-8 with involvement of middle hepatic vein (MHV) and right hepatic vein (RHV). Extended right hepatectomy was not adopted because of the insufficient volume of residual liver. Moreover, a thick inferior right hepatic vein (IRHV) and two communicating veins (CVs) were observed by preoperative 3-D reconstruction. Thus, laparoscopic RUTH was performed. After fully mobilization of right liver, the RHV and MHV were isolated and encircled. Then, intraoperative ultrasound was used to locate the tumor and identify the tumor-bearing portal territories. Subsequently, parenchymal transection was performed using the Harmonic. The Pringle's maneuver was used intermittently during transection as necessary (total Pringle time was 62 min). Four tumor-bearing portal pedicles were all confirmed and divided with the guidance of intraoperative ultrasound. The MHV and RHV were transected using the stapler and the IRHV was well preserved. Finally, the operation was finished and the color of residual liver was acceptable. The operative time was 240 min and estimated blood loss was 100 cc. The postoperative course was uneventful and the patient was discharged on postoperative Day 6. Laparoscopic RUTH is technically feasible and safe in selected patients with IRHV and CVs.
Sections du résumé
BACKGROUND
BACKGROUND
First proposed by Torzilli et al.,
METHODS
METHODS
A 36-year-old female with HBV-related hepatocellular carcinoma (HCC) was admitted to our institution. Abdominal CT showed a 5.5- × 5.0-cm mass located in deep S7-8 with involvement of middle hepatic vein (MHV) and right hepatic vein (RHV). Extended right hepatectomy was not adopted because of the insufficient volume of residual liver. Moreover, a thick inferior right hepatic vein (IRHV) and two communicating veins (CVs) were observed by preoperative 3-D reconstruction. Thus, laparoscopic RUTH was performed.
RESULTS
RESULTS
After fully mobilization of right liver, the RHV and MHV were isolated and encircled. Then, intraoperative ultrasound was used to locate the tumor and identify the tumor-bearing portal territories. Subsequently, parenchymal transection was performed using the Harmonic. The Pringle's maneuver was used intermittently during transection as necessary (total Pringle time was 62 min). Four tumor-bearing portal pedicles were all confirmed and divided with the guidance of intraoperative ultrasound. The MHV and RHV were transected using the stapler and the IRHV was well preserved. Finally, the operation was finished and the color of residual liver was acceptable. The operative time was 240 min and estimated blood loss was 100 cc. The postoperative course was uneventful and the patient was discharged on postoperative Day 6.
CONCLUSIONS
CONCLUSIONS
Laparoscopic RUTH is technically feasible and safe in selected patients with IRHV and CVs.
Identifiants
pubmed: 35066717
doi: 10.1245/s10434-022-11331-8
pii: 10.1245/s10434-022-11331-8
doi:
Types de publication
Case Reports
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
2977Commentaires et corrections
Type : CommentIn
Informations de copyright
© 2022. Society of Surgical Oncology.
Références
Torzilli G, Procopio F, Donadon M, et al. Upper transversal hepatectomy. Ann Surg Oncol. 2012;19(11):3566.
doi: 10.1245/s10434-012-2596-8
Torzilli G, Procopio F, Cimino M, et al. Radical but conservative liver resection for large centrally located hepatocellular carcinoma: the mini upper-transversal hepatectomy. Ann Surg Oncol. 2014;21(6):1852.
doi: 10.1245/s10434-014-3482-3
Alvarez FA, Sanchez Claria R, Oggero S, de Santibañes E. Parenchymal-sparing liver surgery in patients with colorectal carcinoma liver metastases. World J Gastrointest Surg. 2016;8(6):407–23.
doi: 10.4240/wjgs.v8.i6.407
Makdissi FF, Kruger JAP, Jeismann VB, Herman P. Feasibility of right upper transversal hepatectomy in the absence of an inferior right hepatic vein: new insights regarding this complex procedure. Case Rep Surg. 2021;2021:6668269.
pubmed: 33747594
pmcid: 7960046