Técnica quirúrgica <ol><li> El paciente se acuesta en condiciones estándar de quirófano en posición dorsal y el abdomen se desinfecta. A continuación, el paciente se cubre con sábanas estériles. </li><li> Después de &quot;revertir en forma de L&quot; laparotomía de la cavidad abdominal se explora para excluir a la carcinomatosis peritoneal. Posteriormente, el ligamento redondo y el ligamento falciforme se dividen con ligaduras y electrocauterio. </li><li> Después de la exploración de la cavidad abdominal cuidadosa exploración bimanual del ligamento hepático se realiza para excluir metástasis en los ganglios linfáticos extrahepática. Las estructuras hiliares extrahepáticos permanecen intactos, si el centro de la infiltración tumoral o metástasis en los ganglios linfáticos hilio están excluidos. </li><li> Exploración del hígado comienza con la palpación manual del hígado completo, después de haber dividido el ligamento triangular hepático derecho. Esto es seguido por una ecografía Doppler intraoperatorio para investigar propagación del tumor intrahepático y su relación con las estructuras vasculares intrahepáticas principales, especialmente la vena hepática media, y por lo tanto para determinar y marcar la línea de transección. </li><li> Si un procedimiento curativo parece posible, el derecho hemi-hígado a movilizarse por completo de la subphrenium y de la vena cava inferior retrohepática dividiendo las venas del hígado posterior entre clips o suturas. Este paso continúa hasta que la vena hepática derecha es gratis. Después de aislar la vena hepática derecha, un bucle Mersilene se inserta para su posterior elevación del hígado durante la transección del parénquima. </li><li> A continuación, una colecistectomía retrógrada se lleva a cabo. El conducto cístico se divide entre los clips de titanio. </li><li> Posteriormente, la disección del parénquima se ha iniciado. El hígado es el lugar con cuidado, de forma simétrica levantó y abrió con dos toallas. La transección del parénquima se realiza con un disector CUSA (Valleylab, Boulder, CO, EE.UU.). Los pequeños vasos están cerrados con agua de riego pinzas bipolares (Erbe, T Bingen, Alemania), y los buques más grandes o los conductos biliares se dividen entre las ligaduras, clips o suturas aún. Resecciones se realizan con baja presión venosa central CVP (0 de 5 mm Hg) para reducir la pérdida de sangre. Esta fase continúa hasta que el intrahepática derecha pedículo es totalmente gratuito. Luego, un bucle Mersilene se inserta a levantar el pedículo y permitir la introducción atraumática de una engrapadora vascular (TA Autosuture por Tyco Healthcare Group, Norwalk, Connecticut, EE.UU.). </li><li> El derecho pedículo se secciona con la grapadora y muy divididas, con el cuchillo en su mano derecha. </li><li> A continuación, el resto de la sección transversal del parénquima se completa como se ha descrito anteriormente mediante la suspensión del hígado usando el bucle Mersilene colocado previamente. </li><li> Posteriormente, la vena hepática derecha se diseca con la engrapadora vascular y el lóbulo derecho del hígado se elimina. </li><li> Esto es seguido por la revisión cuidadosa de la superficie de corte y exploración precisa para excluir a las fugas biliares. Una prueba de blancos se puede realizar en este momento si es necesario (7). </li><li> El último paso es la fijación anatómica del lóbulo hepático remanente por puntos separados y luego se cierra el abdomen con puntos de sutura en funcionamiento. </li><li> Después de la cirugía los pacientes se observan en la unidad de cuidados intensivos por una noche, de forma rutinaria. Si el curso postoperatorio sin complicaciones con la ecografía es normal y los pacientes de la función hepática son llevados a la sala de recuperación adicional. </li></ol>

<ol>
	<li>Belghiti, J., Noun, R., Zante, E. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Portal+triad+clamping+or+hepatic+vascular+exclusion+for+major+liver+resection.+A+controlled+study.">Portal triad clamping or hepatic vascular exclusion for major liver resection. A controlled study.</a> Ann Surg. 224, 155-161 (1996).</li><li>Man, K., Fan, S. T., Ng, I. O. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Prospective+evaluation+of+Pringle+maneuver+in+hepatectomy+for+liver+tumors+by+a+randomized+study.">Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study.</a> Ann Surg. 226, 704-711 (1997).</li><li>Wu, C. C., Hwang, C. R., Liu, T. J. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Effects+and+limitations+of+prolonged+intermittent+ischaemia+for+hepatic+resection+of+the+cirrhotic+liver.">Effects and limitations of prolonged intermittent ischaemia for hepatic resection of the cirrhotic liver.</a> Br J Surg. 83, 121-124 (1996).</li><li>Figueras, J., Llado, L., Ruiz, D. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Complete+versus+selective+portal+triad+clamping+for+minor+liver+resections:+a+prospective+randomized+trial.">Complete versus selective portal triad clamping for minor liver resections: a prospective randomized trial.</a> Ann Surg. 241, 582-590 (2005).</li><li>Lesurtel, M., Selzner, M., Petrowsky, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=How+Should+Transection+of+the+Liver+Be+Performed?+A+Prospective+Randomized+Study+in+100+Consecutive+Patients:+Comparing+Four+Different+Transection+Strategies..">How Should Transection of the Liver Be Performed? A Prospective Randomized Study in 100 Consecutive Patients: Comparing Four Different Transection Strategies..</a> Ann Surg. 242, 814-823 (2005).</li><li>K&#246;nigsrainer, I., Steurer, W., Witte, M. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Liver+resection+without+hilus+preparation+and+with+selective+intrahepatic+hilus+stapling+for+benign+tumors+and+liver+metastasis.">Liver resection without hilus preparation and with selective intrahepatic hilus stapling for benign tumors and liver metastasis.</a> Langenbecks Arch Surg. 392, 485-488 (2007).</li><li>Nadalin, S., Li, J., Lang, H. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=The+White+test:+a+new+dye+test+for+intraoperative+detection+of+bile+leakage+during+major+liver+resection.">The White test: a new dye test for intraoperative detection of bile leakage during major liver resection.</a> Arch Surg. 143, 402-404 (2008).</li></ol>

Hemihepatectomies se realiza sobre todo después de preparar las estructuras hiliares extrahepática en el ligamento hepatoduodenal, incluso en tumores benignos o metástasis hepáticas. 5.1 en varios centros, la transección del parénquima se realiza con completa o selectiva oclusión vascular hiliar. Las principales desventajas de estos procedimientos son la preparación compleja del hilio con el riesgo de lesionar las estructuras contralateral y la posibilidad de sangrado de la vena porta ramas laterales ...

right hemihepatectomy by suprahilar intrahepatic transection of the right hemipedicle using a vascular stapler

La resección hepática con éxito requiere un profundo conocimiento anatómico y la técnica quirúrgica delicada. Hemihepatectomies se realiza sobre todo después de preparar las estructuras hiliares extrahepática en el ligamento hepatoduodenal, incluso en tumores benignos o metástasis hepáticas.<sup&gt; 1.5</sup&gt;. Linfadenectomía regional extrahepáticas es una norma oncológicos en colangiocarcinoma hiliar, intrahepática la colangiopancreatografía celular y carcinoma hepatocelular, mientras que las metástasis de ganglios linfáticos en el hilio hepático en pacientes con metástasis hepáticas rara vez se oculta. Las principales desventajas de estos procedimientos son la preparación compleja del hilio con el riesgo de lesionar las estructuras contralateral y la posibilidad de sangrado de la vena porta ramas laterales o alteración de la perfusión de los conductos biliares. Hemos desarrollado una técnica de hemihepatectomía derecho o la resección de los segmentos de lateral izquierdo con sección del pedículo intrahepática que deja el ligamento hepatoduodenal completamente intacta.<sup&gt; 6</sup&gt; Sin embargo, si la visualización intraoperatoria o la palpación del ligamento es sospechoso de infiltración tumoral o metástasis en los ganglios linfáticos, el hilio se debe explorar y realizar una linfadenectomía.

Watch this Scientific Journal Video about Right Hemihepatectomy by Suprahilar Intrahepatic Transection of the Right Hemipedicle using a Vascular Stapler at JoVE.com

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

Este video describe una hemihepatectomía derecha con sección intrahepática del hemipedicle derecho de salir del ligamento hepatoduodenal completamente intacta.

Hemihepatectomía derecho por transección intrahepática suprahiliar del derecho Hemipedicle utilizando una grapadora vascular

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

right-hemihepatectomy-suprahilar-intrahepatic-transection-right

Universidad de Cartagena UDEC

Research

JoVE Journal

Biology

14.0K vistas.  Tübingen University Hospital. Este video describe una hemihepatectomía derecha con sección intrahepática del hemipedicle derecho de salir del ligamento hepatoduodenal completamente intacta.

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

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.

Aplicación de dispositivos hemostáticos en la hepatectomía laparoscópica

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

Investigación

Investigación sobre el cáncer

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.

Aplicación del concepto En Bloc combinado con resección anatómica en hepatectomía laparoscópica

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.

Hepatectomía laparoscópica anterior derecha: una experiencia en un solo centro

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

Comportamiento

Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy

Split liver transplantation and living liver donor liver transplantation were developed in the clinic to utilize liver organs in a more efficient manner. To better understand the mechanism behind these surgical procedures, a rat partial liver transplantation (PLTx) model was established for relevant surgical studies. Because of the complexity of the rat PLTx model, a protocol with detailed descriptions is required. An article published previously reported a protocol in which ex vivo hepatectomy was used to achieve 50% rat PLTx. In contrast to this protocol, we introduced a re-arterialized PLTx with an in vivo 70% hepatectomy. An updated vessel-oriented hepatectomy was incorporated into the rat PLTx to refine the microsurgical procedure. The portal veins and hepatic arteries of the left lateral lobe and the median lobe were individually dissected and ligated before removal of the liver parenchyma, thereby decreasing the probability of bleeding in the remnant liver stump. Furthermore, an end-to-side vessel anastomosis between the common hepatic artery and the enlarged proper hepatic artery was introduced to re-arterialize the hepatic artery. By using this end-to-side vessel anastomosis technique, the diameter of the anastomosis was enlarged, thereby decreasing the difficulty of hand suture and maintaining a high rate of anastomotic patency. Moreover, the cuff anastomosis of the infrahepatic vena cava was slightly modified. A section of circumferential liver parenchyma around the vena cava of a recipient was preserved during cuff anastomosis to maintain the three-dimensional shape of the vascular lumen. This section of liver parenchyma was removed after completing the anastomosis. With this modification, the step involving placement of stay sutures was omitted, thereby further shortening the cuff anastomosis time. By using this protocol of rat PLTx, a low liver enzyme level, an intact liver lobular architecture and a high survival rate were achieved after microsurgery.

Re-Arterialized Rat Partial Liver Transplantation with an in vivo Vessel-Oriented 70% Hepatectomy

Here, a protocol involving re-arterialized rat partial liver transplantation is presented. Specifically, 70% liver was resected in vivo by using an updated technique of vessel-oriented hepatectomy. The hepatic artery was reconstructed in an end-to-side manner. The cuff technique was modified to shorten the anastomosis time of the infrahepatic vena cava.

Volver a arterializada rata parcial trasplante del hígado con una en vivo orientada al barco 70% hepatectomía

Split liver transplantation and living liver donor liver transplantation were developed in the clinic to utilize liver organs in a more efficient manner. ...

Medicina

Robotic Left Hepatectomy using Indocyanine Green Fluorescence Imaging for an Intrahepatic Complex Biliary Cyst

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. Surgery is the cornerstone treatment for patients with BC. While total BC excision and Roux-Y hepaticojejunostomy is the treatment method of the choice in patients with extrahepatic BC (i.e., Todani I-IV), patients with intrahepatic BC (i.e., Todani V) benefit the most from a surgical liver resection. In recent years, minimally invasive liver surgery (MILS) including robotic MILS has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. Robotic major MILS is still considered technically demanding and a detailed description of the technical approach during robotic major MILS has only been limitedly discussed in the literature. The current article describes the main steps for a robotic left hepatectomy in a patient with a large BC Todani Type V. The patient is in French position with 5 trocars placed (4 robotic, 1 laparoscopic assistant). After mobilizing the left hemiliver, the left and right hepatic artery are dissected carefully followed by a cholecystectomy. Intraoperative ultrasound is performed to confirm localization and margins of the BC. The Left hepatic artery and left portal vein are isolated, clipped, and divided. Indocyanine green (ICG) fluorescence imaging is used regularly during the entire procedure to visualize and confirm biliary tract anatomy and the BC. Parenchymal transection is performed with robotic cautery hook for the superficial part and robotic cautery spatula, bipolar cautery, and vessel sealer for the deeper parenchyma. The postoperative course was uncomplicated. A robotic left hepatectomy is technically demanding, yet a feasible and safe procedure. ICG-fluorescence imaging aids in delineating the BC and bile duct anatomy. Further, comparative studies are needed to confirm clinical benefits of robotic MILS for benign and malignant indications.

Robotic liver surgery has gained more acceptance as a feasible, safe, and effective procedure for the treatment of both benign and malignant indications. However, robotic left hepatectomy is still technically demanding. We describe our surgical technique of a robotic left hepatectomy using indocyanine green fluorescence imaging for a large biliary cyst.

Hepatectomía izquierda robótica con imágenes de fluorescencia verde de indocianina para un quiste biliar complejo intrahepático

Biliary cysts (BC) are rare congenital dilatations of intra- and extrahepatic parts of the biliary tract and bear a significant risk of carcinogenesis. ...

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.

Hepatectomía robótica Taj Mahal para el colangiocarcinoma hiliar

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

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.

Hepatectomía anatómica laparoscópica modificada: técnica de dos cirujanos combinada con la simple maniobra extracorpórea de Pringle

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

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.

Técnicas de seccionectomía laparoscópica posterior derecha: abordaje glissoniano y técnica de transección parenquimatosa

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>Sección laparoscópica con ligamento redondo para hepatectomía sin sangre

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 destacado: Avance en el tratamiento de tumores hepatobiliares y pancreáticos con técnicas quirúrgicas mínimamente invasivas

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.

Sección lateral izquierda laparoscópica: guiada por el ligamento redondo hepático y la vena de la fisura umbilical

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

Hemihepatectomía derecho por transección intrahepática suprahiliar del derecho Hemipedicle utilizando una grapadora vascular

Resumen

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Hepatectomía laparoscópica anterior derecha: una experiencia en un solo centro

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Hepatectomía robótica Taj Mahal para el colangiocarcinoma hiliar

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Sección lateral izquierda laparoscópica: guiada por el ligamento redondo hepático y la vena de la fisura umbilical

Sección lateral izquierda laparoscópica: guiada por el ligamento redondo hepático y la vena de la fisura umbilical