手術手技<ol><li>患者は仰臥位での標準的な手術室の条件の下で層状と腹部全体がdesinfectedです。次に、患者は無菌シートで覆われている。 </li><li> &quot;逆L字型&quot;開腹術後に腹腔内に腹膜癌腫症を除外するために検討されている。その後、肝円索と靱帯falciformeはリガチャと電気メスで分けられています。 </li><li>肝靭帯の腹腔慎重双方向マニュアル探査の探査に続いて肝外のリンパ節転移を除外するために実行されます。肝外肝門部の構造は中央の腫瘍の浸潤や門リンパ節転移が除外される場合、そのまま何もしません。 </li><li>肝臓の探査は、右肝三角靱帯を分割した後に、完全な肝臓の触診から始まります。これは、肝内腫瘍の広がり、特に主要な肝内血管構造、中肝静脈との関係を調査し、その結果、切除線を決定し、マークする術中ドップラー超音波検査が続いている。 </li><li>治療の手順が可能表示された場合は、右半球肝臓が完全にクリップや縫合糸の間に後の肝静脈を割ってsubphreniumからとretrohepatic下大静脈から動員される。右肝静脈が解放されるまで、この手順が続行されます。右肝静脈を分離した後、mersileneループは、後に実質切除時の肝の解除のために挿入されます。 </li><li>次に、逆行性胆嚢摘出術が行われます。胆嚢管は、チタンのクリップの間に分かれています。 </li><li>その後、実質の解剖が開始されます。肝臓を穏やかに対称的に持ち上げ二タオルと開かれた、開催されます。実質の切除は、CUSA解剖（Valleylab、ボルダー- CO、米国）で行われます。小血管はバイポーラ鉗子（エルベ、Tビンゲン、ドイツ）を水灌漑、および大血管や胆管を結紮糸、クリップ、あるいは縫合糸との間で分割されて密封されている。切除は、血液の損失を減らすために低中心静脈圧CVP（0から5ミリメートルHg）で実行されます。右の茎肝内が完全にフリーになるまで、この段階となっています。その後、mersileneループは、茎を持ち上げ、血管のステープラー（タイコヘルスケアグループによるAutosuture TA、ノーウォーク、コネチカット、米国）の非外傷性の導入を可能にするために挿入されます。 </li><li>右の茎は、ホッチキスでtransectedし、急激にその右側にナイフで分割されています。 </li><li>以前に以前に置かmersileneループを使用して肝臓を懸濁することによって説明されているようにし実質切除の残りの部分は完了です。 </li><li>その後、右肝静脈は血管ステープラーで解剖され、右肝葉が削除されます。 </li><li>これは、切断面の慎重な改訂と胆汁の漏れを除外するために精密な探査が続きます。 （7）必要に応じて白色テストは、この時点で行うことができます。 </li><li>最後のステップは中断ステッチによる残存肝葉の解剖学的固定ですし、腹部を実行している縫合して閉じている。 </li><li>術後の患者が日常的に一晩のために集中治療室で観察される。術後経過は通常の超音波検査と肝機能の患者平穏無事であれば、さらに回復のための病棟に運ばれている。 </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がほとんどであっても良性腫瘍または肝転移で、肝十二指腸間膜内肝外の肺門の構造を準備した後に実行されています。1-5様々なセンターでは、実質切除が完全または選択的肝門部血管閉塞下で行われる。これらの手順の主要な欠点​​は、対側の構造を負傷のリスクと門脈の側枝や胆管の障害血流からの出血の可能性を持つ門の複雑な準備です。 ...

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

成功した肝切除は、深い解剖学的知識と繊細な手術手技を必要とします。 Hemihepatectomiesは主であっても良性腫瘍または肝転移で、肝十二指腸間膜内肝外の肺門の構造を準備した後に実行されます。<sup&gt; 1月5日</sup&gt;。肝転移患者における肝門部のリンパ節転移がほとんどオカルトであるのに対し、地域の肝外のリンパ節郭清は、肝門部胆管癌、肝cholangio -細胞癌と肝細胞癌における腫瘍学的標準です。これらの手順の主要な欠点​​は、対側の構造を負傷のリスクと門脈の側枝や胆管の障害血流からの出血の可能性を持つ門の複雑な準備です。我々は完全にそのまま肝十二指腸間膜を残すその茎の肝切除と左横のセグメントの右側hemihepatectomyまたは切除の技術を開発した。<sup&gt; 6</sup靭帯の術中の可視化や触診では腫瘍の浸潤やリンパ節転移の疑いの場合&gt;しかし、、門を探求し、リンパ節郭清は行うべきである。

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

このビデオでは、完全にそのまま肝十二指腸間膜を残して右hemipedicleの肝切除と右hemihepatectomyを説明します。

血管ホッチキスを使って右HemipedicleのSuprahilar肝内切除により右Hemihepatectomy

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 ビュー.  Tübingen University Hospital. このビデオでは、完全にそのまま肝十二指腸間膜を残して右hemipedicleの肝切除と右hemihepatectomyを説明します。

ビデオ: 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.

腹腔鏡下肝切除術における止血装置の適用

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

がん研究

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.

腹腔鏡下肝切除術における解剖学的切除と組み合わせたEnBloc概念の適用

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.

腹腔鏡下右前方肝切除術:単一施設の経験

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

行動学

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.

再門脈部分肝移植のラット体内血管指向 70% 肝切除

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

医学

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.

肝臓内複合体胆道嚢胞のためのインドシアニングリーン蛍光イメージングを用いたロボット左肝切除術

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.

肺門胆管癌に対するロボットタージマハル肝切除術

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.

修正腹腔鏡下解剖学的肝切除術:単純な体外プリングル操作と組み合わせた2人の外科医技術

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.

腹腔鏡下右後部切除術の技術:グリッソニアンアプローチと実質離断術

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>無血肝切除術のためのLigamentum Teresを使用した腹腔鏡切片切除術

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>著者スポットライト:低侵襲手術技術による肝胆道および膵臓腫瘍治療の進歩

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.

腹腔鏡下左外側切片切除術:肝靭帯と臍裂静脈による指導

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

血管ホッチキスを使って右HemipedicleのSuprahilar肝内切除により右Hemihepatectomy

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腹腔鏡下肝切除術における止血装置の適用

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