Name: transradial access chemoembolization for hepatocellular carcinoma patients
Uploaded: 2020-09-20T13:00:00.000+00:00
Duration: 5 min 31 s
Description: Watch this Scientific Journal Video about Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients at JoVE.com

Bu çalışma Fudan Üniversitesi Zhongshan Hastanesi'nden (2016ZSLC17) klinik araştırma özel fonu tarafından desteklendi. Yazarlar, Fudan Üniversitesi Zhongshan Hastanesi'ndeki Dr. Xianglin Hu'ya İngilizce yazmaya yönelik çok profesyonel önerileri için çok minnettarlar.

Bu tek merkezli retrospektif çalışma, Fudan Üniversitesi Zhongshan Hastanesi yerel Kurumsal İnceleme Kurulu tarafından onaylandı.
1. Bilgilendirilmiş onay alma
<ol><li>TRA müdahalelerinden önce girişimsel radyologlara (IR) TRA'nın faydalarını ve potansiyel komplikasyonlarını hastalara açıklatır.</li>
</ol>2. Hasta değerlendirmesi
<ol><li>Bilgilendirilmiş onay aldıktan sonra, ra'yı delinme ve canülasyonun fizibilitesi için değerlendirin.</li>
	<li>Hastanın tıbbi geçmişinin kapsamlı bir incelemesini gerçekleştirin. Hastaların ciddi vasküler tortuosite, şiddetli periferik vasküler hastalık, diyaliz için fistül veya RA diyaliz operasyonuna hazırlık olup olmadığını onaylayın. Bunlar TRA müdahalesi alan hastalar için göreceli kontrendikasyonlardır.</li>
	<li>RA'nın görünürlüğünü değerlendirin.<ol>
<li>Müdahaleden önce el kollateraral arterlerin ne kadar görünür olduğunu değerlendirmek için nabız oksimetresi kullanarak bir Barbeau testi gerçekleştirin11. Barbeau D dalga formu RA cannülasyonu için mutlak bir kontrendikasyon olarak kabul edilir.</li>
		<li>Barbeau C dalga formu olarak test edilen hastalar için, kol ve eldeki kol sirkülasyon miktarı hakkında daha güvenilir bilgi sağlamak için Doppler ultrason muayenesi uygulayın. 2 mm'den küçük bir iç çap kontrendikasyon olarak kabul edilir. NOT: Tıbbi öykü değerlendirmesi ve RA değerlendirmesinden sonra kontrendikasyonları olan hastalar ipsilateral RA yoluyla delinme durumundan kaçınmalıdır. Kontrallateral RA, Barbeau test değerlendirmesi yoluyla patent olduğu tespit edilirse ideal bir tedarik görevi görebilir. Sol RA başlangıçta tercih edilen bir erişim yolu olarak seçilir. Sol RA uygun bulunamazsa, sağ RA alternatif bir seçim olarak hizmet edebilir.</li>
	</ol>
</li>
</ol>3. Radyal arter erişimi
<ol><li>Hastayı anjiyografi masasına bir destek pozisyonuna getirin. Daha sonra, sol kolu hastanın vücuduna paralel ve sol bele yakın bir yere yerleştirin, kateter ve telin kolay yerleştirilmesini sağlar ve operatör konumlandırmasını TFA ile karşılaştırılabilir hale getirin.</li>
	<li>Distal RA nabzını palpasyonla işaretleyin. Cilt yüzeyini %10 povidon-iyot cerrahi ovma çözeltisi ile temizleyin ve çözeltinin havayla kurumasını bekleyin. Sol kolu cerrahi bir örtü ile örtün.<ol>
<li>Olası sol RA delinme arızası durumunda, sağ kol veya sağ kasık bölgesini sterilize ederek ve perdeleyerek alternatif bir erişim yolu hazırlayın.</li>
	</ol>
</li>
	<li>Lokal anestezi uygulayın (yani% 2 1 mL lidoksin) sol RA'nın en güçlü titreşim ekseni boyunca styloid işlemine proksimal.</li>
	<li>Modifiye Seldinger tekniğini kullanarak bileği uzatın ve RA'yı 20 G iğne ile delin. Pulsatile arteriyel kan dönüşü göze çarpıldığında, 0.025 inç hidrofilik kılavuz tel tanıtın.<ol>
<li>Kılavuz telini geri çek ve dirençle karşılaşılırsa iğneyi yeniden düzenle. Kılavuz telin takılmasını zorlamayın. Dijital çıkarma anjiyografisinin (DSA) yardımıyla, RA'yı vurgulamak ve hidrofilik kılavuz telini yerleştirmeye yardımcı olmak için yaklaşık 1 ila 2 mL kontrast enjekte edin.</li>
	</ol>
</li>
	<li>Erişim elde edildikten sonra, iğneyi çıkarın ve kılavuz tel ile 4 Fransız hidrofilik kılıfı tanıtın. Kılış takıldıktan sonra, kılım ucunun damar içinde olduğunu doğrulamak için bir şırınna ile az miktarda arteriyel kanı hafifçe geri pompalayın.</li>
</ol>4. Antikoagülasyon ve vasküler genişleme
<ol><li>10 mL vazodilasyon kokteyl çözeltisi hazırlayın (3.000 IU kırılmamış heparin, 0.1 mg nitrogliserin ve 20 mg lidotrin).</li>
	<li>Vazodilasyon kokteyl çözeltisinin 8 mL'lik kısmını kılıktan 0,5 mL/s hızında geçirin(Şekil 1). NOT: Orta veya yüksek kanama riski olan hastalar için heparin dozunu azaltın veya durdurun.</li>
</ol>5. Kateter seçimi
<ol><li>Subklaviyen arterden geçmek ve alçalanı meşgul etmek için 4-Fransız, 125 cm ortak kateter ve standart 0,035 inç x 180 cm hidrofilik tel kullanın. Bir arter döngüsüne veya damar işkencesine olası lezyonları önlemek için kol içinde navigasyon sırasında proksimal aksiller arteri görselleştirmek için DSA floroskopi kullanın. NOT: Subklaviyen arterin birçok atardamar dalı vardır. Anjiyografik kılavuz, retrograd kateterizasyon sırasında kılavuz tel kateterlerin kollateral damarlara girmesini önler. Birkaç vakada radyal arterde atardamar döngüsü vardır. Standart tel döngüyü geçemiyorsa, bir mikrokreter kullanılması ve açılı 0.016 inç veya 0.018 inç mikro tel kullanılması önerilir.</li>
	<li>4-Fransız, 125 cm ortak kateteri standart bir 0.035 inç tel ile birlikte kullanarak kılavuz telleri alçalana doğru yönlendirmek için enine kemeri müzakere edin. NOT: Aort ve sol subklaviyen arter arasındaki açı çok akutsa, bu dönüşü gerçekleştirmek için Kobra 2 şeklinde bir kateter (örneğin Simmons I veya Simmons II kateter) önerilir.</li>
	<li>İnen aortu kateterizasyondan sonra, ortak kateteri koaksiyel bir teknikle değiştirin. Ortak kateter alçalan aort içine yerleştirildikten sonra, DSA floroskopisi rehberliğinde çölyak gövdesinin kateterizasyonu için kateter ucunu ventral olarak yönlendirin. Çoğu durumda, çölyak gövdesinin, hepatik arterin ve üstün mezenterik arterin kateterize ve anjiyografisini yapmak kolaydır. NOT: Çölyak arteri ile azalan aort arasındaki açı çok akutsa, işlemi tamamlamak için bir Kobra kateteri kullanın.</li>
	<li>Hepatik embolizasyon işlemleri için koaksiyel bir teknik kullanarak süper seçici kateterizasyon ve kemoembolizasyon gerçekleştirin ve tümörleri besleyen hepatik arterin hedeflenen dalına 2,8-Fransız 150 cm mikrokreter yerleştirin (Şekil 2). Hastalığın yüküne ve hasta tercihine göre TACE işlemi gerçekleştirin.</li>
	<li>Yeterli embolizasyonu doğrulamak için yüksek basınçlı bir enjektör kullanarak ortak kateter aracılığıyla anjiyogram yapın. Kateter ucu genellikle ortak hepatik arterde bulunur. Kontrast maddesinin 9-12 mL'lik kısmını 3-4 mL oranında, floroskopi süresi ~15 s olan enjekte edin. Ardından, RA'nın zarar görmesini önlemek için kateteri bir kılavuz telin üzerine çıkarın.</li>
</ol>6. Radyal arter hemostazı
NOT: Nonocclusive hemostaz RA açıklığını korumak için özel bir turnike kullanılarak gerçekleştirilir (Şekil 3).
<ol><li>Kalan 2 mL vazodilasyon kokteyl çözeltisini (bölüm 4) RA kılımı aracılığıyla geçirin. Hemen sonra, kılım yaklaşık 5 cm alın.</li>
	<li>Sol bilekteki radyal erişim bölgesinin üzerine bir turnike yerleştirin ve beraberindeki şırınnayı kullanarak turnike hava yastığını hava ile yeterince şişirin. Sonra kılıfi tamamen çıkarın ve hava yastığını yavaşça söndür. Erişim alanında sızıntı gözlendiğinde, manşete 1 mL hava ekleyin. Tipik olarak, hemostaz tutmak için hava yastığına 10-15 mL hava eklenir.</li>
	<li>Kanama veya sızıntı olmadığını onaylayın. Aynı zamanda, distal radyal arter darbesinin hemostaz sırasında hissedilebilir olduğundan emin olun. Sol başparmak üzerindeki arteriyel dalga biçimini doğrulamak için darbe oksimetre dalga biçimini kullanın.</li>
	<li>Hava kesesini her 2 saatte bir ~2 mL'de 6 saatten uzun süre yavaşça şişirin. Ameliyattan 6 saat sonra turnike çıkarıldıktan sonra hemostazın gerçekleştirildiğini doğrulayın. NOT: Deflasyon sırasında delinme bölgesinden kanama veya sızıntı görülürse, hava kesesine 30 dakika boyunca hava eklenir ve işlem tekrarlanır.</li>
	<li>Taburcu olmadan önce, RA'nın açıklığını doğrulamak ve radyal arter tıkanıklığı olan hastaları kaydetmek ve yakından takip etmek için Barbeau testi yaptırın.</li>
</ol>7. Takip
<ol><li>Müdahaleden yaklaşık 1 ay sonra, TRA hastalarına sol bilek muayenesi ve nabız muayenesi de dahil olmak üzere kapsamlı bir fizik muayene verin. Potansiyel olarak tıkanmış RA'ları olan hastalar için, forearm Doppler ultrason veya nabız oksimetresi kullanarak el kan akışının sonraki değerlendirmelerini yapın.</li>
	<li>TACE sonrası tüm hastaları yakından takip edin. BT taramalarında yeni tümör nodülleri belirginse ve ilk lezyonlar yeniden yaygınlaşmış gibi görünüyorsa, başka bir TACE tedavisi yapın.</li>
</ol>

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L., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=Transradial+Approach+for+Hepatic+Radioembolization:+Initial+Results+and+Technique.">Transradial Approach for Hepatic Radioembolization: Initial Results and Technique.</a> AJR: American Journal of Roentgenology. 207 (5), 1112-1121 (2016).</li><li>Bernat, I., et al. <a target="_blank" href="http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?db=PubMed&cmd=Search&doptcmdl=Citation&defaultField=Title+Word&term=ST-segment+elevation+myocardial+infarction+treated+by+radial+or+femoral+approach+in+a+multicenter+randomized+clinical+trial:+the+STEMI-RADIAL+trial.">ST-segment elevation myocardial infarction treated by radial or femoral approach in a multicenter randomized clinical trial: the STEMI-RADIAL trial.</a> Journal of the American College of Cardiology. 63 (10), 964-972 (2014).</li></ol>

WZ ve ZPY tarafından çalışma konsepti ve tasarımı; ND, ZHZ ve MJY tarafından veri alımı; ZPY tarafından fon elde edildi. Yazarların konuyla ilgili herhangi bir finansal açıklaması bulunmamaktadır.

TRA girişimsel tedavi son yıllarda özellikle tanısal ve Girişimsel kardiyoloji işlemlerinde dünya çapında önemli ölçüde artmıştır12. Ayrıca periferik vasküler hastalık müdahalesine de ilgi artmaktadır. Prosedürel başarı oranlarından ödün vermeden, TRA'dan kardiyak girişime TFA13 , 14ile karşılaştırıldığında kanama ve vasküler komplikasyon oranlarını etkili bir şekilde azaltabilir. TFA ile karşılaş...

Hepatosellüler karsinom (HCC), dünya çapında altıncı en yüksek insidans oranına sahip çok yaygın bir malignitedir. Aynı zamanda dünyada kanser ölümlerinin ikinci önde gelen nedenidir1. Hastaların sadece %5-20'si iyileştirici tedavi alabildiğinden, transarterial kemoembolizasyon (TACE) tedavi edilemeyen HCC2hastaları için en popüler palyatif tedavidir. TACE,3.ara evrede HCC hastaları için en sık kullanılan ve etkili tedavi yaklaşımı olarak kabul edilmiştir. Transfemoral erişim (TFA) kemoembolizasyonu TACE4için en yaygın yaklaşımdır. Bununla birlikte, erişim yerinde kanama ve majör vasküler komplikasyonlar da dahil olmak üzere TFA müdahalesi ile ilgili riskler vardır5. Bu komplikasyonlar hastaneye yatış süresinin uzamasına ve maliyetlerin artmasına yol açar. Ayrıca, TFA en az 6 saat boyunca hareketsiz hale getirilmesini gerektirir, bu da hastalar için rahatsızlık ve memnuniyetsizliği arttırır.
Transradial erişim (TRA), yirmi yıldan fazla bir süredir perkütan koroner müdahalede (PCI) kullanılan alternatif bir yaklaşımdır5,6. TRA PCI'nin birkaç avantajı vardır: artan prosedür konforu, erişim bölgesine bağlı kanamada azalma, majör vasküler komplikasyonlarda azalma ve mortalitede azalma7,8. Radyal artere (RA) yüzeysel konumu nedeniyle erişmek ve delinmek kolaydır7. Hemostazın müdahaleden sonra yapılması kolaydır ve katı bir immoblizasyon yoktur9. Kardiyak kateterizasyonda TRA müdahalesi için teşvik edici kanıtlara rağmen, bugüne kadar sadece birkaç çalışmada TRA periferik hastalık müdahalesinde kullanılmıştır. Kötü huylu karaciğer tümörleri için TRA müdahaleleri daha da nadirdir. Burada TRA hepatik embolizasyonun klinik fizibilitesi ve güvenliği analiz edilir. Bir kurumun sağlanan adım adım TRA protokolü ile ilgili deneyimi de açıklanmıştır.

<table><tbody><tr><td>&lt;strong&gt;Reagents&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Embosphere</td><td>Merit</td><td>20173776165</td><td></td></tr><tr><td>Gelfoam</td><td>Alicon</td><td>20143771056</td><td></td></tr><tr><td>Heparin</td><td>Hepatunn</td><td>H51021209</td><td></td></tr><tr><td>Injection syringe</td><td>KDL</td><td>20163150518</td><td></td></tr><tr><td>Iodinated oil</td><td>Yantai Luyin Pharmaceutical Co.Ltd</td><td>H37022398</td><td></td></tr><tr><td>Lidocaine</td><td>Shandong Hualu Pharmaceutical Co.Ltd</td><td>H37022147</td><td></td></tr><tr><td>Lobaplatin</td><td>Hainan Changan International Pharmaceutical Co.Ltd</td><td>H20050308</td><td></td></tr><tr><td>Nitroglycerin</td><td>Brijing Yimin Pharmaceutical Co.Ltd</td><td>H11020289</td><td></td></tr><tr><td>Normal saline</td><td>Anhui Shuanghe Pharmaceutical Co.Ltd</td><td>H34023609</td><td></td></tr><tr><td>Pharmorubicin</td><td>Pfizer</td><td>H20000496</td><td></td></tr><tr><td>Ultravist 370</td><td>Bayer</td><td>H20171333</td><td></td></tr><tr><td>&lt;strong&gt;Material&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>Hydrophilic Guide Wire</td><td>Merit</td><td>LWSTDA38180</td><td></td></tr><tr><td>Injection syringe</td><td>KDL</td><td>20163150518</td><td></td></tr><tr><td>Maestro Microcatheter</td><td>Merit</td><td>28MC24150SN</td><td></td></tr><tr><td>MPA1 (I) catheter</td><td>Cordis</td><td>451-406P0</td><td></td></tr><tr><td>Sheath Introducer</td><td>Merit</td><td>PSI-4F-11-035</td><td></td></tr><tr><td>Steerable Guidewire</td><td>Merit</td><td>TNR2411</td><td></td></tr><tr><td>TR Band</td><td>Terumo</td><td>XX*RF06</td><td></td></tr><tr><td>&lt;strong&gt;Equipment&lt;/strong&gt;</td><td></td><td></td><td></td></tr><tr><td>DSA</td><td>Toshiba</td><td>INFX-9000V</td><td></td></tr><tr><td>Ultrasonic machine</td><td>SonoScape</td><td>20172231180</td><td></td></tr></tbody></table>

transradial access chemoembolization for hepatocellular carcinoma patients

Transarterial kemoembolizasyon (TACE), hepatosellüler karsinom (HCC) tedavisinde ara aşamada en sık görülen modalitedir. TACE genellikle transfemoral erişim (TFA) yoluyla gerçekleştirilir. Ancak koroner arter müdahalelerinde komplikasyon ve mortalitenin azalmasına bağlı olarak transradyal erişim (TRA) tercih edilmektedir. TRA'nın avantajlarının TACE gerekli araştırmaya uygulanıp uygulanamayacağı.
Tek merkezde TRA TACE alan hastalar retrospektif olarak çalışmaya alındı. Prosedürel detaylar, teknik başarı, radyal arter tıkanma (RAO) oranı ve erişim bölgesine bağlı kanama komplikasyonları değerlendirildi. Ekim 2017'den Ekim 2018'e kadar 112 hastaya 160 TRA TACE işlemi uygulandı. Genel teknik başarı oranı %95,0 (152/160) idi. TRA'dan TFA'ya geçiş oranı %1,9 oldu. Hiçbir vakada erişim bölgesine bağlı kanama komplikasyonlarına rastlanmadı. Asemptomatik RA tıkanma üç hastada (%2.7) meydana geldi. TFA ile karşılaştırıldığında TRA, erişim sitesine bağlı kanama komplikasyonlarını azaltırken güvenliği ve hasta memnuniyetini artırabilir. Ayrıca, TRA müdahaleleri ileri yaş, obezite veya kanama komplikasyonları riski yüksek olan hastalara fayda sağlayabilir.

Ekim 2017'den Ekim 2018'e kadar 112 hastaya 160 TRA TACE işlemi uygulandı ve genel teknik başarı oranı %95,0 (152/160) oldu. Sekiz vaka teknik arızayla karşılandı. Bunlardan beşi sol RA delinme hatasından kaynaklandı ve daha sonra sağ RA erişimi ile başarılı TACE uygulandı. Diğer üç vaka kanülasyon hatasından kaynaklandı ve daha sonra sağ SK erişimine çapraz geçişle başarılı bir müdahaleye maruz kaldı. RA erişiminin SK erişimine geçiş oranı sadece% 1,9 idi. Vakaların hiçbirinde er...

Watch this Scientific Journal Video about Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients at JoVE.com

Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

Transarterial kemoembolizasyon (TACE), hepatosellüler karsinomun ara aşamasındaki hastalar için standart tedavidir ve tipik olarak femoral arter erişimi ile gerçekleştirilir. Transfemoral erişim ile karşılaştırıldığında, transradial erişim (TRA) kanama komplikasyonlarının oranını azaltabilir ve hasta toleransını artırabilir. Burada radyal arter erişimi ile transarterial kemoembolizasyon yapmak için bir yöntem sunulmaktadır.

Hepatosellüler Karsinom Hastaları için Transradyal Erişim Kemoembolizasyonu

Transarterial chemoembolization (TACE) is the most common modality for treatment of hepatocellular carcinoma (HCC) at the intermediate stage. TACE is ...

transradial-access-chemoembolization-for-hepatocellular-carcinoma

Universidad de Cartagena UDEC

Research

JoVE Journal

Cancer Research

5.4K Görüntüleme.  Fudan University. Transarterial kemoembolizasyon (TACE), hepatosellüler karsinomun ara aşamasındaki hastalar için standart tedavidir ve tipik olarak femoral arter erişimi ile gerçekleştirilir. Transfemoral erişim ile karşılaştırıldığında, transradial erişim (TRA) kanama komplikasyonlarının oranını azaltabilir ve hasta toleransını artırabilir. Burada radyal arter erişimi ile transarterial kemoembolizasyon yapmak için bir yöntem sunulmaktadır.

Video: Transradial Access Chemoembolization for Hepatocellular Carcinoma Patients

Dual-phase Cone-beam Computed Tomography to See, Reach, and Treat Hepatocellular Carcinoma during Drug-eluting Beads Transarterial Chemo-embolization

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 dimensional&#160;(3D) diagnostic imaging in the interventional suite and can enhance minimally-invasive therapy beyond the limitations of 2D angiography alone. The role of CBCT has been recognized in transarterial chemo-embolization (TACE) treatment of hepatocellular carcinoma (HCC). The recent introduction of a CBCT technique: dual-phase CBCT (DP-CBCT) improves intra-arterial HCC treatment with drug-eluting beads (DEB-TACE). DP-CBCT can be used to localize liver tumors with the diagnostic accuracy of multi-phasic multidetector computed tomography (M-MDCT) and contrast enhanced magnetic resonance imaging (CE-MRI) (See the tumor), to guide intra-arterially guidewire and microcatheter to the desired location for selective therapy (Reach the tumor), and to evaluate treatment success during the procedure (Treat the tumor). The purpose of this manuscript is to illustrate how DP-CBCT is used in DEB-TACE to see, reach, and treat HCC.

Dual-phase cone-beam computed tomography (DP-CBCT) is a useful intraprocedural imaging technique for transarterial chemo-embolization treatment with drug-eluting beads of hepatocellular carcinoma. DP-CBCT has been used to perform three major steps in oncologic interventional radiology: tumor localization (see), navigation and intraprocedural catheter guidance (reach), and intraprocedural evaluation of treatment success (treat).

Çift faz konik ışınlı Bilgisayarlı Tomografi, görün Reach ve İlaç salınımlı Boncuk Transarteriel Kemo-embolizasyon sırasında hepatosellüler karsinom şımartın

The advent of cone-beam computed tomography (CBCT) in the angiography suite has been revolutionary in interventional radiology. CBCT offers 3 ...

Tıp

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.

Laparoskopik Hepatektomide Anatomik Rezeksiyon ile Kombine En Blok Kavramının Uygulanması

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

Kanser Araştırmaları

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

Successful hepatic resection requires profound anatomical knowledge and delicate surgical technique. Hemihepatectomies are mostly performed after preparing the extrahepatic hilar structures within the hepatoduodenal ligament, even in benign tumours or liver metastasis.1-5. Regional extrahepatic lymphadenectomy is an oncological standard in hilar cholangiocarcinoma, intrahepatic cholangio-cellular carcinoma and hepatocellular carcinoma, whereas lymph node metastases in the hepatic hilus in patients with liver metastasis are rarely occult. Major disadvantages of these procedures are the complex preparation of the hilus with the risk of injuring contralateral structures and the possibility of bleeding from portal vein side-branches or impaired perfusion of bile ducts. We developed a technique of right hemihepatectomy or resection of the left lateral segments with intrahepatic transection of the pedicle that leaves the hepatoduodenal ligament completely untouched. 6 However, if intraoperative visualization or palpation of the ligament is suspicious for tumor infiltration or lymph node metastasis, the hilus should be explored and a lymphadenectomy performed.

This video describes a right hemihepatectomy with intrahepatic transection of the right hemipedicle leaving the hepatoduodenal ligament completely untouched.

Damar Zımba kullanarak sağ Hemipedicle Suprahilar İntrahepatik transeksiyonu sağ Hemihepatectomy

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

Biyoloji

Transarterial Administration of Oncolytic Viruses for Locoregional Therapy of Orthotopic HCC in Rats

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis. In recent years, oncolytic virotherapies have proven themselves to be potentially powerful tools to fight malignancy. Due to the unique dual blood supply in the liver, it is possible to apply therapies locally to orthotopic liver tumors, which are predominantly fed by arterial blood flow. We have previously demonstrated that hepatic arterial delivery of oncolytic viruses results in safe and efficient transduction efficiency of multifocal HCC lesions, resulting in significant prolongation of survival in immune competent rats. This procedure closely mimics the application of transarterial embolization in patients, which is the standard palliative care provided to many HCC patients. The ability to administer tumor therapies through the hepatic artery in rats allows for a highly sophisticated preclinical model for evaluating novel viral vectors under development. Here we describe the detailed protocol for microdissection of the hepatic artery for infusion of oncolytic virus vectors to treat orthotopic HCC.

Oncolytic virotherapies are under development as novel therapeutics for the treatment of hepatocellular carcinoma (HCC). Here we describe a method for locoregional therapy of HCC via hepatic arterial administration of oncolytic virus.

Sıçanlarda Ortotopik HCC Lokorejyonel Tedavisi için oncolytic virüs transarteryel İdaresi

Hepatocellular carcinoma (HCC) is a disease with limited treatment options and poor prognosis.  In recent years, oncolytic virotherapies have proven ...

Percutaneous Hepatic Perfusion (PHP) with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn unresectable metastases into resectable ones. Some patients however, suffer from side effects or progression under systemic treatment. For patients with metastasized uveal melanoma there are no standard systemic therapy options. For patients without extrahepatic disease, isolated liver perfusion (IHP) may enable local disease control with limited systemic side effects. Previously, this was performed during open surgery with satisfying results, but morbidity and mortality related to the open procedure, prohibited a widespread application. Therefore, percutaneous hepatic perfusion (PHP) with simultaneous chemofiltration was developed. Besides decreasing morbidity and mortality, this procedure can be repeated, hopefully leading to a higher response rate and improved survival (by local control of disease). During PHP, catheters are placed in the proper hepatic artery, to infuse the chemotherapeutic agent, and in the inferior caval vein to aspirate the chemosaturated blood returning through the hepatic veins. The caval vein catheter is a double balloon catheter that prohibits leakage into the systemic circulation. The blood returning from the hepatic veins is aspirated through the catheter fenestrations and then perfused through an extra-corporeal filtration system. After filtration, the blood is returned to the patient by a third catheter in the right internal jugular vein. During PHP a high dose of melphalan is infused into the liver, which is toxic and would lead to life threatening complications when administered systemically. Because of the significant hemodynamic instability resulting from the combination of caval vein occlusion and chemofiltration, hemodynamic monitoring and hemodynamic support is of paramount importance during this complex procedure.

Percutaneous Hepatic Perfusion PHP with Melphalan as a Treatment for Unresectable Metastases Confined to the Liver

In this manuscript, we describe percutaneous isolated hepatic perfusion with simultaneous chemofiltration as treatment for unresectable liver metastases. This procedure is performed under general anaesthesia in the angiosuite by an experienced team, consisting of an interventional radiologist, a clinical perfusionist and anaesthesiologist.

Karaciğer için Kapalı ckiabl Metastazına bir tedavi olarak Melfalan ile Perkütan karaciğer perfüzyon (PHP)

Unresectable liver metastases of colorectal cancer can be treated with systemic chemotherapy, aiming to limit the disease, extend survival or turn ...

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.

Hilar Kolanjiyokarsinom için Robotik Tac Mahal Hepatektomi

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

Y-90 TARE and PD-1 Inhibition as Bridging Therapy in Hepatocellular Carcinoma

Y-90 Radioembolization and PD-1 Inhibitor as Neoadjuvant Treatment in Hepatocellular Carcinoma

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 transarterial radioembolization (TARE) and Programmed Cell Death-1 (PD-1) inhibitors as neoadjuvant therapy. Highlighted through a case report, it offers a step-by-step reference for similar therapeutic interventions. A retrospective analysis was conducted on a patient who underwent hepatectomy following Y-90 TARE and PD-1 inhibitor treatment. Key demographic and clinical details were recorded at admission to guide therapy selection. Y-90 TARE suitability and dosage calculation were based on Technetium-99m (Tc-99m) macroaggregated albumin (MAA) perfusion mapping tests. Lesion coverage by Y-90 microspheres was confirmed through single photon emission computed tomography/computed tomography (SPECT/CT) fusion imaging, and adverse reactions and follow-up outcomes were meticulously documented. The patient, with a 7.2 cm HCC in the right hepatic lobe (T1bN0M0, BCLC A, CNLC Ib) and an initial alpha-fetoprotein (AFP) level of 66,840 ng/mL, opted for Y-90 TARE due to high recurrence risk and initial surgery refusal. The therapy's parameters, including the lung shunting fraction (LSF) and non-tumor ratio (TNR), were within therapeutic limits. A total of 1.36 GBq Y-90 was administered. At 1 month post-therapy, the tumor shrank to 6 cm with partial necrosis, and AFP levels dropped to 21,155 ng/mL, remaining stable for 3 months. After 3 months, PD-1 inhibitor treatment led to further tumor reduction to 4 cm and AFP decrease to 1.84 ng/mL. The patient then underwent hepatectomy; histopathology confirmed complete tumor necrosis. At 12 months post-surgery, no tumor recurrence or metastasis was observed in follow-up sessions. This protocol demonstrates the effective combination of Y-90 TARE and PD-1 inhibitor as a bridging strategy to surgery for HCC patients at high recurrence risk, providing a practical guide for implementing this approach.

This study illustrates the methodological potential of combining Yttrium-90 Trans-Arterial Radioembolization (Y-90 TARE) with an anti-PD-1 monoclonal antibody as an effective neoadjuvant strategy leading to hepatectomy in hepatocellular carcinoma (HCC) patients with a high initial recurrence risk. It emphasizes the safety, feasibility, and step-by-step procedural guidance of this approach.

This study showcases a comprehensive treatment protocol for high-risk hepatocellular carcinoma (HCC) patients, focusing on the combined use of Y-90 ...

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.

Perihiler Kolanjiokarsinom Tip IIIb'nin Komple Laparoskopik Radikal Rezeksiyonu

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

Trans-Arterial Indocyanine Green Staining for Precise Anatomical Hepatectomy of Liver Segments VII and VIII

Anatomical hepatectomy for resectable hepatocellular carcinoma (HCC) is performed with precision using the Glissonean system, ultrasound imaging, and indocyanine green (ICG) fluorescence staining to define liver segments, enhancing surgical radicality and preserving liver volume. However, laparoscopic clamping and ultrasound-guided ICG staining for deep-seated tumors in liver segments VII and VIII pose challenges due to the depth of the Glissonean ducts and other technical limitations. This study aimed to overcome these obstacles by exploring a protocol using trans-arterial ICG staining, a technique specifically tailored for complex anatomical hepatectomy of liver segments VII and VIII. In this method, an interventionalist accessed the right femoral artery and advanced to the celiac trunk for arteriography, followed by strategic placement of a microcatheter into the tumor's blood supply vessel to facilitate surgical resection. During the operation, ICG was injected through the microcatheter to fluorescently label the tumor's liver segment, enabling precise anatomical resection under fluorescence guidance. This trans-arterial ICG staining approach allows for the accurate identification of tumor subsegments, facilitates complete resection, and optimizes liver function preservation, ultimately improving oncological outcomes without increasing surgical complication rates.

Laparoscopic anatomical hepatectomy has gained global recognition in liver surgery. However, delineating tumor boundaries in liver segments VII and VIII presents distinct technical challenges. This protocol utilizes trans-arterial indocyanine green (ICG) staining to accurately identify liver subsegments, facilitating complete tumor resection while preserving functional liver volume.

Karaciğer segmentleri VII ve VIII'in hassas anatomik hepatektomisi için trans-arteriyel indosiyanin yeşili boyama

Anatomical hepatectomy for resectable hepatocellular carcinoma (HCC) is performed with precision using the Glissonean system, ultrasound imaging, and ...

Laparoscopic Left Hemihepatectomy Combined with Caudate Lobe Resection

Intrahepatic cholangiocarcinoma (ICC) is the common malignant tumor of the liver. Radical surgical resection is the mainstay of potentially curative treatment for ICC. Anatomical liver resection for ICC in the caudate lobe is one of the most difficult liver resections. Because the tumor is located deep and easily invades surrounding blood vessels, such as the left hepatic pedicle, right hepatic pedicle, and middle hepatic vein. Laparoscopic anatomic hepatectomy of the caudate lobe not only ensures a negative incision margin but also offers a more minimally invasive approach for patients. This technique is poised to become the preferred choice for radical surgery of the caudate lobe in the future. In this surgical protocol, a 65-year-old male patient with intrahepatic cholangiocarcinoma (sized about 3.2&#160;&#215; 1.9 cm2) located in the left caudal lobe underwent laparoscopic left hemihepatectomy combined with caudate lobe resection successfully without any postoperative complications. Postoperative pathological examination showed a cholangiocarcinoma with a tumor thrombus visible in the vasculature. The patient was discharged on the 14th postoperative day. Laparoscopic left hemihepatectomy combined with caudate lobectomy for the treatment of caudate lobe ICC can be performed safely and does not add significantly to the morbidity or mortality of the procedure.

Intrahepatic cholangiocarcinoma of the caudate lobe is a challenge for many surgeons due to its unique location. Here, we present a protocol to show the step-by-step details of laparoscopic left hemihepatectomy combined with caudate lobe resection for cholangiocarcinoma.

Laparoskopik Sol Hemihepatektomi ve Kaudat Lob Rezeksiyonu

Intrahepatic cholangiocarcinoma (ICC) is the common malignant tumor of the liver. Radical surgical resection is the mainstay of potentially curative ...