X. Cai – Laparoscopic Hepatectomy (2015)

Автор: X. Cai
Название книги: Laparoscopic Hepatectomy
Формат: PDF
Жанр: Медицина
Страницы: 327
Качество: Изначально компьютерное, E-book

This book introduces laparoscopic surgeries in liver resection using the technique of curettage and aspiration. Surgical procedures, techniques and special instruments are described in this book. Each step is explained and illustrated with high-quality figures, hand-drawings and videos. This atlas will serve as a step-by-step guide for laparoscopic liver resection.

The laparoscopic approach, which has been adopted worldwide, allows
patients a rapid return to daily activity with less postoperative pain. Even
though the advantage of laparoscopic surgery is widely recognized by surgeons,
laparoscopic hepatectomy is still a rarely performed procedure, as
open liver resection is still the most widely used procedure for liver lesions in
most hospitals worldwide. The main reasons include the diffi culty of dissecting
the intrahepatic vessels, the risk of intraoperative massive bleeding, and
the ineffi ciency of mobilizing liver lobe in the laparoscopic situation.
We began to perform laparoscopic hepatectomy in August 1998. The technique
of laparoscopic hepatectomy by curettage and aspiration was developed,
and a special instrument, the laparoscopic Peng’s multifunctional
operative dissector (LPMOD), was designed. Local resection of liver tumors
was the major procedure in the initial stage, and then, laparoscopic left lateral segmentectomy became the fi rst anatomical liver resection in our institute,
Sir Run Run Shaw Hospital, School of Medicine, Zhejiang University, and
also became the major procedure performed in our institute before 2005. In
2005, laparoscopic left hemihepatectomy was performed as a routine procedure,
and the technique of laparoscopic selective infl ow occlusion was developed
for controlling intraoperative bleeding. After that, anatomical major
liver resections with selective infl ow occlusion were performed routinely in
our institute.
For the purpose of safe transection of liver parenchyma and of dissecting
small vessels in the transection plane, a special surgical instrument was
designed and was named LPMOD. This instrument could be used for blunt
dissection, cutting, electric coagulation, and aspiration. It can execute all the
functions at the same time, which facilitates the manipulation and decreases
the operating time by avoiding frequently changing instruments. LPMOD
was designed based on Peng’s multifunctional operative dissector (PMOD),
which was invented by Prof. Shuyou Peng and was used in open surgery. We
extended the length of the stalk and modifi ed the aspiration system to fi t the
laparoscopic purpose.
Blunt dissection is the major point of the technique of laparoscopic hepatectomy
by curettage and aspiration. By using LPMOD, liver parenchyma
can be crashed and aspirated immediately, the intrahepatic ducts and small
vessels can be preserved and safely dissected for ligation, and massive bleeding
can be avoided by the meticulous dissection. Laparoscopic selective
infl ow occlusion is routinely performed in anatomical major hepatectomies,
including left hemihepatectomy and right hemihepatectomy. It is more technically
diffi cult than total vascular occlusion, but it can avoid complications
of ischemia–reperfusion injury and gastrointestinal congestion. Furthermore,
the selective infl ow occlusion does not require fast liver transection to
decrease the occlusion time, which allows surgeons to have suffi cient time for
meticulous dissection. Total vascular occlusion is the conventional procedure
for controlling intraoperative bleeding in open major liver resections and is
used in some laparoscopic liver resections. It is easier to perform laparoscopically
compared with the selective infl ow occlusion. In our opinion, in local
resections, especially in patients with severe liver cirrhosis, the occlusion
tape could be placed before liver resection and total vascular occlusion executed
only if encountering unmanageable massive bleeding.
Recently, a new two-stage surgery named ALPPS (associating liver partition
with portal vein ligation for staged hepatectomy) is drawing the attention
of surgeons. This procedure enables the rapid growth of the future liver remnant
(FLR) and extends surgical indication to patients with “insuffi cient”
FLR. The fi rst-stage operation includes the in situ splitting of the liver, which
could lead to the high occurrence of postoperative biliary leakage. In 2014,
we performed the completely laparoscopic ALPPS using round-the-liver ligation,
which replaced liver splitting and got good results. The surgical technique
is also presented in this book. We hope this procedure could give
patients who are waiting for liver transplantation another alternative to fi ght
liver diseases.
This book introduces the surgical technique of laparoscopic hepatectomy
by curettage and aspiration and different procedures for laparoscopic hepatectomy
with LPMOD, which were explored and established by our group in
16 years of practice. We want to share our experience with hepatobiliary–
pancreatic surgeons and deliver an understanding of laparoscopic liver resection
by writing this book. Finally, I would like to express my deepest gratitude
to my teacher Prof. Shuyou Peng, who taught me the technique of open liver
resection hand by hand when I was a resident student, leading me into the
fi eld of hepatobiliary–pancreatic surgery. He also gave me much valuable
advice in the exploration of laparoscopic hepatectomy by curettage and
aspiration.