Hand-assisted laparoscopic management of liver tumors

Poultsides, George A.; Brown, Mathew; Orlando, Rocco

doi:10.1007/s00464-006-9174-8

Cited by 20 publications

(9 citation statements)

References 14 publications

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“…We used a totally laparoscopic rather than a hand-assisted approach as used by many others [39, 40]. With some other surgeons, we believe that the hand-assisted method or hybrid techniques have a limited role [9].…”

Section: Discussionmentioning

confidence: 99%

Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments

et al. 2011

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BackgroundTotally laparoscopic liver resection of lesions located in the posterosuperior segments is reported to be technically challenging. This study aimed to define whether these technical difficulties affect the surgical outcome.MethodsA total of 220 patients underwent laparoscopic liver resection during 244 procedures from August 1998 to December 2010. The patients who underwent primary minor single liver resection for malignant tumors affecting either posterosuperior segments 1, 7, 8, and, 4a (group 1) or anterolateral segments 2, 3, 5, 6, and 4b (group 2) were included in the study. Seventy-five procedures found to be eligible for the study, including 28 patients in group 1 and 47 patients in group 2. Intraoperative unfavorable incidents were graded on the basis of the Satava approach and postoperative complications were graded in agreement with the Accordion classification.ResultsThe operative time (median, 127 min) and blood loss (median, 200 ml) were equivalent in the two groups. The rates for blood transfusions and intraoperative accidents did not differ statistically between the groups. A tumor-free margin resection was achieved in 94.7% of the procedures, equivalently in both groups. The postoperative course was similar in the two groups. Postoperative complications developed in 2 cases (7.1%) in group 1 and 2 cases (4.3%) in group 2 (p = 0.626). The median hospital stay was 2 days in both groups.ConclusionsLaparoscopic liver resection for lesions located in posterosuperior segments represents certain technical challenges. However, appropriate adjustment of surgical techniques and optimal patient positioning enables the laparoscopic technique to provide safe and effective parenchyma-sparing resections for lesions located in both posterosuperior and anterolateral segments.

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Section: Discussionmentioning

confidence: 99%

Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments

et al. 2011

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“…There is no agreement about indications to hand-assisted or hybrid liver resection. Hand assistance has been systematically adopted by some centres, while it has been considered as having a limited role by others (12)(13)(14)(15)(16)(17)(18).…”

Section: Technical Considerations Total Laparoscopic Resection Hand-mentioning

confidence: 99%

Laparoscopic Liver Surgery: New Frontiers

2011

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“…A silicon-and plastic-based hand port was used to gain manual access to the abdominal cavity while maintaining an air-sealed capnoperitoneum. This device has been established for use in laparoscopic liver procedures previously and various studies have shown increased safety and reduced operation time compared with the conventional laparoscopic approach [10,11]. The intraabdominal hand allows immediate compression of bleeding liver vessels and ensures adequate presentation of the resection plane (Fig.…”

Section: Discussionmentioning

confidence: 98%

Imaging sequences for intraoperative MR-guided laparoscopic liver resection in 1.0-T high field open MRI

et al. 2009

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The aim of this study was to identify suitable interactive (dynamic) magnetic resonance (MR) sequences for real-time MR-guided liver dissection in a 1.0-T high field open MRI system. Four dynamic sequences encompassing balanced steady state free precession (bSSFP), T1W gradient echo (GRE), T2W GRE and T2W fast spin echo (FSE) were analysed regarding the image quality, artefact susceptibility and the performance of SNR and CNR. The T2W FSE sequence (1.5 s/image) was considered superior because of an intraoperative SNR of 6.9 (+/-0.7) and CNR (vessel to parenchyma) of 5.6 (+/-1.7) in the interventional setting. As a proof of concept, MR-guided laparoscopic liver resection was performed in two healthy domestic pigs by using the T2W FSE sequence. The additional MR images offered simultaneous multiplanar real-time visualisation of the liver vessels during the intervention and thereby increased the anatomical orientation of the surgeon.

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Hand-assisted laparoscopic management of liver tumors

Abstract: For selected patients, the hand-assisted technique can be applied safely and effectively to laparoscopic liver surgery and may identify the presence of previously undetectable intrahepatic or extrahepatic disease.

Cited by 20 publications

References 14 publications

Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments

Comparative evaluation of laparoscopic liver resection for posterosuperior and anterolateral segments

Laparoscopic Liver Surgery: New Frontiers

Imaging sequences for intraoperative MR-guided laparoscopic liver resection in 1.0-T high field open MRI

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