Role of laparoscopy during surgery at the porta hepatis

Yamataka, Atsuyuki; Lane, Geoffrey J.; Koga, Hiroyuki; Cazares, Joel; Nakamura, Hiroki

doi:10.7196/samj.8921

Cited by 12 publications

(6 citation statements)

References 3 publications

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“…Regardless of open, laparoscopic or robotic surgical approach, for the choledochal cyst, It is important to consider the following aspects in decision making and surgical technique: distal common bile duct ligation, ductoplasty for hepatic duct stenosis, intrahepatic duct and common channel protein plug clearance. Also timing of surgery for antenatally diagnosed choledochal cyst, and the Roux loop length in choldedochal cyst in children [14]. Total cyst excision should be performed as early as possible, and the optimal treatment time is the infant period [2].…”

Section: Resultsmentioning

confidence: 99%

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Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Arellano¹

2019

Act Scie Paedia

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Report our experience in the treatment of choledochal cyst with robot-assisted surgery in children and perform a current analysis of both approaches of minimally invasive surgery, for this anomaly. Results:We treated 4 patients with choledochal cyst, relation 1:3 female, the averages was in age 3 years, weight 15 kg and height 94.2 cm. Type 1-A cysts were three and one 1-C, the average size of the cysts, 9.6 cm. Clinically, they presented: abdominal mass 3, jaundice episode 3 and fever 2. The following are average values of: total surgical times 360 min and console surgery time 230 min, bleeding 32.5 ml, and postoperative stay 4.7 days. Conversions, complications and mortality 0%. Follow-up average 29 months, and all patients are asymptomatic. Currently, the number of children with choledochal cyst treated with robotic surgery, barely reaches about 3%, in relation to those treated with conventional laparoscopy. The initial experience was published with laparoscopy in Oct-1995 and with robotic surgery in Apr-2006. Conclusions: Our results are encouraging, and show the advantages of robotic surgery, although our experience is limited to a few cases. Robotic surgery for the treatment of choledochal cyst is feasible and safe. The current results with both minimally invasive approaches are very similar, but we consider that it represents an important bias, the great advantage in the application that conventional laparoscopy takes to robotic surgery. To date, very few pediatric surgeons in the world have applied robotic surgery to the choledochal cyst. Material and Methods:Study observational, prospective, and longitudinal, in pediatric patients with choledochal cyst treated with robotic-assisted surgery, from Jul-2016 to Apr-2019. The diagnosis was made with laboratory studies, USG and cholangioresonance.The surgery performing one part by laparoscopy, the extracorporeal Roux-en-Y, and other part with robotic assistance (cholecystectomy, retrocolic Roux-en-Y, and the hepaticojejunostomy). We use 5 trocars, 4 robotics and a laparoscopic. Registered variables: demographic data, cysts according to Todani's classification, size, clinic, total and robotic surgery time, bleeding, conversions, complications, postoperative stay and follow-up. We carry out a detailed non-systematic review of previous publications on this pathology with conventional laparoscopic and robotic surgery. A choledochal cyst is a rare congenital cystic dilatation of the extra or intrahepatic biliary tract or both. It was first described by Vater and Ezler in 1723 [1].Choledochal cysts have an incidence of 1 in 100,000-150,000 live births in the western population, but reported to be as high as 1 in 13,500 live births in the United States and 1 in 15,000 in Australia. The incidence is higher in Asian population with an incidence of 1 in 1000, of which about two-third cases are reported from Japan. Choledochal cysts are diagnosed in childhood about 75%, also have an unexplained female:male preponderance, commonly reported as 4:1 to 3:1 [2].

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Section: Resultsmentioning

confidence: 99%

“…However, the laparoscopic approach it has not been widely used, because especially the laparoscopic hepaticojejunostomy are quite technically demanding [13]. Although this approach is safe and effective in the hands of experts [14], and also in hospitals with a high volume of cases.…”

Section: Introductionmentioning

confidence: 99%

Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Arellano¹

2019

Act Scie Paedia

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“…30,31 However, after the recent advancement of the technology and instrumentation, some researchers reported the good outcome of the LPE. 32,33 In addition, there are many advantages of LPE including less tissue injury, no mobilization of the liver, smaller wounds, decreased pain and fewer abdominal adhesions. 28 In the meta-analysis published by Li et al in 2019, the outcome of the two techniques (OPE and LPE) for the management of BA patients was compared.…”

Section: Treatment Methodsmentioning

confidence: 99%

Summarization of the literature published on biliary atresia: a comprehensive literature review

Alferaidi

2023

Int J Adv Med

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The leading cause of pediatric liver failure and liver transplantation is biliary atresia. Early diagnosis of BA is challenging, and delayed diagnosis caused many complications. Most BA patients eventually went through liver transplantation even if received the initial treatment of the disease. The incidence of BA is rare hence limited literature has been published about diagnosis, treatment, risk factors and survival rate among BA patients. Therefore, this literature review aimed to provide an opportunity for physicians and researchers to know about different diagnostic and treatment tools as well as about the risk factors causing variation in the survival rate after liver transplantation. Therefore, knowledge about the advanced methods of diagnosis provides an early and accurate diagnosis and providing treatment with fewer risk factors help to increase favorable outcome and increase the survival rate among BA patients.

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“…In 2002, Esteves [4] developed the laparoscopic Kasai portoenterostomy (LKPE) procedure, which created a new era of minimally invasive surgery for BA. Although a learning curve of LKPE is present, some satisfactory results have been achieved, in which the 3-year and 5-year survival with native liver (SNL) rates after LKPE were not inferior, or even superior, to those after open Kasai portoenterostomy (OKPE) [5][6][7][8][9][10]. Unfortunately, LKPE is not effective in every patient with BA, as is the case for OKPE.…”

Section: Introductionmentioning

confidence: 99%

Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia

Zhang

Chen

et al. 2021

Orphanet J Rare Dis

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Objective To determine whether revision laparoscopic Kasai portoenterostomy (RLKPE) is a viable treatment option for patients with biliary atresia (BA) who had undergone initially successful laparoscopic Kasai portoenterostomy (ILKPE). Methods The medical records of 312 patients with nonsyndromic BA who had undergone ILKPE between May 2009 and May 2017 were retrospectively reviewed. The patients were divided into three groups according to their outcomes after ILKPE: group A: 25 patients who had undergone RLKPE; group B: 203 patients who had undergone ILKPE and required no further surgical intervention; group C: 84 patients with failed ILKPE who had either died or required liver transplantation for survival. The 3-year and 5-year survival with native liver (SNL) rates were compared between groups A and B and between groups A and C. Among the 25 patients in group A, the perioperative data of RLKPE were compared with those of ILKPE. Results Of the 312 patients who had undergone ILKPE, 228 reached the normal bilirubin concentration range within 6 months postoperatively. Among them, 25 patients with a sudden cessation of bile flow had undergone RLKPE. Adequate biliary drainage, as evidenced by normalized conjugated bilirubin levels, was achieved in 80% of patients who had undergone RLKPE. The perioperative variables, including the operative time, blood loss, rate of conversion to open surgery and complications of RLKPE, were not significantly different between RLKPE and ILKPE. The 3-year and 5-year SNL rates in patients after RLKPE were 64.0% and 52.0%, respectively, which were not significantly different from the corresponding rates of 86.2% and 73.9%, respectively, in patients after unrevised ILKPE (P > 0.05). Conclusion Our data demonstrated that RPLKE is a viable and effective treatment option in patients with sudden cessation of bile drainage after ILKPE. RPLKE can delay the need for liver transplantation, yielding encouraging medium-term patient outcomes.

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Role of laparoscopy during surgery at the porta hepatis

Cited by 12 publications

References 3 publications

Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Experience in the Treatment of Choledochal Cyst with Robot-Assisted Surgery in Children: and "The Current State of Minimally Invasive Surgery in this Anomaly”

Summarization of the literature published on biliary atresia: a comprehensive literature review

Medium-term outcomes after laparoscopic revision of laparoscopic Kasai portoenterostomy in patients with biliary atresia

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