Silkclasy: A simple way for liver transection during anatomic hepatectomies

Herman, Paulo; Machado, Marcel Autran

doi:10.1002/jso.20613

Cited by 9 publications

(8 citation statements)

References 19 publications

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“…Prior to surgery, all cases were discussed in a weekly multidisciplinary meeting. Liver resection was performed as previously reported and included 109 major and 120 minor hepatectomies. Major hepatectomy was defined as any resection of three or more contiguous liver segments .…”

Section: Methodsmentioning

confidence: 99%

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Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases

Fonseca

Mello

Faraj

et al. 2018

Journal of Surgical Oncology

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Section: Methodsmentioning

confidence: 99%

“…Prior to surgery, all cases were discussed in a weekly multidisciplinary meeting. Liver resection was performed as previously reported 24 and included 109 major and 120 minor hepatectomies.…”

Section: Methodsmentioning

confidence: 99%

Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases

Fonseca

Mello

Faraj

et al. 2018

Journal of Surgical Oncology

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“…The liver was released from the ligaments before resection of the parenchyma in all cases. The technique used for resection of the parenchyma was the "silkclasy" method, described by Herman et al 7 , in the majority of the open cases. Was used the "CUSA" technique (cavitron ultrasonic surgical aspirator, Integra Radionics, USA) in two cases.…”

Section: Methodsmentioning

confidence: 99%

Hepatectomy: a critical analysis on expansion of the indications

Lopes-Junior

Belebecha

Jacob

2014

ABCD, arq. bras. cir. dig.

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BackgroundHepatic resection has evolved to become safer, thereby making it possible to expand the indications.AimTo assess the results from a group of patients presenting these expanded indications.MethodWere prospectively studied all the hepatectomy procedures performed for hepatic tumor resection. Patients with benign and malignant primary and secondary tumors were included. Were included variables such as age, gender, preoperative diagnosis, preoperative treatment, type of operation performed, need for transfusion, final anatomopathological examination and postoperative evolution. The patients were divided into two groups: group A, with a traditional indication for hepatectomy; and group B, with an expanded indication (tumors in both hepatic lobes, extensive resection encompassing five or more segments, cirrhotic livers and postoperative chemotherapy using hepatotoxic drugs).ResultsWere operated 38 patients, and 40 hepatectomies were performed: 28 patients in group A and 10 in group B. The mean age was 57.7 years, and 25 patients were women. Three in group B were operated as two separate procedures. Groups A and B received means of 1.46 and 5.5 packed red blood cell units per operation, respectively. There were three cases with complications in group A (10.7%) and six in group B (60%). The mortality rate in group A was 3.5% (one patient) and in groups B, 40% (four patients). The imaging examinations were sensitive for the presence of tumors but not for defining the type of tumor. The blood and derivative transfusion rates, morbidity and mortality were greater in the group with expanded indications and more extensive surgery.ConclusionThe indications for liver biopsy and portal vein embolization or ligature can be expanded, with special need of cooperation of the anesthesiology department and the use of hepatic resection devices to diminish blood transfusion.

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“…For patients with initially unsusceptible disease, the inclusions in institutional protocols or individual conducts have been made. Many efforts have been made to increase the number of patients who could obtain benefits with hepatic resection: refining prognostic factors that would improve patient selection; advancements in surgical technique such as, use of intraoperative ultrasonography, controlling hemorrhage through use of vascular clamping techniques supplemented with low central venous pressure anesthesia, availability of novel devices for parenchymal transection, and controlled anatomic hepatectomy; and novel approaches to permit curative hepatic resection such as, preoperative portal vein embolization for hypertrophy of future liver remnant, ablation techniques and staged hepatic resection [27][28][29][30][31][32].…”

Section: Surgical Approachmentioning

confidence: 99%

Local and Systemic Treatment of Potentially Resectable Colorectal Liver Metastases

Araújo

Herman²

2014

J Carcinog Mutagen

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Advances in surgical fields and chemotherapy regimens have been increasing long-term outcomes for patients with Colorectal Liver Metastases (CRLM). The liver resection remains the main treatment for resectable CRLM, but the progress of the chemotherapy regimens has been changing the oncologic approach for those patients who present unrespectable liver disease treated with chemotherapy who reach tumor shrinkage allowing hepatic resection. Looking for potentially resectable CRLM, it seems that chemotherapy should always be offered as additional treatment to curative-intention liver resections, increasing Recurrence Free Survival (RFS), but not affecting Overall Survival (OS). The optimal timing for each chemotherapy regimen has not been answered by Randomized Clinical Trials (RCT) yet. Retrospective series are biased on different patient selection for different chemo modalities. The best candidate for each regimen of chemotherapy could not yet be defined, but clearly patients with more aggressive disease were preferred to preoperative chemo regimens testing chemo responsiveness and selecting "good responders" before surgery. These patient selection criteria have not been standardized yet but the rational of additional chemotherapy, regardless the timing of administration, has been assumed as stand of care for patients who underwent curative-intent resection. The main objective of this review was to collect information to be taken in consideration for different approaches in the management of CRLM.

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Silkclasy: A simple way for liver transection during anatomic hepatectomies

Abstract: This technique allows a safe and quick liver transection without the use of expensive hemostatic devices, and also precludes the use of inflow occlusion maneuvers. We recommend the use of this technique in centers with low economic resources.

Cited by 9 publications

References 19 publications

Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases

Prognostic significance of poorly differentiated clusters and tumor budding in colorectal liver metastases

Hepatectomy: a critical analysis on expansion of the indications

Local and Systemic Treatment of Potentially Resectable Colorectal Liver Metastases

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