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01-03-2016 | How-I-Do-It Article

Routes for virtually guided endoscopic liver resection of subdiaphragmatic liver tumors

Authors: Takeshi Aoki, Masahiko Murakami, Akira Fujimori, Tomotake Koizumi, Yuta Enami, Tomokazu Kusano, Kazuhiro Matsuda, Kosuke Yamada, Koji Nogaki, Yusuke Wada, Tomoki Hakozaki, Satoru Goto, Makoto Watanabe, Koji Otsuka

Published in: Langenbeck's Archives of Surgery | Issue 2/2016

Abstract

Purpose

Laparoscopic and thoracoscopic/laparoscopic hepatectomy is a safe procedure that has potential advantages over open surgery. However, deeply positioned liver tumors require expert laparoscopic and thoracoscopic/laparoscopic hepatectomy techniques. Using simulated preoperative three-dimensional virtual endoscopy (P3DVE) guidance, we demonstrate herein that a thoracoscopic approach (TA), thoracoscopic–laparoscopic approach (TLA), and laparoscopic approach (LA) are all feasible and safe routes for performing pure laparoscopic and thoracoscopic/laparoscopic resection of liver tumors located in the 4a, 7, and 8 liver subdiaphragmatic areas.

Methods

Thirty-eight patients underwent laparoscopic and thoracoscopic/laparoscopic partial liver resection (TA 13 cases, TLA two cases, and LA 23 cases) of the subdiaphragmatic area at Showa University Hospital. All surgical approaches were preoperatively determined based on preoperative 3D virtual endoscopic simulation (P3DVES) visualization and findings using the image processing software SYNAPSE VINCENT^®.

Results

Laparoscopic and thoracoscopic/laparoscopic liver resection was successfully performed for all cases under P3DVE instruction. The mean operative times using TA, TLA, and LA approaches were 193, 185, and 190 min, respectively. Mean blood loss during TA, TLA, and LA was 179, 138, and 73 g, respectively. No patients required conversion to open surgery, and there were no deaths, although there were three cases of Clavien–Dindo grade I in TA along with three cases of grade I and one case of grade II in LA.

Conclusions

TA, TLA, and LA routes performed under P3DVE instruction are feasible and safe to perform for pure laparoscopic and thoracoscopic/laparoscopic liver resection in selected patients with lesions located in the hepatic subdiaphragmatic area.

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Title: Routes for virtually guided endoscopic liver resection of subdiaphragmatic liver tumors
Authors: Takeshi Aoki
Masahiko Murakami
Akira Fujimori
Tomotake Koizumi
Yuta Enami
Tomokazu Kusano
Kazuhiro Matsuda
Kosuke Yamada
Koji Nogaki
Yusuke Wada
Tomoki Hakozaki
Satoru Goto
Makoto Watanabe
Koji Otsuka
Publication date: 01-03-2016
Publisher: Springer Berlin Heidelberg
Published in: Langenbeck's Archives of Surgery / Issue 2/2016
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-016-1385-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Routes for virtually guided endoscopic liver resection of subdiaphragmatic liver tumors

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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