Laparoscopic Liver Resection Ten year experience in one center Tran - - PowerPoint PPT Presentation

▶
laparoscopic liver resection
SMART_READER_LITE
LIVE PREVIEW

Laparoscopic Liver Resection Ten year experience in one center Tran - - PowerPoint PPT Presentation

Jan 14, 2023 113 likes •580 views

Laparoscopic Liver Resection Ten year experience in one center Tran Cong Duy Long MD. Nguyen Hoang Bac MD. University Medical Center Ho Chi Minh City Vietnam Laparoscopic Liver Resection in UMC Ho Chi Minh City Vietnam The development

slide-1
SLIDE 1

Tran Cong Duy Long MD. Nguyen Hoang Bac MD.

Laparoscopic Liver Resection

Ten year experience in one center

University Medical Center Ho Chi Minh City Vietnam

slide-2
SLIDE 2
  • The development progress
  • Surgical techniques
  • Short and long-term results

Laparoscopic Liver Resection in UMC Ho Chi Minh City Vietnam

slide-3
SLIDE 3

Laparoscopic Liver Resection Surgical techniques

slide-4
SLIDE 4

Technical demanding in liver resection

Inflow control

Total inflow control Selective inflow control

Outflow control

Low CVP (Anesthesiologist assistance) IVC Clamping

Parenchymal transection

Surgical instrument, energy devices,,… Surgeon experience, skill...

slide-5
SLIDE 5

Total inflow control - Pringle maneuver

Decrease blood supply Minimize bleeding Total liver ischemia Non-anatomic liver resection

slide-6
SLIDE 6

No dissection in liver hilus Decrease post-op ascites Selective inflow control Minimize remnant ischemia

Hemi inflow control

Simple and effective for right side segmentectomy in cirrhotic liver

slide-7
SLIDE 7

Laparoscopic Left lateral sectionectomy

University Medical Center - Ho Chi Minh - Vietnam

slide-8
SLIDE 8

Innovation in the technique

Left lateral Sectionectomy

slide-9
SLIDE 9

Technichal innovation

Left lateral Sectionectomy

University Medical Center - Ho Chi Minh - Vietnam

slide-10
SLIDE 10

Innovation in the technique

Segmentectomy 3

slide-11
SLIDE 11

Laparoscopic Left medial sectionectomy

University Medical Center - Ho Chi Minh - Vietnam

slide-12
SLIDE 12

Technichal innovation

Left Medial Sectionectomy

slide-13
SLIDE 13

Laparoscopic Major Hepatectomy...? Liver hilar dissection

slide-14
SLIDE 14

Glissonean structures

slide-15
SLIDE 15

Technichal innovation

Liver Hilar Dissection

How’s … in laparoscopic techniques ?

Extrahepatic Approach Intra Glissonean Dissection Individual ligation Intrahepatic Approach Extra Glissonean Dissection

slide-16
SLIDE 16

Isolating Portal Vein, Artery and Bile duct Time consuming Avoiding complication (Abnormal variation) Increasing ascites Anatomical Sectionectomy ? Segmentectomy ?

Suitable for Right or Left Anatomic Hepatectomy

Intra Glissonean Dissection Individual ligation

slide-17
SLIDE 17

Extra Glissonean Approach Right hepatectomy

University Medical Center - Ho Chi Minh - Vietnam

slide-18
SLIDE 18

University Medical Center - Ho Chi Minh - Vietnam

Laparoscopic Left Liver Resection

slide-19
SLIDE 19

Parenchymal-sparing liver resection Laparoscopic Anatomic Sectionectomy

University Medical Center - Ho Chi Minh - Vietnam

slide-20
SLIDE 20

Technical innovation Right Anterior Sectionectomy

University Medical Center - Ho Chi Minh - Vietnam

slide-21
SLIDE 21

Laparoscopic right posterior sectionectomy

Right posterior Glissonean pedicle clamping Anatomical transection plane

slide-22
SLIDE 22

Laparoscopic liver resection Extra Glissonean Dissection

Minimizing liver hilus dissection

Decreasing ascites Avoiding complication (Anatomic variation)

Selecting inflow control

(Sectors Gilssonean pedicles)

Identifying sector limitation Performing Anatomic Resection

Minimize bloodloss Better oncologic results

slide-23
SLIDE 23

Extra-Glissonean Approach Feasible and effective in laparoscopic liver resection technique

University Medical Center in Ho Chi Minh - Vietnam

slide-24
SLIDE 24

How to do Liver parenchymal transsection

  • Selective Glissonean pedicle controled
  • Low CVP controled
  • Anatomic transection

Intersegmental plane

  • Caudate approach

Criteria steps of technique

slide-25
SLIDE 25

Laparoscopic liver resection

Caudate approach

(Source: Wakabayashi et al)

“…to the liver hilum and IVC”

slide-26
SLIDE 26

Liver parenchymal transsection

  • Instruments

Harmonic scalpel CUSA Bipolar Hem o lok Stapler

How to do liver parenchymal transection…

slide-27
SLIDE 27

Recent cases... with a tumor located in caudate lobe

slide-28
SLIDE 28

Recent cases... Lap caudate lobectomy

slide-29
SLIDE 29

Laparoscopic Liver Resection Short and long term results

slide-30
SLIDE 30

Our result of Lap liver resection

04 cases Diagnostic Lap 11 cases Conversion 260 cases Lap Liver Resection 275 patients Indicated for Lap Liver Resection From Jan, 2007 to Jun, 2014

slide-31
SLIDE 31

Patients features

Tumor size Mean tumor size: 3,85 cm. (1 cm, 12 cm) Stage of desease, BCLC classification Very early (BCLC 0): 13,8% Early (BCLC A): 65,0% Intermediate (BCLC B): 21,2%

slide-32
SLIDE 32

Type of resection

Type of resection Quantity Percent One segment Segment II 11 4.2 Segment III 11 4.2 Segment IV 14 5.4 Segment V 22 8.5 Segment VI 51 19.6 Segment VII 7 2.7 Segment VIII 2 0.8 Two segments Posterior sector 9 3.5 Anterior sector 7 2.7 Segment V & VI 20 7.7 Left lateral sector 82 31.5 Three segments Left liver 13 3.0 Central hepatectomy 2 0.8 Four segments Right liver 9 3.5 Total 260 100

slide-33
SLIDE 33

Safety of laparoscopic liver resection

Complications Number Percentage None 247 95,0 Bile leakage 2 0,77 Ascites 4 1,54 Hemorrhage 2 0,77 Pneumonia 2 0,77 Pleural effusion 3 1,15 Total 260 100

Overall complications: 13 patients (5 %) No mortality

Clavien-Dindo Classification: I (8 patients), II (2 patients) IIIA: 1 patient with pleural effusion  Thoracentesis IIIB: 2 post op hemorrhage  Reoperation

slide-34
SLIDE 34

Disease-free survival

Months Disease-free rate

Time 1 year 2 year 3 year 4 year 5 year Percent 79,3% 64,5% 56,0% 51,2% 46,8%

slide-35
SLIDE 35

Overall survival

Months Disease-free rate

Time 1 year 2 year 3 year 4 year 5 year Percent 96,4% 84% 78,7% 77,3% 77,3%

slide-36
SLIDE 36

Summary

With experience in performing Laparoscopic liver resection

  • Feasible and safe
  • Technique were standardized

Extra Glissonean pedicle dissection Caudate approach

  • Extended Indication: major, central liver resection
  • Oncologic results: comparable with open surgery
slide-37
SLIDE 37

Why we do ... lap surgery...?

Liver Resection

Why we do ... open...?

Maybe...in near future...

slide-38
SLIDE 38

Why…Laparoscopic Liver Resection?

slide-39
SLIDE 39

Liver Special anatomic position Liver resection Highly invasive surgery

Liver resection

Minimizing the invasion of treatment most expected innovation in surgery

slide-40
SLIDE 40

Lap liver resection

First performed by Gagner (1992) Through a long journey of developing… We have got great achievements – Initial dificulties were overcome – Surgical techniques were gradually standardized – Indications were extended

slide-41
SLIDE 41

Current status of Laparoscopic Liver Resection

  • Challenging tumor location

– Posterior, superior segments

  • Major and difficult hepatectomy

− Right or left hepatectomy − Central hepatectomy − Caudate lobectomy

  • Anatomical resection

– Better oncologic results

  • Lap Donor Hepatectomy
slide-42
SLIDE 42
  • During the dissection of the liver

parenchyma, there are no small branches

  • of the Glissonean pedicle, but only

branches of the hepatic vein across the

  • cut surface
  • intersegmental plane
slide-43
SLIDE 43

The most favorable indications for the laparoscopic resection Solitary lesions Smaller than 5 cm Located in peripheral liver segments 2 to 6. Left lateral sectionectomy, anterior segmentectomies

  • r

wedge resections were the most widely applied procedures. Major liver resections were shown to be feasible but remain difficult procedures

slide-44
SLIDE 44

Laparoscopic right liver resection

slide-45
SLIDE 45

Extra Glissonean Dissection Right hepatectomy

slide-46
SLIDE 46

Laparoscopic Right Liver Resection