Detailed Abstract
[Liver Video Exhibition - Liver (Liver Disease/Surgery)]
[LV VE 8] Laparoscopic Anatomical Liver Resection Of Segment 8 With Glissonean Approach And ICG-guided Negative Counterstaining
Gianluca CASSESE*1 , Roberto MONTALTI1 , Roberto Ivan TROISI1
1 Department Of Minimally Invasive And Robotic HPB Surgery And Transplantation Service, Federico II University Hospital, Naples, ITALY
Background : Laparoscopic liver resection (LLR) of segment VIII (SVIII) is a challenging surgical procedure, mainly due to its postero-superior anatomical position.
Methods : Case presentation: A 72 years old female patient came to our attention because of a 30mm HCC recurrence of segment VIII, with an history of a previous RFA, on a HCV-related cirrhotic liver, Child A5.
Results : Procedure: Right hepatic liver mobilization is performed by transecting the round ligament, falciform ligament, and right triangular ligament. To perform a SVIII segmentectomy the reverse-Trendelenburg position and the contralateral retraction of the round ligament can be sufficient, without the need for a full mobilization of the right lobe. The cholecystectomy is performed to expose the Glissonean pedicles. Intraoperative ultrasounds are performed to confirm the tumor location, ruling out any involvement of adjacent vascular structures. The liver is lifted up by grasping the stump of the round ligament. The first step is the isolation of the right anterior pedicle, for which the key landmark is represented by the cystic plate, that leads to the gate 5 according to Sugioka description. Once the right anterior pedicle has been isolated at this level, G8 is identified cranially to G5 and clamped with a bulldog. To isolate the G8, a small hepatotomy with the aid of the CUSA is performed. The ischemic demarcation line is followed to highlight the resection margins. IV injection of 0.05mg/kg of ICG is used to obtain a negative counterstaining of the SVIII. The course of the right and median hepatic is checked. Parenchymal transection is carried out with the aid of CUSA and Thunderbeat, while the portal pedicles are secured by using the hem-o-locks. CUSA is very helpful to preserve the middle and right hepatic veins. The specimen is extracted within a vinyl endobag, through the Pfannenstiel incision.
Conclusions : Conclusion: Anatomical LLR of segment VIII can be safely performed using the Glissonean approach. ICG-guided fluorescence can help the surgeon.
Methods : Case presentation: A 72 years old female patient came to our attention because of a 30mm HCC recurrence of segment VIII, with an history of a previous RFA, on a HCV-related cirrhotic liver, Child A5.
Results : Procedure: Right hepatic liver mobilization is performed by transecting the round ligament, falciform ligament, and right triangular ligament. To perform a SVIII segmentectomy the reverse-Trendelenburg position and the contralateral retraction of the round ligament can be sufficient, without the need for a full mobilization of the right lobe. The cholecystectomy is performed to expose the Glissonean pedicles. Intraoperative ultrasounds are performed to confirm the tumor location, ruling out any involvement of adjacent vascular structures. The liver is lifted up by grasping the stump of the round ligament. The first step is the isolation of the right anterior pedicle, for which the key landmark is represented by the cystic plate, that leads to the gate 5 according to Sugioka description. Once the right anterior pedicle has been isolated at this level, G8 is identified cranially to G5 and clamped with a bulldog. To isolate the G8, a small hepatotomy with the aid of the CUSA is performed. The ischemic demarcation line is followed to highlight the resection margins. IV injection of 0.05mg/kg of ICG is used to obtain a negative counterstaining of the SVIII. The course of the right and median hepatic is checked. Parenchymal transection is carried out with the aid of CUSA and Thunderbeat, while the portal pedicles are secured by using the hem-o-locks. CUSA is very helpful to preserve the middle and right hepatic veins. The specimen is extracted within a vinyl endobag, through the Pfannenstiel incision.
Conclusions : Conclusion: Anatomical LLR of segment VIII can be safely performed using the Glissonean approach. ICG-guided fluorescence can help the surgeon.
SESSION
Liver Video Exhibition
Video Exhibition 3/23/2023 12:00 AM - 12:00 AM