Laparoscopic bisegmentectomy 6 and 7 using a Glissonian approach and a half-Pringle maneuver

Página do item simplificado
dc.contributorSistema FMUSP-HC: Faculdade de Medicina da Universidade de São Paulo (FMUSP) e Hospital das Clínicas da FMUSP
dc.contributor.authorHERMAN, Paulo
dc.contributor.authorKRUEGER, Jaime
dc.contributor.authorLUPINACCI, Renato
dc.contributor.authorCOELHO, Fabricio
dc.contributor.authorPERINI, Marcos
dc.date.accessioned2013-09-23T16:39:10Z
dc.date.available2013-09-23T16:39:10Z
dc.date.issued2013
dc.description.abstractDespite accumulated experience and advancing techniques for laparoscopic hepatectomy, surgeons still face challenging resections that require specific and innovative intraoperative maneuvers [1-3]. The right posterior sectionectomy presents special concerns about its location, the extensive transection area, and the difficult access to the pedicle [4, 5]. The intrahepatic Glissonian approach allows safe en masse control of the portal structures without prolonged dissection [2]. Its association with the half-Pringle maneuver results in less bleeding during parenchymal transection [1, 6]. A 34-year-old woman was referred for treatment of an 8-cm hepatocellular adenoma located at segments 6 and 7. She was placed in a semi-supine position, and six ports were located in a distribution that resembled a Makuuchi incision. The right liver was mobilized, and preparation for an anatomic Glissonian approach was performed. A vascular clamp was placed to ensure that full control of the right posterior pedicle was possible. Then a vascular stapler replaced it, with division of the right posterior Glissonian pedicle. A vascular clamp was inserted from the inferior right-flank 5-mm trocar for performance of a half-Pringle maneuver of the right pedicle to minimize blood loss during parenchymal transection. The liver parenchyma was transected with a harmonic scalpel and a vascular stapler. The right hepatic vein was divided intraparenchymally with a vascular stapler. The specimen was extracted through a Pfannenstiel incision. The total surgical time was 210 min, and the estimated blood loss was 200 ml. No blood transfusion was required. The recovery was uneventful, and hospital discharge occurred on postoperative day 5. Pathology confirmed the diagnosis of an hepatocellular adenoma. Technical issues initially hindered the development of laparoscopic liver resections [7-10]. Surgeons were concerned about hemostasis, bleeding control, safe and effective parenchymal transection, adequate visualization, and the feasibility of working on deeper regions of the liver. During the past decade, many limitations were overcome, but lesions located on the posterosuperior liver are still considered tough to beat [5, 11]. Large series and extensive reviews [12-14] show that resections located on the posterior segments still are infrequent. Limited access to the portal triad, difficult pedicle control, and a large transection area and its anatomic location, attached to the diaphragm and retroperitoneum and hidden from the surgeon's view, makes such resections defying. The authors' team has performed 97 laparoscopic hepatectomies, including resection of 6 lesions in the right posterior sector. In their series, half-pedicle clamping was used for 12 patients, and they adopt such a maneuver as an inflow control when operating on peripheric lesions with difficult vascular control (e.g., enucleations or posterosuperiorly located segmentectomies). This technique is safe and useful because it reduces liver ischemic aggression, a very important issue with diseased livers (e.g., steatosis, steatohepatitis, prolonged chemotherapy, cirrhosis) [6, 15]. In their series, the authors applied the Glissonian intrahepatic approach in 7 cases (2 left hepatectomies and 5 right hepatectomies). They understand that laparoscopy applies perfectly to oddly (posterosuperior) located tumors and that right posterior sectionectomy can be accomplished safely. In fact, they share the opinion of other specialized hepatobiliary centers, believing that this may be the preferred approach [16].
dc.description.indexMEDLINE
dc.identifier.citationSURGICAL ENDOSCOPY AND OTHER INTERVENTIONAL TECHNIQUES, v.27, n.5, p.1840-1841, 2013
dc.identifier.doi10.1007/s00464-012-2681-x
dc.identifier.issn0930-2794
dc.identifier.urihttps://observatorio.fm.usp.br/handle/OPI/1938
dc.language.isoeng
dc.publisherSPRINGER
dc.relation.ispartofSurgical Endoscopy and Other Interventional Techniques
dc.rightsrestrictedAccess
dc.rights.holderCopyright SPRINGER
dc.subject.otherhemihepatic vascular occlusion
dc.subject.otherright posterior sectionectomy
dc.subject.otherliver resection
dc.subject.otherhepatocellular-carcinoma
dc.subject.otherfeasibility
dc.subject.otherexperience
dc.subject.othersegments
dc.subject.wosSurgery
dc.titleLaparoscopic bisegmentectomy 6 and 7 using a Glissonian approach and a half-Pringle maneuver
dc.typearticle
dc.type.categoryoriginal article
dc.type.versionpublishedVersion
dspace.entity.typePublication
hcfmusp.author.externalKRUEGER, Jaime:Univ Sao Paulo, Dept Gastroenterol, BR-05403000 Sao Paulo, Brazil
hcfmusp.citation.scopus17
hcfmusp.contributor.author-fmusphcPAULO HERMAN
hcfmusp.contributor.author-fmusphcRENATO MICELLI LUPINACCI
hcfmusp.contributor.author-fmusphcFABRICIO FERREIRA COELHO
hcfmusp.contributor.author-fmusphcMARCOS VINICIUS PERINI
hcfmusp.description.beginpage1840
hcfmusp.description.endpage1841
hcfmusp.description.issue5
hcfmusp.description.volume27
hcfmusp.origemWOS
hcfmusp.origem.pubmed23389058
hcfmusp.origem.scopus2-s2.0-84925971068
hcfmusp.origem.wosWOS:000317853100055
hcfmusp.publisher.cityNEW YORK
hcfmusp.publisher.countryUSA
hcfmusp.relation.referenceAbecassis M, 2007, ANN SURG, V246, P392
hcfmusp.relation.referenceBuell JF, 2008, ANN SURG, V248, P475, DOI 10.1097/SLA.0b013e318185e647
hcfmusp.relation.referenceBuell JF, 2008, ANN SURG, V250, P825
hcfmusp.relation.referenceChau GY, 2005, WORLD J SURG, V29, P1374, DOI 10.1007/s00268-005-7766-4
hcfmusp.relation.referenceCherqui D, 2003, ARCH SURG-CHICAGO, V138, P769
hcfmusp.relation.referenceCherqui D, 2000, ANN SURG, V232, P753, DOI 10.1097/00000658-200012000-00004
hcfmusp.relation.referenceCho JY, 2008, SURGERY, V144, P32, DOI 10.1016/j.surg.2008.03.020
hcfmusp.relation.referenceDagher I, 2007, SURG ENDOSC, V21, P619, DOI 10.1007/s00464-006-9137-0
hcfmusp.relation.referenceDulucq JL, 2005, SURG ENDOSC, V19, P886, DOI 10.1007/s00464-004-2044-3
hcfmusp.relation.referenceGumbs AA, 2008, J GASTROINTEST SURG, V12, P1154, DOI 10.1007/s11605-007-0455-x
hcfmusp.relation.referenceHerman P, 2010, J LAPAROENDOSC ADV S, V20, P35, DOI 10.1089/lap.2009.0215
hcfmusp.relation.referenceKoffron AJ, 2007, ANN SURG, V246, P385, DOI 10.1097/SLA.0b013e318146996c
hcfmusp.relation.referenceLaurent A, 2003, ARCH SURG-CHICAGO, V138, P763, DOI 10.1001/archsurg.138.7.763
hcfmusp.relation.referenceMachado Marcel Autran C, 2008, Am J Surg, V196, pe38, DOI 10.1016/j.amjsurg.2007.10.027
hcfmusp.relation.referenceMAKUUCHI M, 1987, SURG GYNECOL OBSTET, V164, P155
hcfmusp.relation.referenceNguyen KT, 2009, ANN SURG, V250, P831, DOI 10.1097/SLA.0b013e3181b0c4df
hcfmusp.relation.referenceTorzilli G, 2008, ANN SURG, V247, P603, DOI 10.1097/SLA.0b013e31816387d7
hcfmusp.relation.referenceYoon YS, 2006, J LAPAROENDOSC ADV S, V16, P274, DOI 10.1089/lap.2006.16.274
hcfmusp.scopus.lastupdate2024-04-12
relation.isAuthorOfPublication4a6061ac-5d2f-4385-8340-fdecdd376813
relation.isAuthorOfPublication732906d1-2682-40cc-aeda-c624d2df6cfc
relation.isAuthorOfPublicationd5ccf3fe-e567-47d8-80c8-d15947ed200f
relation.isAuthorOfPublication8f5051c1-bf86-4498-80ba-7e2e6147e11b
relation.isAuthorOfPublication.latestForDiscovery4a6061ac-5d2f-4385-8340-fdecdd376813
Arquivos
Pacote Original
Agora exibindo 1 - 1 de 1
Nenhuma Miniatura disponível
Nome:
art_HERMAN_Laparoscopic_bisegmentectomy_6_and_7_using_a_Glissonian_2013.PDF
Tamanho:
178.42 KB
Formato:
Adobe Portable Document Format
Descrição:
publishedVersion (English)
Baixar
Coleções
Artigos e Materiais de Revistas Científicas - FM/MGT
Artigos e Materiais de Revistas Científicas - HC/ICESP
Artigos e Materiais de Revistas Científicas - HC/ICHC
Artigos e Materiais de Revistas Científicas - ODS/05