1,720,976 research outputs found
Extreme hepatectomies and non-resectability technical breakthrough for liver neoplasia, focusing on colorectal metastases: experimental pilot study on safety, efficacy, and regeneration patterns with new insight on ALLPS-LT hybrid techniques
Full text linkBACKGROUND
New strategies to broaden resectability criteria in hepatobiliary surgery has led to the development of two-stage hepatectomy techniques, multi-step procedures with the aim of promoting effective regeneration of the future liver residue (FLR).
The first multicentre international case study was published in 2012 for a new surgical technique defined ALPPS (Associating Liver partition and Portal vein ligation for Staged hepatectomy), which implies in Step1 (laparotomy) ligation of the right portal branch (PVL) with subtotal parenchymal transection (in situ splitting), in order to stimulate rapid FLR hypertrophy for a staged hepatectomy. At the UOC of Hepatobiliary Surgery and Liver Transplantation Unit of Padova University a new surgical
technique was introduced that reverses the “classic ALPPS paradigm” based on a Step1 with laparoscopic PVL or portal vein embolization (sequential radiological PVE) and microwave (MWA) thermal ablation on the future transection plane. This method has been identified with the term LAPS (Laparoscopic microwave Ablation and Portal vein occlusion for Staged hepatectomy).
MATERIALS AND METHODS
Ten patients (M: F = 6: 4, mean age 62.5 years - gamma 29-81) were evaluated, underwent LAPS intervention for primitive or secondary malignant liver disease, upfront unresectable for insufficient preoperative FLR. The intraoperative data, the bio-morphological profile were collected during the first
week respectively after both surgical procedures, complications, overall survival and analysis of oncological and postoperative outcomes (median follow-up 17 months, range 4-36).
RESULTS
Significant increase in FLR from 372.3 cc (range 179-407) to 664 cc (range 491-923) - p = 0.002 – and of the FLR/BW ratio was obtained (0.53% - 0.94%; p = 0.002), with a FLR hypertrophy of 71.5% (range 42.8-132%) and a median daily volume increase of 29.3 cc die (range 16.4 -43.3).
All patients considered gained Step2, with effective FLR increase on average in 9.5 days (range 7-11 days).
Median duration of Step1 (145 min; range 75-325 min) was significantly lower (p = 0.0005) than Step2 (402.5 min; range 185-630); blood loss was negative (range 0-70 cc) during Step1 so no patient needs transfusion, and 800 cc (range 600-3600) in Step2 (p = 0.0001). The need for postoperative monitoring in intensive care unit was averaged after Step1 and Step2
respectively unnecessary and 2.5 days (range 1-6 days) (p = 0.0057). Total hospitalization was 14 days (range 10-46) with particular feature that 7/10 patients (70%) had interstage home discharge period. The study of postoperative complications using the Dindo-Clavien classification revealed 20 events in 8 patients (80% of patients had at least one complication); analyzing for single Step 4/10 patients (40%) had complications after Step1 while 7/10 (70) patients had complications after Step2; after Step1 and Step2, respectively, 20% and 40% of grade ≥IIIa complications (with a single event IIIb, no grade IV events and no biliary complications). No perioperative mortality event was registered (90-days mortality 0%). Overall Survival (12-months) was 77.8% with a median of 28.2 months. Pathological analysis revealed 8/10 patients (80%) with an oncologically radical resection (R0).
CONCLUSIONS
LAPS technique was effective in achieving resectability in patients upfront unresectable for FLR insufficiency, although with a remarkable rate of complications, but with comparable data literature ALPPS data. Compared with standard ALPPS data there was sno perioperative mortality rate and 70% of patients had a short interstage discharge. In the broad panorama of two-stage hepatectomy techniques development, LAPS seems to be able to describe one of the new paradigms, enabling by means of minimally-invasive techniques to achieve significant oncological results in selected preoperative unresectable patients
Massive Carbon Dioxide Embolism During Laparoscopic Liver Resection: A Case Report
Full text linkCarbon dioxide embolism during laparoscopic surgery is a serious and life-threatening complication. The overall incidence of embolism during laparoscopic surgery is low (0.15%). Although the potential fatal consequences of this complication are reported in literature, a well-documented report of the effect of massive CO2 embolism during laparoscopic liver resection on cardiovascular, respiratory and encephalographic parameters does not exist. The authors describe a well-documented case of massive carbon dioxide embolism during laparoscopic liver resection suspected by both hemodynamic instability and elevation of EtCO2 and confirmed by arterial blood gas. The surgeon's rapid closure of the vascular breach resulted in an overall improvement of the patient's vital signs without further consequences. Our case report shows the cardiovascular, respiratory and encephalographic effects of a massive carbon dioxide embolism and highlights the importance of a strict cooperation between the surgeon and the anesthesiologist and the importance for a prompt treatment when massive carbon dioxide embolism occurs
Intestinal Surgery for Crohn's Disease: Predictors of Recovery, Complications and Health Related Quality of Life
No full textErratum: Pain Control After Liver Transplantation Surgery (Transplantation Proceedings (2014) 46 (2300-2307))
No full textLaparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy (LAPS): A Minimally Invasive First-Step Approach.
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Totally Laparoscopic Microwave Ablation and Portal Vein Ligation for Staged Hepatectomy : A New Minimally Invasive Two-Stage Hepatectomy.
No full textAbstract
BACKGROUND:
Laparoscopic microwave ablation and portal vein ligation for staged hepatectomy (LAPS) is a new technique with a first laparoscopic step available in cases of unresectable right liver masses and inadequate future liver remnant (FLR).
METHODS:
In Step 1, laparoscopic right portal vein occlusion is performed with microwave ablation on the future transection plane and in the FLR. Step 2 consists of a totally laparoscopic right trisectionectomy.
RESULTS:
Duration of the Step 1 operation was 170 min, without the need for blood transfusions and intensive care unit admission. The postoperative liver volumetric computed tomography scan was performed on postoperative day 9 and revealed a satisfactory left hepatic hypertrophy (FLR 666 cm3; FLR to body weight ratio 0.96; FLR increase 90.4 %; daily FLR hypertrophy 35 cm3/day). Duration of the Step 2 operation was 630 min (liver transection time 240 min). Blood loss was 700 cc, with no need for transfusion. The specimen was extracted through a 10-cm Pfannenstiel incision, and pathology revealed a tumor-free resection margin (R0). The patient was discharged on postoperative day 7 without complications (total hospital stay for Step 1 + Step 2: 10 days).
CONCLUSIONS:
Totally LAPS is a technically feasible and safe procedure. It could provide benefit in selected patients with primarily non-resectable liver cancer, making extreme liver surgery easy and safe in well-selected patients
Diverting loop ileostomy after restorative proctocolectomy for ulcerative and indeterminate colitis: predictors of outcome and quality of life
No full textLiver Transplantation and Hepatobiliary Surgery - Interplay of Technical and Theoretical Aspects Small-for-Size Syndrome
No full text
Going Beyond Counting First Authors in Author Co-citation Analysis
Full text linkThe present study examines one of the fundamental aspects of author co-citation analysis (ACA) - the way co-citation
counts are defined. Co-citation counting provides the data on which all subsequent statistical analyses and mappings
are based, and we compare ACA results based on two different types of co-citation counting - the traditional type that
only counts the first one among a cited work's authors on the one hand and a non-traditional type that takes into
account the first 5 authors of a cited work on the other hand. Results indicate that the picture produced through this non-traditional author co-citation counting contains more coherent author groups and is therefore considerably clearer. However, this picture represents fewer specialties in the research field being studied than that produced through the traditional first-author co-citation counting when the same number of top-ranked authors is selected and analyzed. Reasons for these effects are discussed
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