Frontiers in Surgery | |
A Combined “Hanging Liver Maneuver” and “Intrahepatic Extra-Glissonian Approach” for Anatomical Right Hepatectomy: Technique Standardization, Results, and Correlation With Portal Pedicle Anatomy | |
article | |
Fabio Ferrari Makdissi1  Jaime Arthur Pirola Kruger1  Vagner Birk Jeismann1  Fabricio Ferreira Coelho1  Paulo Herman1  | |
[1] Digestive Surgery Division, Department of Gastroenterology, Hospital das Clínicas, Instituto do Câncer do Estado de São Paulo (ICESP), University of São Paulo School of Medicine | |
关键词: hepatectomy; colorectal liver metastasis; hanging liver maneuver; intrahepatic glissonian approach; portal pedicle; anatomy; | |
DOI : 10.3389/fsurg.2021.690408 | |
学科分类:社会科学、人文和艺术(综合) | |
来源: Frontiers | |
【 摘 要 】
Background: The hanging liver maneuver and intrahepatic extra-Glissonian approach are distinct modalities to facilitate safe anatomical liver resections. This study reports a standardized combination of these techniques focusing on safety, results and correlation with portal pedicle anatomy in oncological patients. Method: Combined hanging liver maneuver and intrahepatic extra-Glissonian approach for anatomic right hepatectomy was described stepwise. Portal pedicle anatomy was correlated with the Glissonian approach failure and complications. Clinical characteristics of patients, perioperative outcomes, short and long-term survival rates were analyzed. Results: Thirty colorectal liver metastases patients submitted to the combined approach were evaluated. Anatomical variations of the right portal pedicle were present in 26.6%. Hanging liver maneuver was feasible in 100%, and Glissonian approach in 96.7% despite portal pedicle variations. Mean operative time was 326 min. Mean blood loss was 507 ml. Mean hospital stay was 8 days. There was no 90-day operative mortality and no significant morbidity. Oncological surgical margins were free. Overall and disease-free 5-year survival were 59 and 37%. Conclusion: Regardless of frequent anatomical variations of the right portal pedicle, the hanging liver maneuver, and intrahepatic extra-Glissonian approach can be combined, being useful for anatomical right hepatectomies in a safe and reproducible way in most patients.
【 授权许可】
CC BY
【 预 览 】
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RO202108160005129ZK.pdf | 1008KB | download |