Hybrid laparoscopic complete untinatectomy of pancreas by Shuriken shaped umbilicoplasty with sliding windows method.

In this study, we demonstrated the complete resection of untinate process that was performed by the hybrid laparoscopic surgery using our original new technique of Shuriken shaped umbilicoplasty with sliding window`s method. A 70-year-old weman was hospitalized for surgery of intraductal papillary mucinous neoplasm located in the uncinate process of pancreas. Under general anesthesia, a Shuriken shaped umbilical skin incision was made by 7 cm in horizontal and 4cm longitudinal width with 3cm round skin incision. The intermediate skin between outside and inside skin incision was removed. Subcutaneous tissue around the umbilicus and the upper abdominal subcutaneous region was dissected, and the 8cm of upper abdominal minilaparotomy was performed. The complete resection of untinate process was performed by hybrid laparoscopic procedure with the hand-assisted or the laparo-assisted manner. The umbilicoplasty of only 3cm round skin wound was made by the reefing of subcutaneous suture with 5-0 absorbable suture. The patient suffered from pancreas leakage from pancreas stump, however it was recovered spontaneously. Our new procedure could be used for PD, DP, and Major hepatectomy with the hybrid laparoscopic procedure. It might be considered that our method is good for both cosmetic and safety benefits in HPB surgery.

Catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route for acute portal venous thrombosis: report of two cases.

Although acute portal venous thrombosis (PVT) is a potentially life-threatening complication that occurs after hepatobiliary surgery with portal vein (PV) reconstruction or splenectomy, no effective or universal treatments have yet been established. Transjugular or transhepatic catheter-directed thrombolysis has recently been reported to be effective for treating acute PVT. However, the efficiency of this treatment for complete PV occlusion might be limited because a poor portal venous flow prevents thrombolytic agents from reaching and dissolving thrombi. Moreover, the use of the transjugular or transhepatic route might not be suitable in patients who have undergone major hepatectomy or in those with ascites due to an increased risk of residual liver injury or intra-abdominal bleeding following puncture to the residual liver. We herein describe the cases of two patients with almost total PV occlusion caused by massive thrombi that formed after hepatobiliary surgery, who were successfully treated with catheter-directed continuous thrombolysis following aspiration thrombectomy via the ileocolic route. This treatment should be considered beneficial for treating selected patients such as the two patients described herein.

Video-assisted living donor hemihepatectomy through a 12-cm incision for adult-to-adult liver transplantation.

OBJECTIVES: There has been remarkable progress in recent technical innovations for laparoscopic hepatectomy. However, a laparoscopic procedure rarely has been indicated for donation of the liver in living-related liver transplantation (LRLT). Here, we described the technique and the outcome of video-assisted donor hepatectomy (VADH) for adult-to-adult LRLT. METHODS: For 13 donors in adult-to-adult LRLT, 3 types of major hepatectomy--right hemihepatectomy (3), and left hemihepatectomy, with or without the caudate lobe (10)--were performed through video-assisted procedures; surgical manipulation via ports or via a 12-cm incision and viewing through a laparoscope or through incision were combined and used. RESULTS: VADH was completed in 13 donors, with a median operation time of 363 +/- 33 minutes and a median blood loss of 302 +/- 191 mL. No complications specific to video-assisted procedures, postoperative bile leak, or bleeding were observed. The restoration of the liver function was smooth, and the use of an analgesic (median: 1.2 times) was reduced, compared with the historical control (median: 3.8 times) that underwent a standard donation of the liver. Currently, all donors are healthy and have returned to their previous activities. The grafts have been functioning well, excluding 3 recipients who succumbed to serious complications unrelated to the video-assisted procedure. CONCLUSION: We have shown a new method of VADH through a 12-cm laparotomy for adult-to-adult LRLT. This technique is as feasible as standard open donor hepatectomy, with less pain and with improved postoperative symptoms.

FK506 may reduce early liver injury following living related liver transplantation.

BACKGROUND/AIMS: We investigated the influence of FK506 which has been used frequently after transplant surgery as an immunosuppressant, on liver injury after partial hepatectomy by comparing laboratory data from donors and recipients after liver transplantation. METHODOLOGY: Seventeen donors and respective recipients who underwent living related donor liver transplantation were included in the present study. Serum levels of transaminases and cytokines were measured and compared preoperatively and in the early period after the operation. RESULTS: Serum level of asparaginic acid aminotransferase in the postoperative day 1 was significantly higher in the donor group. Serum levels of alanine aminotransferase in the early period after the operation were significantly higher in the donor group. Serum levels of interferon y and soluble Fas ligand in the early period after the operation were significantly higher in the donor group. Steroid doses administered were significantly higher in the recipient group. CONCLUSIONS: FK506 administration and steroid administration in larger doses were thought to reduce serum transaminase levels of the recipient group. These findings might suggest that cell-mediated immunity weigh heavier than the operation time of ischemia-reperfusion injury as a cause of liver injury after partial hepatectomy.

Splenectomy for reduction of excessive portal hypertension after adult living-related donor liver transplantation.

BACKGROUND/AIMS: We investigated the effects of splenectomy on the reduction of excessive portal hypertension immediately after adult living-related donor liver transplantation, paying particular attention to peritransplanted portal pressure in seven adult patients. METHODOLOGY: We studied the relationship between portal hypertension and hyperbilirubinemia in small-for-size graft liver transplantation. RESULTS: In the three cases, the portal pressures increased beyond 30 cmH2O after living-related donor liver transplantation, despite the right lobe graft, and these patients underwent splenectomy. After splenectomy, their portal pressures decreased below 25 cmH2O. The portal pressure underwent auxiliary orthotopic partial liver transplantation due to the hypercitrullinemia and did not change after surgery (9.5 to 11.5 cmH2O). Interestingly, the hyperbilirubinemia occurring after living-related donor liver transplantation were as the primary result of direct bilirubin except for the patient with citrullinemia. The posttransplanted portal pressures were controlled below 25 cmH2O in all patients, with their peak serum total bilirubin levels not exceeding 15 mg/dL, and the patients were discharged without major complications. Three patients underwent splenectomy, and did not suffer from serious infection. The reduction in excessive portal hypertension after living-related donor liver transplantation might prevent liver injury and post-transplant hyperbilirubinemia. CONCLUSIONS: However, splenectomy remains a life-threatening factor. Therefore, transplant surgeons encountering living-related donor liver transplantation must continue to seek out additional solutions to problems with excessive portal hypertension.