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Objective@#To explore the safety and efficacy of totally laparoscopic right posterior liver resection for hepatocellular carcinoma (HCC).@*Methods@#The clinical data of 16 HCC patients undergoing laparoscopic right posterior liver resection at the First People′s Hospital of Foshan between Apr 2014 and Sep 2018 was retrospectively analyzed.@*Results@#14 out of the 16 cases, underwent totally laparoscopic right posterior liver resection by right hepatic Glisson pedicle transection, 2 were converted to open surgery.The operation time was (378±65) min, blood loss was (500±287) ml. There was no transfusion except for 2 cases. The median hospital stay after operation was 8 days . There was no mortality . With the median follow up period of 22 months (range 1 to 54 months). Tumor recurrence was found in one case.@*Conclusion@#Laparoscopic Glisson′s pedicle transection for right posterior liver resection for hepatocellular carcinoma was safe and effective.
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Objective To explore the safety and efficacy of totally laparoscopic right posterior liver resection for hepatocellular carcinoma (HCC).Methods The clinical data of 16 HCC patients undergoing laparoscopic right posterior liver resection at the First People's Hospital of Foshan between Apr 2014 and Sep 2018 was retrospectively analyzed.Results 14 out of the 16 cases,underwent totally laparoscopic right posterior liver resection by right hepatic Glisson pedicle transection,2 were converted to open surgery.The operation time was (378 ±65) min,blood loss was (500 ±287) ml.There was no transfusion except for 2 cases.The median hospital stay after operation was 8 days.There was no mortality.With the median follow up period of 22 months (range 1 to 54 months).Tumor recurrence was found in one case.Conclusion Laparoscopic Glisson's pedicle transection for right posterior liver resection for hepatocellular carcinoma was safe and effective.
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Objective To summarize the clinical experience of combined liver and kidney procurement from pediatric organ donation. Methods Clinical data of 6 pediatric donors undergoing combined liver and kidney procurement in the First People's Hospital of Foshan from October 2011 to December 2016 were collected and relevant clinical experience was summarized. Results According to the diagnostic criteria for brain death (for children) established by Brain Injury Evaluation Quality Control Center of National Health and Family Planning Commission, 6 pediatric donors received combined liver and kidney procurement for organ donation under the status of brain death. Modified liver-kidney perfusion was performed by external iliac arterial intubation using No.7 suction catheter, or arteria iliaca communis intubation using 24 F catheter for the perfusion of portal vein and abdominal aorta, thoracic aorta occlusion. The operation time was 55-60 min. A total of 6 liver grafts and 12 renal grafts were harvested, which were successfully applied in clinical liver and renal transplantation. No primary nonfunction was observed in the liver or renal grafts. Conclusions Timely assessment of brain death, rigorous and cautious measures for organ maintenance and modified techniques for combined liver and kidney procurement play a key role in the success of combined liver and kidney procurement from pediatric organ donation.
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Objective To study the feasibility and safety of pure laparoscopic right hemihepatectomy for hepatocellular carcinoma via the anterior approach.Methods The data of five patients with hepatocellular carcinoma who underwent pure laparoscopic right hemihepatectomy at the First People's Hospital of Foshan between December 2013 and December 2016 were retrospectively analyzed.Patients'operation time,blood loss,blood transfusion rate,surgical margins,hospital stay,complication and short term outcomes were reviewed.Results All the five patients completed pure laparoscopic right hemihepatectomy without conversion to open surgery.The average (range) operation time was 6.0 (5 ～ 8) h.The average blood loss was 340 (110 ～ 600) ml.No patient received blood transfusion.The average surgical margin was 2.4 (1 ～4.5) cm.The average postoperative hospital stay was 7 (4 ～ 15) d.The average follow-up was 22 (2 ～38) months.Three patients experienced postoperative complications,which included ascites,pleural effusion,and ascites accompanied by biliary leakage,respectively.The last patient recovered well from drainage.No liver failure,cancer recurrence or death was noted.Conclusions This study demonstrated that pure laparoscopic right hemihepatotectomy via the anterior approach is a minimally invasive procedure which has the advantage of fast postoperative recovery.It was feasible and safe to treat hepatocellular carcinoma with favorable short-term outcomes.
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Objective To study the feasibility and safety of laparoscopic hepatic caudate lobe resec tion.Methods The clinical data of seven patients who underwent laparoscopic hepatic caudate lobe resection in our hospital were retrospective analyzed.There were 3 male and 4 female patients.The mean age was 45.3 years.The primary diseases included hepatic haemangioma (n =2),metastatic liver cancer (n =2),hepatocellular carcinoma (n =1),recurrent hepatocellular carcinoma (n =1) and hepatic adenoma (n =1).The total blood loss,operation time,hospital stay after surgery and complication were analyzed.Results The surgery was successful in all these 7 patients and no patients required any conversion to open surgery.Five patients underwent partial caudate lobe resection,and the remaining 2 underwent combined left hemi hepatectomy with partial caudate lobe resection.The operation time ranged from 200 to 250 minutes with a mean of 235 minutes.The intraoperative blood loss ranged from 40 to 600 ml with a mean of 188 ml.There was no postoperative bleeding and bile leakage.The resections were all R0 resections.Conclusions Laparoscopic hepatic caudate lobe resection was safe and feasible in appropriate patients.Familiarity with anatomy of the liver caudate lobe and skilled laparoscopic techniques are important to carry out this surgery.
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group was significantly longer than that in the low MELD score group (P <0.05).And there was no significant difference in the length of hospital stay,mortality during hospitalization,incidence of early complications, follow-up time and overall survival rate between two groups (all in P >0.05).The peak level of aspartate aminotransferase (AST)in the high MELD score group was significantly higher compared with that in the low MELD score group (P <0.05 ).The incidence of bile leakage,abdominal abscess and liver dysfunction significantly differed between two groups (all in P <0.05 ).Conclusions It is a safe and short-term efficacious approach to perform liver transplantation with organs obtained from Chinese donation after citizens’ death in patients with high MELD score liver recipients.
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Objective To summarize the feasibility and safety of fast perfusion through abdominal aorta and portal vein in combined liver and kidney procurement from organ donation. Methods Clinical data of 43 donors of donation after cardiac death (DCD)undergoing combined liver and kidney procurement in the First People’s Hospital of Foshan from September 201 1 to June 2014 were analyzed retrospectively. Among the 43 donors,15 cases were China DCD donor category Ⅰ (donor after brain death) (C-Ⅰ),1 case was category Ⅱ (donor after cardiac death) (C-Ⅱ)and 27 cases were categoryⅢ(C-Ⅲ). Combined abdominal aorta and portal vein perfusion with fast cannulation were performed. Results The time from abdomen incision to abdominal aorta cannulation was 1.5-2.0 min. Forty-three livers and eighty-six kidneys were procured from 43 donors. The warm ischemia time (WIT)was 0 for C-Ⅰ donors,and was 3-21 min for the other donors (mean:10 min). Two liver grafts were discarded for major injury of the porta hepatis and severe fatty liver respectively. Eighteen kidney grafts were discarded for kidney stones, kidney atrophy, high level of preoperative serum creatinine,severe renal atherosclerosis,renal microvessel thrombosis,multiple renal cyst, kidney traumatic rupture,etc. The total discard rate of donor organs was 16%. Conclusions Fast perfusion through abdominal aorta and portal vein is a simple and safe method in combined procurement liver and kidney from organ donation.
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Associating liver partition and portal vein ligation for two-staged hepatectomy(ALPPS) is a novel approach for hepatectomy.The case we reported was a 68 years old male patient diagnosed with hilar cholangiocellular carcinoma and obstructive jaundice.ALPPS surgery was operated.Since the patient's left lateral lobe volume was less than 40％ of the whole liver volume (merely 33.91％),the ligation of the right portal vein,plus in situ split of the junction zone between left medial and left lateral liver lobe and the dissection of portal lymph nodes as the first stage operation was conducted.Abdominal CT on the 8th day after the operation reported an increase on the volume of left lateral lobe by 32％ to 41.5％ of the whole liver volume.On the 12th day after the first stage operation,an extended right trilobate hepatectomy combined with left hepatic duct intra-jejunum drainage was performed as the second operation.The patient completely recovered and was discharged three weeks after the second stage operation.