Hypothermic ante situm resection in tumors of the hepatocaval confluence.

Primary liver malignancies together with metastatic liver tumors are among the most common tumors in human. The best available treatment option for these diseases is surgical resection. One major parameter which had been considered as contraindication for liver resection owing to technical difficulties in achieving tumor-free margins was the involvement of the hepatocaval confluence. To overcome this problem, several techniques including hypothermic in situ, ante situm and ex situ liver resection have been introduced. The common basis for these liver resections is the total vascular exclusion of the liver, and perfusion of the organ by preservation solution under hypothermic conditions. The major indications for the ante situm liver resection are tumors in the liver that are either unresectable or inadequately resectable by conventional surgery because they involve the venous confluence and/or the retrohepatic vena cava, or are in close proximity to them. This technique is a realistic option to achieve surgical cure or substantial gain of life time with quality of life in otherwise unresectable tumors of the liver. Due to fewer anastomoses, the ante situm approach is easier and safer than the ex situ approach, with an acceptable morbidity and mortality rate. Patient selection is of utmost importance to achieve a good outcome. To minimize the postoperative morbidities and mortality, this procedure requires a multidisciplinary approach and should be performed in experienced centers with a high case volume of hepatobiliary surgeries.

Comparison of different surgical techniques in distal pancreatectomy: an experimental study in a porcine model.

AIMS: Different surgical transection methods have been used for distal pancreatectomy (DP), but none of them has yet achieved perfect results. This study compares 2 standard transection techniques with the alternative LigaSure technique. METHODS: Forty-eight pigs underwent a DP. Sixteen animals were operated on with a scalpel followed by hand suturing. Sixteen pigs received a DP using an Endo GIA, and the pancreas of 16 pigs was transected with LigaSure. The transection surface of remnant pancreas was observed for liquid collection and abscess on postoperative day 7. RESULTS: Operating time on the day of DP was significantly different, with a shorter operating time in the stapler and LigaSure groups. The morbidity on postoperative day 7 was similar in all groups. CONCLUSION: In the present experimental animal study, LigaSure seems to be fast and safe as well as comparable with the standard transection and closure techniques in DP.

Computer-based liver volumetry in the liver perfusion simulator.

BACKGROUND: An exact preoperative liver volume calculation is important prior to liver surgery and living-related liver transplantation. However, CT or MRI assessment of preoperative liver volume is associated with an estimation error of 1.2% to 36%, and little data is available on its accuracy on the segmental level. The aim of this study was to validate arterial and portal venous flow rates and gain information on liver volumetry, including liver segments, in the liver perfusion simulator and compare it to in vivo measurements in a porcine model. MATERIAL AND METHODS: The arterial and portal venous flow rates and liver volumes of 10 pigs were measured in vivo and compared with the flow rates and volumes ex vivo. CT scans were performed and the volume of the liver and its lobes calculated by water displacement or computer-assistance based on the CT scans. The right lateral lobe was plasticized and reconstructed for the volume calculation. RESULTS: In the liver perfusion simulator, arterial and portal venous flow rates comparable to the in vivo rates were achieved. The liver volume had a mean difference of 10.3% between in vivo and ex vivo measurements. In the liver perfusion simulator, the mean deviation in liver volume between the computer calculation and water displacement was 2.8%. On the segmental level, the Heidelberg algorithm provided an accuracy of 97.7%. CONCLUSION: The liver perfusion simulator is an excellent device for studies in liver perfusion and volumetry. Furthermore, the simulator is applicable for teaching and performing interventions and surgeries in livers.