ABSTRACT
Hemihepatectomy continues to be a standard procedure for the resection of primary or secondary liver tumours in hepatobiliary surgery. In this tutorial, a case study illustrates the indication for liver resection as well as surgical steps and different techniques. Indications for right or left hemihepatectomy include liver tumours that cause a diffuse or extended infiltration of one half of the liver or tumours extending to the central confluence of liver veins or the liver hilum. Usually, a resection limit is only required in the case of extended hemihepatectomies, where a two-stage resection is needed. In addition to exploration and intraoperative ultrasound, this tutorial presents different entry sites, liver mobilisation, hilum preparation and common techniques of parenchymal dissection. Finally, a number of haemostasis, closure and biliary monitoring techniques are shown. The video tutorial demonstrates all fundamental steps of hemihepatectomy from indication to closure, with a special focus on different approaches.
Subject(s)
Colorectal Neoplasms/surgery , Hepatectomy/methods , Liver Neoplasms/secondary , Liver Neoplasms/surgery , Biliary Fistula/prevention & control , Chemotherapy, Adjuvant , Colorectal Neoplasms/pathology , Combined Modality Therapy , Hemostasis, Surgical/methods , Humans , Liver Neoplasms/drug therapy , Liver Neoplasms/pathology , Neoadjuvant Therapy , Postoperative Complications/prevention & control , Suture TechniquesABSTRACT
Several transplant programs have recently added cyclophosphamide (CyP) to their immune suppression protocols in an attempt to reduce intestinal graft rejection rates. The present study was undertaken to confirm the benefits of this drug in a murine small bowel transplant model. A short course of monotherapy with CyP 20 mg/kg per dose resulted in a mean survival time (MST) of 17.5 +/- 3.6 days, compared with a MST of 7.5 +/- 0.7 days in the untreated controls (P < 0.01). Cyclosporin A (CsA) 30 mg/kg per day produced comparable survival rates when used as monotherapy (MST: 14.2 +/- 1.3 days) or in combination with CyP 20 mg/kg per dose (MST: 21.3 +/- 5.1 days). Treatment with high dose CyP (40 mg/kg per dose) completely prevented graft loss in 8 of 10 animals (MST: 72.5 +/- 5.3 days, P < 0.01). However, adding CsA abrogated the induction of long-term survival achieved by CyP alone (MST: 23 +/- 0.4 days). These data have important implications for the use of CyP in clinical transplantation.