Pure Laparoscopic Anatomic Resection of the Segment 8 Dorsal Area Using the Dorsal Approach of the Right Hepatic Vein.

BACKGROUND: Anatomical resection of segment 8 (s8) is a challenging procedure. S8 can be subdivided into two areas: ventral (s8v) and dorsal (s8d). In the last years, different approaches for performing laparoscopic resection of s8 or any of its subsegments have been described, i.e. the hilar extrafascial approach, transfissural approach for s8v, transparenchymal approach for s8d, and the intrahepatic Glissonean approach. We recently described the dorsal approach of the right hepatic vein (RHV) for anatomical segment 7 resection. This video report describes the approach to a dorsal s8 pedicle using the RHV dorsal approach. METHODS: A 50-year-old woman with a history of morbid obesity and sleep apnea was diagnosed after episodes of hematochezia sigmoid cancer and a 2-cm liver metastases in the s8d, according to vascular reconstruction (Cella Medical Solutions, Murcia, Spain). The surgical technique started with mobilization of the right liver until the root of the RHV was identified and exposed in a craniocaudal fashion and until the s8d Glissonean pedicle was identified and clamped. Indocyanine green counterstaining depicted an intersegmental plane between the s8d and segment 5 and s8v. Transection continued until the anterior fissural vein was exposed at its root, as a landmark of the medial plane. RESULTS: Operative time lasted 265 min. Transection was carried out using the intermittent Pringle maneuver over a period of 81 min. Estimated blood loss was 252 cc. There were no postoperative complications and the patient was discharged on postoperative day 2. CONCLUSIONS: In some cases, the RHV dorsal approach can be used as the landmark for the s8d Glissonean pedicle, allowing anatomical resection of this particular area.

Laparoscopic two stage hepatectomy: combined Glissonean approach of hepatic pedicles and dorsal approach of right and middle hepatic veins and vascular reconstruction.

Major vascular involvement often constitutes a contraindication to the laparoscopic approach. Lopez-Ben and colleagues described a purely laparoscopic surgical technique consisting of two stages, eight weeks apart, utilizing the caudal view and proximal approach for complete removal of colorectal liver metastases in close proximity to all three hepatic veins.

Cirugía plástica tras la pérdida de peso masiva / Plastic surgery after massive weight loss

Cuando la cirugía bariátrica es un éxito, es decir, cuando con ella se consigue una pérdida de peso sustancial y mantenida en el tiempo, se produce en la mayoría de los pacientes flacidez de la piel y el tejido celular subcutáneo, lo que condiciona la calidad de vida paralelamente a la percepción del propio aspecto físico, requiriendo en muchos casos una remodelación corporal. Una vez estabilizada la pérdida de peso, es decir, a partir de los 2 años tras la cirugía, pueden ser necesarias una dermolipectomía abdominal o braquial, una mamoplastia reductora o la corrección de deformidades localizadas en la cara interna de los muslos. El presente artículo sintetiza las principales intervenciones vigentes en la actualidad, desde las referencias anatómicas de interés a los detalles técnicos, destacando las complicaciones más significativas (AU)