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Laparoscopic approach to suspected T1 and T2 gallbladder carcinoma

World Journal of Gastroenterology 2017年第14期23卷 2556-2565页

作者： yusuke ome Kazuki Hashida Mitsuru Yokota Yoshio Nagahisa Michio Okabe Kazuyuki Kawamoto Department of Surgery Kurashiki Central Hospital

AIM To evaluate a laparoscopic approach to gallbladder lesions including polyps, wall-thickening lesions, and suspected T1 and T2 gallbladder cancer(GBC).METHODS We performed 50 cases of laparoscopic whole-layer cholecystectomy(LCWL) and 13 cases of laparoscopic gallbladder bed resection(LCGB) for those gallbladder lesions from April 2010 to November 2016. We analyzed the short-term and long-term results of our laparoscopic approach. RESULTS The median operation time was 108 min for LCWL and 211 min for LCGB. The median blood loss was minimal for LCWL and 28 ml for LCGB. No severe morbidity occurred in either procedure. Nine patients who underwent LCWL and 7 who underwent LCGB were postoperatively diagnosed with GBC. One of these patients had undergone LCGB for pathologically diagnosed T2 GBC after LCWL. All of the final surgical margins were negative. Three of these 15 patients underwent additional open surgery. The mean follow-up period was 26 mo, and only one patient developed *** LCWL and LCGB are safe and useful procedures that allow complete resection of highly suspected or earlystage cancer and achieve good short-term and longterm results.

关键词： Laparoscopic cholecystectomy Whole-layer cholecystectomy Gallbladder bed resection Radical cholecystectomy Gallbladder carcinoma

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Major hepatectomy using the glissonean approach in cases of right umbilical portion

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World Journal of Hepatology 2016年第34期8卷 1535-1540页

作者： yusuke ome Kazuyuki Kawamoto Tae Bum Park Tadashi Ito Department of Surgery Kurashiki Central Hospital

Right umbilical portion(RUP) is a rare congenital anomaly associated with anomalous ramifications of the hepatic vessels and biliary system. As such, major hepatectomy requires a careful approach. We describe the usefulness of the Glissonean approach in two patients with vessel anomalies, such as RUP. The first patient underwent a right anterior sectionectomy for intrahepatic cholangiocarcinoma. We encircled several Glissonean pedicles that entered the right anterior section along the right side of the RUP. We temporarily clamped each pedicle, confirmed the demarcation area, and finally cut them. The operation was performed safely and was successful. The second patient underwent a left trisectionectomy for perihilar cholangiocarcinoma. We secured the right posterior Glissonean pedicle. The vessels in the pedicle were preserved, and the other vessels and contents were resected. Identifying the vessels for preservation facilitated the safe lymphadenectomy and dissection of the vessels to be resected. We successfully performed the operation.

关键词： Right anterior sectionectomy Right umbilical portion Glissonean approach Left trisectionectomy Glissonean pedicle Cholangiocarcinoma Hepatocellular carcinoma

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