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Chasing the right path: tips, tricks and challenges of robotic approach to posterior segments

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hepatobiliary surgery and Nutrition 2019年第5期8卷 512-514页

作者： Fabrizio Di Benedetto Giuseppe Tarantino Paolo Magistri hepato-Pancreato-biliary surgery and liver transplantation Unit University of Modena and Reggio EmiliaModenaMOItaly

The advent of minimally invasive technologies to approachliver diseases changed some paradigms of liver surgeryduring the last two *** allow to safely treatpatients with poor liver function,portal hypertension andcirrhosis,reducing the risk of decompensation(1).However,those potential benefits resulted to be in contrast with theactual application of such technologies in the real-life(2,3).

关键词： liver diseases surgery

Small-for-size syndrome in liver transplantation:Definition,pathophysiology and management

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hepatobiliary & Pancreatic Diseases International 2020年第4期19卷 334-341页

作者： Yuichi Masuda Kazuki Yoshizawa Yasunari Ohno Atsuyoshi Mita Akira Shimizu Yuji Soejima Division of Gastroenterological Hepato-Biliary-PancreaticTransplantation and Pediatric SurgeryDepartment of SurgeryShinshu University School of Medicine3-1-1 AsahiMatsumotoNaganoJapan

Background:Since the first success in an adult patient,living donor liver transplantation(LDLT)has become an universally used ***-for-size syndrome(SFSS)is a well-known complication after partial LT,especially in cases of adult-to-adult *** definition of SFSS slightly varies among transplant *** use of a partial liver graft has risks of SFSS *** portal vein(PV)hypertension and PV hyper-perfusion after LT were identified as the main ***,various approaches were explored to modulate PV flow and decrease PV pressure in order to alleviate this ***,the definition,clinical symptoms,pathophysiology,basic research,as well as preventive and treatment strategies for SFSS are reviewed based on an extensive review of the literature and on our own *** sources:The articles were collected through PubMed using search terms“liver transplantation”,“living donor liver transplantation”,“living liver donation”,“partial graft”,“small-for-size graft”,“small-forsize syndrome”,“graft volume”,“remnant liver”,“standard liver volume”,“graft to recipient body weight ratio”,“sarcopenia”,“porcine”,“swine”,and“rat”.English publications published before March 31,2020 were included in this ***:Many transplant surgeons performed PV flow modulation,including portocaval shunt,splenic artery ligation and *** these techniques,patient outcome has been improved even when using a"small"*** factors,such as preoperative recipients’nutritional and skeletal muscle status,graft congestion,and donor factors,were also identified as risk factors which all have been addressed using various ***:The surgical approach controlling PV flow and pressure could help to prevent SFSS especially in severely ill *** the absence of efficacious medications to resolve SFSS,conservative treatments,including aggressive fluid balance correction for massive ascites,anti-microbiological therapy t

关键词： liver transplantation Living donor liver transplantation Small-for-size graft Small-for-size syndrome

Impact of endothelial nitric oxide synthase activation on accelerated liver regeneration in a rat ALPPS model

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World Journal of Gastroenterology 2023年第5期29卷 867-878页

作者： Hitoshi Masuo Akira Shimizu Hiroaki Motoyama Koji Kubota Tsuyoshi Notake Takahiro Yoshizawa Kiyotaka Hosoda Koya Yasukawa Akira Kobayashi Yuji Soejima Division of Gastroenterological Hepato-Biliary-PancreaticTransplantation and Pediatric SurgeryDepartment of SurgeryShinshu University School of MedicineMatsumoto 390-8621Japan

BACKGROUND Although the associating liver partition and portal vein ligation for staged hepatectomy(ALPPS)induces more rapid liver regeneration than portal vein embolization,the mechanism remains *** To assess the influence of inflammatory cytokines and endothelial nitric oxide synthase(eNOS)activation on liver regeneration in *** The future liver remnant/body weight(FLR/BW)ratio,hepatocyte proliferation,inflammatory cytokine expression,and activation of the Akt-eNOS pathway were evaluated in rat ALPPS and portal vein ligation(PVL)*** proliferation was assessed based on Ki-67 expression,which was confirmed using *** serum concentrations of inflammatory cytokines were measured using enzyme linked immune-solvent *** Akt-eNOS pathway was assessed using western *** explore the role of inflammatory cytokines and NO,Kupffer cell inhibitor gadolinium chloride(GdCl3),NOS inhibitor N-nitro-arginine methyl ester(L-NAME),and NO enhancer molsidomine were administered *** The ALPPS group showed significant FLR regeneration(FLR/BW:1.60%±0.08%,P<0.05)compared with that observed in the PVL group(1.33%±0.11%)48 h after *** the ALPPS group,serum interleukin-6 expression was suppressed using GdCl3 to the same extent as that in the PVL ***,the FLR/BW ratio and Ki-67 labeling index were significantly higher in the ALPPS group administered GdCl3(1.72%±0.19%,P<0.05;22.25%±1.30%,P<0.05)than in the PVL group(1.33%±0.11%and 12.78%±1.55%,respectively).Phospho-Akt Ser473 and phospho-eNOS Ser1177 levels were enhanced in the ALPPS group compared with those in the PVL *** was no difference between the ALPPS group treated with L-NAME and the PVL group in the FLR/BW ratio and Ki-67 labeling *** the PVL group treated with molsidomine,the FLR/BW ratio and Ki-67 labeling index increased to the same level as in the ALPPS *** Early induction of inflammatory cytokines may n

关键词： Hepatectomy Nitric oxide liver regeneration Cytokines NG-Nitroarginine methyl ester Molsidomine

Terlipressin versus placebo in living donor liver transplantation

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hepatobiliary & Pancreatic Diseases International 2022年第1期21卷 76-79页

作者： Paschalis Gavriilidis Ernest Hidalgo Robert P Sutcliffe Keith J Roberts department of hepato-Pancreato-biliary and liver Transplant surgery Queen Elizabeth University Hospitals Birmingham NHS Foundation TrustBirmingham B152THUK department of hepato-Pancreatico-biliary surgery and transplantation Hospital Universitari Vall d’HebronBarcelona 08035Spain

To the Editor:Terlipressin is a long-acting synthetic analogue of vasopressin,demonstrating several potential benefits in the context of living donor liver transplantation(LDLT).During the recipient hepatec-tomy,terlipressin reduces the portal ***,it may mitigate the extent of bowel congestion following portal vein *** decreasing portal hyperperfusion and hypertension,it protects the graft from further injury and improves renal blood flow.

关键词： donor liver Terlipressin

surgery in biliary lithiasis: from the traditional “open” approach to laparoscopy and the“rendezvous” technique

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hepatobiliary & Pancreatic Diseases International 2017年第6期16卷 595-601页

作者： Giuseppe Tarantino Paolo Magistri Roberto Ballarin Giacomo Assirati Antonio Di Cataldo Fabrizio Di Benedetto hepato-Pancreato-biliary surgery and liver transplantation Unit University of Modena and Reggio Emilia 41124 ModenaItaly department of General surgery Sapienza-University of Rome 00189 Rome Italy department of Surgical Sciences Organ Transplantation and Advanced Technologies University of Catania95124 Catania Italy

BACKGROUND:According to the current literature, biliary lithiasis is a worldwide-diffused condition that affects almost 20% of the general population. The rate of common bile duct stones(CBDS) in patients with symptomatic cholelithiasis is estimated to be 10% to 33%, depending on patient’s *** to stones in the gallbladder, the natural history of secondary CBDS is still not completely understood. It is not clear whether an asymptomatic choledocholithiasis requires treatment or not. For many years, open cholecystectomy with choledochotomy and/or surgical sphincterotomy and cleaning of the bile duct were the gold standard to treat both pathologies. Development of both endoscopic retrograde cholangiopancreatography(ERCP) and laparoscopic surgery,together with improvements in diagnostic procedures, influenced new approaches to the management of CBDS in association with *** SOURCES:We decided to systematically review the literature in order to identify all the current therapeutic options for CBDS. A systematic literature search was performed independently by two authors using Pub Med, EMBASE, Scopus and the Cochrane Library ***:The therapeutic approach nowadays varies greatly according to the availability of experience and expertise in each center, and includes open or laparoscopic common bile duct exploration, various combinations of laparoscopic cholecystectomy and ERCP and combined laparoendoscopic ***:Although ERCP followed by laparoscopic cholecystectomy is currently preferred in the majority of hospitals worldwide, the optimal treatment for concomitant gallstones and CBDS is still under debate, and greatly varies among different centers.

关键词： biliary obstruction bile duct stones gallstones endoscopic retrograde cholangiopancreatography laparoscopic cholecystectomy

Routine use of a transanastomotic stent is unnecessary for hepatojejunostomy in liver transplantation

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Chinese Medical Journal 2012年第14期125卷 2411-2416页

作者： WANG Gen-shu YANG Yang JIANG Nan FU Bin-sheng LI Hua LI Shi-hui JIN Hai YANG Jian-xu ZHANG Jian CHEN Gui-hua liver transplantation Center department of Hepatic surgery

Background The use of transanastomotic stents for Roux-en-Y hepatojejunostomy （RYHJ） in liver transplantation （LT） remains controversial. The aim of this retrospective study was to assess the role of transanastomotic stent for RYHJ in LT. Methods RYHJ for biliary reconstruction in LT was performed in 52 patients. Twenty-five patients had bile duct reconstruction by RYHJ with transanastomotic stents （S group）, while 27 patients underwent the same procedure without transanastomotic stents （non-S group）. The two groups were compared in terms of post-LT biliary complications and survival. Results The incidences of bile leakage, anastomotic stricture, non-anastomotic stricture, biliary sludge/lithiasis and biliary infection were 12% （3/25）, 9.5% （2/21）, 23.5% （4/17）, 11.8% （2/17）, and 24% （6/25）, respectively in the S group, and 0, 0, 20.0% （5/25）, 10.0% （2/20）, and 16.7% （4/24）, respectively in the non-S group. One and three year survival rates were 48.0% （12/25） and 34.0% （8/23）, respectively, in the S group and 57.7% （15/26） and 38.9% （7/18）, respectively, in the non-S group. There was no significant difference between the two groups in terms of the incidence of various biliary complications and survival （P 〉0.05）. Conclusion The routine use of transanastomotic stents is not necessary for RYHJ for biliary reconstruction in LT.

关键词： hepatojejunostomy liver transplantation, stent

Surgical vs percutaneous radiofrequency ablation for hepatocellular carcinoma in dangerous locations

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World Journal of Gastroenterology 2011年第1期17卷 123-129页

作者： Ji-Wei Huang Roberto Hernandez-Alejandro Kristopher P Croome Lu-Nan Yan Hong Wu Zhe-Yu Chen Pankaj Prasoon Yong Zeng department of hepato-biliary-Pancreatic surgery Division of Liver Transplantation West China Hospital Sichuan University Chengdu 610041 Sichuan Province China department of surgery University of Western Ontario Hepatobiliary and Liver Transplant Surgery London Health Sciences Centre London Ontario N6A 4S2 Canada

AIM:To compare the long-term outcome of percutaneous vs surgical radiofrequency ablation(RFA) for hepatocellular carcinoma(HCC) in dangerous ***:One hundred and sixty-two patients with HCC in dangerous locations treated with percutaneous or surgical RFA were enrolled in this *** patients were divided into percutaneous RFA group and surgical RFA *** the patients were regularly followed up for a long time,their curative rate,hospital stay time,postoperative complications and 5-year local tumor progression were compared and ***:No significant difference was observed in curative rate between the two groups(91.3% vs 96.8%,P = 0.841).The hospital stay time was longer and more analgesics were required while the incidence of bile duct injury and RFA-related hemorrhage was lower in surgical RFA group than in percutaneous RFA group(P < 0.05).The local progression rate of HCC in dangerous locations was significantly lower in surgical RFA group than in percutaneous RFA group(P = 0.05).The relative risk of local tumor progression was 14.315 in percutaneous RFA ***:The incidence of severe postoperative complications and local tumor progression is lower after surgical RFA than after percutaneous RFA.

关键词： hepatocellular carcinoma Radiofrequency ablation liver cirrhosis Recurrence Local therapy

Treatment of hepatocellular carcinoma accompanied by portal vein tumor thrombus

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World Journal of Gastroenterology 2006年第47期12卷 7561-7567页

作者： Masami Minagawa Masatoshi Makuuchi department of hepato-biliary-Pancreatic surgery Department of Artificial Organ and Transplantation Graduate School of Medicine University of Tokyo Tokyo Japan

The prognosis of patients with hepatocellular cardnorna （HCC） accompanied by portal vein tumor thrombus （PVTT） is generally poor if leo untreated： a median survival time of 2.7-4.0 mo has been reported. Furthermore, while transcatheter arterial chemoembolization （TACE） has been shown to be safe in selected patients, the median survival time with this treatment is still only 3.8-9.5 mo. Systemic single-agent chemotherapy for HCC with PVTT has failed to improve the prognosis, and the response rates have been less than 20%. While regional chemotherapy with low-dose cisplatin and 5-fluorouracil or interferon and 5-fluorouracil via hepatic arterial infusion has increased the response rate, the median survival time has not exceeded 12 （range 4.5-11.8） mo. Combined treatment consisting of radiation for PVTT and TACE for liver tumor has achieved a high response rate, but the median survival rates have still been only 3.8-10.7 mo. With hepatic resection as monotherapy, the 5-year survival rate and median survival time were reportedly 4%-28.5% and 6-14 mo. The most promising results were reported for combined treatments consisting of hepatectomy and TACE, chemotherapy, or internal radiation. The reported 5-year survival rates and median survival times were 42% and 31 mo for TACE followed by hepatectomy; 36.3% and 22.1 mo for hepatectomy followed by hepatic arterial infusion chemotherapy; and 56% for chemotherapy or internal radiation followed by hepatectomy.

关键词： hepatocellular carcinoma Portal vein tumor Thrombus Hepatic resection Transcatheter arterial chemoembolization Chemotherapy Radiation

General-motors diet: A quick fix for steatotic live liver donors

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iliver 2023年第3期2卷 151-155页

作者： Anish Gupta Abhideep Chaudhary Gaurav Sood Niteen Kumar Imtiakum Jamir Aditya Shriya Vipin Pal Singh Rekha Subramaniyam Hitesh Soni Milind Mandwar department of hepato-Pancreato-biliary surgery and liver transplantation BLK MAX Super Specialty HospitalNew DelhiIndia

Background and aims:GM(General-Motors)diet is a low-calorie 7-day diet plan using complex carbohydrates used for quick weight *** optimisation is known to decrease steatosis and improve outcomes in liver *** evaluated the efficacy and feasibility of using GM diet in steatotic live liver donors(LLD).Methods:LLDs who either had BMI>30 kg/m^(2),Computerised tomography liver attenuation index(CT-LAI)10%were started on GM diet for 1 *** of these LLDs and their recipients were retrieved retrospectively and ***,liver function tests(LFT),MR fat-frac-tion,CT-LAI,hospital-stay and complications were analysed in LLDs while early graft dysfunction(EGD)and complications were assessed in ***:A total of 51 LLDs with mean age of 34.6?9.5 years with baseline mean weight of 80.6±10.8 kg and BMI of 29.1±2.78 kg/m^(2) were started on GM *** a week of following the GM diet,there was an average weight loss of 3.46±2.1 kg,a decrease in fat-fraction by 3.8%±2.7,and an improvement in CT-LAI by 6.7?3.7 *** patients could successfully undergo donor hepatectomy with an average postoperative ICU stay of 2.86±0.8 days and hospital stay of 6.82?0.81 *** donor had steatosis>10% on intraoperative Tru-cut biopsy and their post-operative outcomes were similar to normal liver *** were intra-abdominal collections in 2 donors requiring drainage and one required re-exploration for intestinal *** was EGD in 8 recipients(15.6%)and mortality in 1(1.9%)***:GM diet is safe and effective regimen to reduce steatosis and increase healthy LLD pool without compromising donor or recipient safety.

关键词： Steatosis GM diet weight loss donor optimization LDLT donor hepatectomy donor outcomes