ObjectiveTo investigate the clinical application value of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein.MethodsClinical data of 8 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein in Xinqiao Hospital from May 2017 to December 2019 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, and hospitalization duration were observed.ResultsAll patients were confirmed by pathology, the postoperative pathological results showed that: hepatocellular carcinoma was found in 6 patients, mixed hepatocellular carcinoma and cholangiocarcinoma was found in 2 patients. All patients completed the operation successfully without conversion to open surgery. The median operation time was 220 min (190-240 min), median blood loss was 230 mL (200-280 mL), and blood transfusion was not needed. The postoperative median hospital stay was 8 d (7–12 d). All the patients recovered well without severe complications. Eight patients were followed up for 10.5 to 31.7 months, with a median follow-up time of 16.9 months. During the follow-up period, none of them developed hemorrhage, bile leakage, and other complications. There was no reoperation or perioperative mortality during the follow-up.ConclusionsThe method of laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein is safe and effective. This method can shorten the operation time, improve the safety, and reduce the difficulty of operation.
ObjectiveTo investigate the clinical value of three-dimensional reconstruction of liver and resection of hepatocellular carcinoma with indocyanine green (ICG) fluorescence staining. MethodsClinical data of a patient with hepatocellular carcinoma admitted to the Department of Liver Surgery of West China Hospital of Sichuan University in May 2021 were retrospectively collected. In this patient, intrahepatic vascular reconstruction was performed by SYNAPSE 3D software of Japan before operation, and the portal vein and hepatic vein corresponding to the tumor were analyzed to simulate the resection range. Intraoperative ICG fluorescence staining was used to perform laparoscopic resection of segment Ⅳ of the liver.ResultsIn this patient, the fluorescence boundary on the liver surface was clear after staining, and the intrahepatic segment fluorescence interface could still be maintained in the hepatic parenchyma dissociation, and the resection of the liver segment was consistent with the preoperative three-dimensional reconstruction plan. The operation took 230 min in total, and the bleeding was about 200 mL. On the first day after the operation, blood biochemical test showed that the plasma albumin was slightly low, and no obvious abnormalities were observed in transaminase, bilirubin, etc. After the infusion of human albumin, the indexes returned to normal, and the patient recovered and was discharged on the fourth day after the operation. No complications occurred after the operation, and no tumor recurrence and metastasis were observed during follow-up period. Conclusion3D reconstruction and ICG fluorescence guidance are safe and feasible for the treatment of hepatocellular carcinoma after laparoscopic anatomic segment Ⅳ resection, and the positive staining method of ICG fluorescence segment is recommended.
ObjectiveTo explore the clinical value and experience of enhanced recovery after surgery (ERAS) of “LEER” model with “less pain” “early move” “early eat” and “reassuring” as its ultimate goal in perioperative period of laparoscopic anatomical hepatectomy of patients with primary liver cancer.MethodsThe basic clinical data of 98 patients treated in our department from May 2017 to March 2020 who were diagnosed as primary liver cancer and underwent laparoscopic anatomical hepatectomy were retrospectively analyzed. The incidence of postoperative complications, postoperative recovery and patients’ satisfaction were compared between 40 patients managed with traditional model (traditional group) and 58 patients managed with measures of ERAS of “LEER” model (“LEER”-ERAS group).ResultsCompared with the traditional group, the “LEER”-ERAS group had lower postoperative pain scores (t=2.925, P=0.004), earlier postoperative anal exhaustion, bowel movement and normal diet (t=3.071, t=3.770, t=3.232, all P<0.005) , shorter time to postoperative off-bed activity (t=5.025, P<0.001) and earlier postoperative removal time of drainage tube (t=3.232, P=0.001). Postoperative hospital stay was shorter (t=4.831, P<0.001), the cost of hospitalization was lower (t=3.062, P=0.003), and the patient’s satisfaction with medical treatment was higher (χ2=9.267, P=0.002). There were no statistical difference in the operative time, intraoperative blood loss, rate of conversion to laparotomy, blocking time of porta hepatis, postoperative complications and postoperative adverse events between the two groups (P>0.05).ConclusionsCompared with the traditional model, the measures of ERAS of “LEER” model that applied to laparoscopic anatomical hepatectomy of patients with primary liver cancer, is safe and effective, and can relieve postoperative pain, accelerate postoperative rehabilitation, improve satisfaction of patients, shorten hospital stay, and reduce medical costs. It has further promotion and research value.
With advancements in the concepts and techniques of liver cancer treatment, surgical management of liver cancer is advancing toward greater precision and individualization. This article systematically reviews the development of precision surgery for liver cancer, with a focus on the modern concept of anatomical liver resection based on portal vein watershed anatomy and liver segmentation. It evaluates the application and value of key technologies such as fluorescence navigation, hepatic segment blood flow control, and robotic surgery, and discusses the “dual-conversion therapy” strategy for unresectable liver cancer. This work provides theoretical insights and practical guidance for the precision and innovation of surgical treatment in liver cancer.
ObjectiveTo evaluate the safety and efficacy of extra-sheath dissection via the Laennec membrane space combined with indocyanine green (ICG) fluorescence navigation in laparoscopic anatomic hepatectomy. MethodsA retrospective analysis was conducted on the clinical data of hepatocellular carcinoma patients who underwent laparoscopic anatomic hepatectomy at Leshan People’s Hospital between January 2022 and September 2025. The study group comprised patients who underwent the extra-sheath anatomical approach via the Laennec’s capsule space combined with ICG fluorescence navigation, while the control group consisted of patients who underwent the conventional intra-sheath Glissonean pedicle transection approach combined with intraoperative ultrasound. ResultsA total of 113 patients were included in this study, including 54 cases in the study group and 59 cases in the control group. Intraoperative blood loss [MD=–139.88 mL, 95%CI (–229.51, –50.25) mL], number of drainage tubes × drainage tube indwelling time [MD=–2.00 (tubes×d), 95%CI (–4.00, 0.00) (tubes×d)], postoperative ambulation time [MD=–0.58 d, 95%CI (–0.94, –0.22) d], alanine aminotransferase level on postoperative day 1 [MD=–129.83 U/L, 95%CI (–259.96, –5.71) U/L], aspartate aminotransferase level on postoperative day 1 [MD=–131.09 U/L, 95%CI (–259.12, –3.06) U/L], albumin level on postoperative day 1 [MD=1.64 g/L, 95%CI (0.21, 3.06) g/L], and hospitalization cost [MD=–5 523.10 yuan, 95%CI (–10 572.42, –471.77) yuan] of the study group were all better than those in the control group (P< 0.05). ConclusionExtra-sheath dissection via the Laennec membrane space combined with ICG fluorescence navigation can improve the safety and efficacy of laparoscopic anatomical hepatectomy, and is worthy to explore further its clinical application value.
