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Minimally Invasive Liver Resection
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Minimally Invasive Liver Resection

A special issue of Journal of Personalized Medicine (ISSN 2075-4426). This special issue belongs to the section "Methodology, Drug and Device Discovery".

Deadline for manuscript submissions: closed (20 October 2023) | Viewed by 7193

Special Issue Editor

Prof. Dr. Atsushi Sugioka

E-Mail Website
Guest Editor
Department of International Medical Center, Fujita Health University Hospital, Aichi, Japan
Interests: hepatobiliary and pancreatic surgery; laparoscopic liver resection; robot-assisted liver resection; Laennec’s capsule; repeat liver resection; hepatocellular carcinoma; metastatic liver tumor; liver transplantation

Special Issue Information

Dear Colleagues,

Minimally invasive surgery, including laparoscopic and robot-assisted approaches, has found application in almost all surgical fields. However, minimally invasive liver resection (MILR) has not yet been established due to the highly demanding techniques required, involving serious risk. It is clear that the precise model of liver anatomy based on Laennec’s capsule has led to the standardization of various procedures in MILR, and this has been expanded to include to anatomic liver resection, living liver transplantation, and perihilar malignancies. This Special Issue, in collaboration with the Journal of Personalized Medicine, will focus on anatomical and histological considerations, surgical techniques, and clinical outcomes of MILR, with the aim of promoting the widespread use of safe and curable MILR.

Prof. Dr. Atsushi Sugioka
Guest Editor

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Keywords

  • minimally invasive surgery
  • laparoscopic liver resection
  • robot-assisted liver resection
  • Laennec’s capsule
  • liver anatomy
  • anatomic liver resection
  • surgical technique

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Published Papers (4 papers)

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Research

13 pages, 2302 KiB  
Article
The First Prospective Study Investigating the Safety and Feasibility of a Spray-Type Adhesion Barrier (AdSpray™) in Minimally Invasive Hepatectomy: An Analysis of 124 Cases at Our Institution
by Masayuki Kojima, Atsushi Sugioka and Yutaro Kato
J. Pers. Med. 2024, 14(3), 309; https://doi.org/10.3390/jpm14030309 - 15 Mar 2024
Cited by 1 | Viewed by 1141
Abstract
(1) Background: With the increasing demand for repeat hepatectomy, preventing perihepatic adhesion formation following initial hepatectomy is crucial. Adhesion-preventative barriers, like the new spray-type AdSprayTM (Terumo Corporation, Tokyo, Japan), have been proposed to reduce adhesion risk. However, data on their safety in [...] Read more.
(1) Background: With the increasing demand for repeat hepatectomy, preventing perihepatic adhesion formation following initial hepatectomy is crucial. Adhesion-preventative barriers, like the new spray-type AdSprayTM (Terumo Corporation, Tokyo, Japan), have been proposed to reduce adhesion risk. However, data on their safety in minimally invasive hepatectomy (MIH) remain scarce. This is the first prospective study to evaluate the safety and feasibility of AdSprayTM in MIH. (2) Methods: A total of 124 patients who underwent MIH with AdSprayTM and 20 controls were analyzed. Subgroup analysis according to the AdSpray™ application area was conducted. Major complications were assessed using the Clavien–Dindo classification. Moreover, intraperitoneal pressure during AdSpray™ application was monitored in 20 cases. (3) Results: Major complications occurred in 6.4% of the patients, which was comparable to that in open hepatectomy. Intraperitoneal pressure remained stable below 12 mmHg during AdSpray™ application without any complications. No significant difference in complication rates was observed among subgroups. However, a potential increase in intra-abdominal abscess formation was suspected with AdSpray™ application to the resected liver surfaces. (4) Conclusions: AdSpray™ can be safely used in MIH; however, further research is needed to confirm the appropriacy of using AdSpray™, particularly over resected liver surfaces. Overall, AdSpray™ is a promising tool for enhancing the safety of MIH. Full article
(This article belongs to the Special Issue Minimally Invasive Liver Resection)
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10 pages, 886 KiB  
Article
Revisiting the Institut Mutualiste Montsouris Difficulty Classification of Laparoscopic Liver Resection with the Data from a Personal Series—Evaluations for the Difficulty of Left Medial Sectionectomy and Length of Hospital Stay
by Zenichi Morise
J. Pers. Med. 2024, 14(3), 232; https://doi.org/10.3390/jpm14030232 - 22 Feb 2024
Viewed by 1038
Abstract
The IMM (Institut Mutualiste Montsouris) difficulty classification for laparoscopic liver resection is based only on the type of surgical procedure. It is useful for assessing outcomes and setting benchmarks in a group sharing the same indications. There is, however, no left medial sectionectomy [...] Read more.
The IMM (Institut Mutualiste Montsouris) difficulty classification for laparoscopic liver resection is based only on the type of surgical procedure. It is useful for assessing outcomes and setting benchmarks in a group sharing the same indications. There is, however, no left medial sectionectomy in the system. Its difficulty was evaluated using the same methodology as IMM with the data from a personal series. Furthermore, length of hospital stay was evaluated as the representative of short-term outcomes. IMM scores of our right and left hemihepatectomies, right anterior sectionectomy, and segment 7 or 8 segmentectomies are 3. That of left medial sectionectomies is 2, the same as right posterior sectionectomy and segment or less anatomical resections. Those of left lateral sectionectomy and partial resection are 0. The group with a score of 3 was divided into two groups—with and without extended hospital stays (extended only for right hemihepatectomies and right anterior sectionectomies). The difficulty of medial sectionectomy was positioned at the same level as posterior sectionectomy and segment or less anatomical resections. The result from the second evaluation may indicate that there are other factors with an impact on difficulty related to short-term outcomes, other than intraoperative surgical difficulty from the procedure itself. Full article
(This article belongs to the Special Issue Minimally Invasive Liver Resection)
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14 pages, 2568 KiB  
Article
Glissonean Pedicle Isolation Focusing on the Laennec’s Capsule for Minimally Invasive Anatomical Liver Resection
by Mamoru Morimoto, Yoichi Matsuo, Keisuke Nonoyama, Yuki Denda, Hiromichi Murase, Tomokatsu Kato, Hiroyuki Imafuji, Kenta Saito and Shuji Takiguchi
J. Pers. Med. 2023, 13(7), 1154; https://doi.org/10.3390/jpm13071154 - 18 Jul 2023
Cited by 3 | Viewed by 2743
Abstract
Background: Inflow control is one of the most important procedures during anatomical liver resection (ALR), and Glissonean pedicle isolation (GPI) is one of the most efficacious methods used in laparoscopic anatomical liver resection (LALR). Recognition of the Laennec’s capsule covering the liver parenchyma [...] Read more.
Background: Inflow control is one of the most important procedures during anatomical liver resection (ALR), and Glissonean pedicle isolation (GPI) is one of the most efficacious methods used in laparoscopic anatomical liver resection (LALR). Recognition of the Laennec’s capsule covering the liver parenchyma is essential for safe and precise GPI. The purpose of this study was to verify identification of the Laennec’s capsule, to confirm the validity of GPI in minimally invasive surgery, and to demonstrate the value of GPI focusing on the Laennec’s capsule using a robotic system that has been developed in recent years. Methods: We used a cadaveric model to simulate the Glissonean pedicle and the surrounding liver parenchyma for pathologic verification of the layers. We performed 60 LALRs and 39 robotic anatomical liver resections (RALRs) using an extrahepatic Glissonean approach, from April 2020 to April 2023, and verified the layers of the specimens removed during LALR and RALR based on pathologic examination. In addition, the surgical outcomes of LALR and RALR were compared. Results: Histologic examination facilitated by Elastica van Gieson staining revealed the presence of Laennec’s capsule covering the liver parenchyma in a cadaveric model. Similar findings were obtained following LALR and RALR, thus confirming that the gap between the Glissonean pedicle and the Laennec’s capsule can be dissected without injury to the parenchyma. The mean GPI time was 32.9 and 27.2 min in LALR and RALR, respectively. The mean blood loss was 289.7 and 131.6 mL in LALR and RALR, respectively. There was no significant difference in the incidence of Clavien–Dindo grade ≥III complications between the two groups. Conclusions: Laennec’s capsule is the most important anatomical landmark in performing a safe and successful extrahepatic GPI. Based on this concept, it is possible for LALR and RALR to develop GPI focusing on the Laennec’s capsule. Furthermore, a robotic system has the potential to increase the safety and decrease the difficulty of this challenging procedure. Full article
(This article belongs to the Special Issue Minimally Invasive Liver Resection)
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Graphical abstract

10 pages, 9079 KiB  
Article
Hepatic Vein-Guided Approach in Laparoscopic Anatomic Liver Resection of the Ventral and Dorsal Parts of Segment 8
by Kazuteru Monden, Hiroshi Sadamori, Toshimitsu Iwasaki, Masayoshi Hioki and Norihisa Takakura
J. Pers. Med. 2023, 13(6), 1007; https://doi.org/10.3390/jpm13061007 - 17 Jun 2023
Cited by 1 | Viewed by 1739
Abstract
Laparoscopic ventral and dorsal segmentectomies 8 are an option for parenchymal-sparing liver resection. However, laparoscopic anatomic posterosuperior liver segment resection is technically demanding because of its deep location and the many variations in the segment 8 Glissonean pedicle (G8). In this study, we [...] Read more.
Laparoscopic ventral and dorsal segmentectomies 8 are an option for parenchymal-sparing liver resection. However, laparoscopic anatomic posterosuperior liver segment resection is technically demanding because of its deep location and the many variations in the segment 8 Glissonean pedicle (G8). In this study, we describe a hepatic vein-guided approach (HVGA) to overcome these limitations. For ventral segmentectomy 8, liver parenchymal transection was initiated at the ventral side of the middle hepatic vein (MHV) and continued exposing it toward the periphery. The G8 ventral branch (G8vent) was identified on the right side of the MHV. Following G8vent dissection, liver parenchymal transection was completed by connecting the demarcation line and G8vent stump. For dorsal segmentectomy 8, the anterior fissure vein (AFV) was exposed peripherally. The G8 dorsal branch (G8dor) was identified on the right side of the AFV. Following G8dor dissection, the right hepatic vein (RHV) was exposed from the root. Liver parenchymal transection was completed by connecting the demarcation line and RHV. Between April 2016 and December 2022, we performed laparoscopic ventral and dorsal segmentectomy 8 in fourteen patients. No complications (Clavien–Dindo classification, Grade ≥ IIIa) were observed. An HVGA is feasible and useful for standardizing safe laparoscopic ventral and dorsal segmentectomies 8. Full article
(This article belongs to the Special Issue Minimally Invasive Liver Resection)
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