Dados do Trabalho

Título

LAPAROSCOPIC PARENCHYMAL-SPARING HEPATECTOMY

Introdução

SURGICAL TECHNIQUES AND STRATEGIES HAVE BEEN IMPROVED OVER DECADES. INCREASED ANATOMICAL KNOWLEDGE OF THE LIVER AND INTRAOPERATIVE ULTRASOUND PROVIDED HEPATIC RESECTIONS WITH ACCEPTABLE MORBIDITY AND MORTALITY. AS THESE VARIABLES ARE RELATED TO THE REMAINING VOLUME, RESECTION THAT PRESERVES THE GLISSONIAN STRUCTURES PROVIDES A BETTER IMMEDIATE AND LONG-TERM RESULT.
PARENCHYMAL-SPARING HEPATECTOMIES (PSH) ARE LIVER RESECTIONS WITH PRESERVATION OF AS MUCH LIVER PARENCHYMA AS POSSIBLE, WHOSE THE MOST COMMON INDICATION IS COLORRETAL LIVER METASTASIS, FOLLOWED BY HEPATOCELLULAR CARCINOMA. IT CAN BE PERFORMED BY LAPAROSCOPICALLY AND DUE TO INFEROCAUDAL PERSPECTIVE, LAPAROSCOPIC LIVER RESSECTIONS ARE EASIER FOR LESIONS LOCATED IN SEGMENTS 3, 4B, 5 AND 6 WHILE LAPAROSCOPIC RESECTIONS OF LESIONS IN THE THREE POSTEROSUPERIOR SEGMENTS (4A, 7 AND 8) AND IN SEGMENT 1 ARE TECHNICALLY CHALLENGING, SPECIALLY WHEN THERE ARE MULTIPLE BILOBAR LESIONS. BESIDES THAT THE PROCEDURE MAY REQUISE REPOSITIONING AND MAY BE LONG AND BORING.

Objetivo

WE AIM TO DEMONSTRATE THE FEASIBILITY AND BENEFITS OF PERFORMING A LAPAROSCOPIC PSH (LPSH)

Casuística

ILLUSTRATION OF 4 LPSH IN GROWING LEVEL OF DIFFICULTY PERFORMED IN AN ONCOLOGY CENTER

Método

SURGICAL VIDEO EDITING

Resultados

IN THIS VIDEO WE FIRST SHOW A LPSH SEGMENT VIII, FOLLOWED BY A LPSH SEGMENTS IVB +V, LEFT LATERAL SECTIONECTOMY + LPSH SEGMENT IVA/VIII AND A LPSH SEGMENTS V/VII, IVA, II/III.

Conclusões

LAPAROSCOPIC HEPATECTOMY IS AS ONCOLOGIC SAFE AS AN OPEN RESECTION AND ALLOW LOWER BLOOD LOSS, SHORTER LENGHT OF STAY, LESS PAIN AND FASTER RECOVERY. THE COMBINATION OF PSH WITH LAPAROSCOPIC APROACH CAN IMPROVE OVERALL SURVIVAL IN NEOPLASMS WITH HIGH RATE OF LIVER RECURRENCE.

Palavras-chave

LAPAROSCOPIC PARENCHYMAL-SPARING HEPATECTOMY
PARENCHYMAL-SPARING LIVER SURGERY

Área

Fígado