Journal of hepato-biliary-pancreatic sciences
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J Hepatobiliary Pancreat Sci · Feb 2013
ReviewThe learning curve in laparoscopic major liver resection.
Laparoscopic major hepatectomy remains a relatively rare operation because it is a difficult and technically demanding procedure, and a standard, safe, reproducible technique has not been widely adopted. This is compounded by "major hepatectomy" encompassing multiple different operations each with their own anatomic and procedural considerations. In 2010, we investigated our learning curve for laparoscopic liver resection. ⋯ An environment with colleagues willing to share their acquired proficiency allows the surgeon to observe and critique his or her performance against colleagues. Also, the guidance of like-minded surgeons supports technical development and improved outcomes. In conclusion, steady progress can be made along the learning curve through committed practice of increasingly complex tasks and with proper coaching in a high-volume environment.
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J Hepatobiliary Pancreat Sci · Feb 2013
ReviewGas embolism in laparoscopic hepatectomy: what is the optimal pneumoperitoneal pressure for laparoscopic major hepatectomy?
Laparoscopic hepatectomy (LH) has become popular as a surgical treatment for liver diseases, and numerous recent studies indicate that it is safe and has advantages in selected patients. Because of the magnified view offered by the laparoscope under pneumoperitoneal pressure, LH results in less bleeding than open laparotomy. ⋯ At many high-volume centers, LH is performed at a pneumoperitoneal pressure less than 12 mmHg, and reports indicate that the rate of clinically severe gas embolism is low. However, more studies will be necessary to elucidate the optimal pneumoperitoneal pressure and the incidence of gas embolism during LH.
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J Hepatobiliary Pancreat Sci · Feb 2013
ReviewRobot-assisted surgery: improved tool for major liver resections?
Minimally invasive liver surgery has recently undergone an explosion in reported worldwide experience. Given its comparable outcomes to its open counterpart, high-volume centers are utilizing minimal access liver surgery more frequently under well-defined criteria. The recent introduction of robot-assisted surgery has further revolutionized the field of minimally invasive surgery and has expanded the reach of feasibility. ⋯ Outcomes indicate that robot-assisted liver resection is feasible and safe for both minor and major liver resections with regard to estimated blood loss, length of stay, and complications. Early data also suggest that robot-assisted liver surgery is efficacious with regard to short-term oncologic outcomes. Future studies will be needed to better evaluate advantages and disadvantages compared to laparoscopic liver resections.
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J Hepatobiliary Pancreat Sci · Feb 2013
Multicenter StudyImpact of hybrid techniques on laparoscopic major hepatectomies.
To assess the types of liver resection, surgical approaches, and surgical outcomes, a questionnaire survey was undertaken at 32 member hospitals of the Japanese Endoscopic Liver Study Group. ⋯ In conclusion, a major hepatectomy using a hybrid technique is safe and feasible.
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J Hepatobiliary Pancreat Sci · Feb 2013
Comparative StudyRisk factors for organ/space surgical site infection after hepatectomy for hepatocellular carcinoma in 359 recent cases.
Surgical site infections (SSIs), particularly organ/space SSIs, remain a common cause of major morbidity after hepatectomy for hepatocellular carcinoma (HCC). ⋯ Repeat hepatectomy and bile leakage represent independent risk factors for organ/space SSIs after hepatectomy for HCC. Establishing treatment strategies is important for preventing postoperative bile leakage and reducing the high rate of organ/space SSIs after repeat hepatectomy.