Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

Haopeng Wen; Nan Cheng; Jiancheng Tang; Songhang Liu; Hongbin Zhou; Xinyu Li; Liangqi Cao

doi:10.3791/64675

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

JoVE Journal
Cancer Research
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JoVE Journal Cancer Research

Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy

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04:41 min

March 10, 2023

DOI: 10.3791/64675-v

Haopeng Wen*¹, Nan Cheng*¹, Jiancheng Tang*¹, Songhang Liu¹, Hongbin Zhou¹, Xinyu Li¹, Liangqi Cao¹

¹Department of Hepatobiliary Surgery,the Second Affiliated Hospital of Guangzhou Medical University

Overview

This study presents an innovative laparoscopic hepatectomy technique that combines the en bloc concept with anatomic resection. This method aims to enhance R0 resection rates while minimizing postoperative complications and recurrence.

Key Study Components

Area of Science

Minimally invasive surgery
Hepatic resection
Oncology

Background

Anatomic resection has shown advantages in surgical outcomes.
The effectiveness of anatomic resection in increasing R0 resection rates is debated.
Postoperative recurrence and metastasis remain significant concerns in liver surgeries.
Innovative surgical techniques are needed to improve patient outcomes.

Purpose of Study

To describe a new laparoscopic technique that combines en bloc resection with anatomic principles.
To maximize R0 resection rates and minimize complications.
To provide a detailed procedural guide for implementing this technique.

Methods Used

Minimally invasive surgical approach.
Use of harmonic scalpel for dissection.
Ligation of cystic duct and artery with hemostatic clips.
Training recommendations for surgeons transitioning from open to laparoscopic techniques.

Main Results

The technique facilitates obtaining wide negative margins.
It reduces the risk of tumor tissue spread during surgery.
Postoperative outcomes show a decrease in complications.
Applicable for resection of multiple liver segments.

Conclusions

This innovative laparoscopic method may improve surgical outcomes in liver resections.
Further studies are needed to validate the effectiveness of this approach.
Surgeons should receive appropriate training to ensure successful implementation.

Frequently Asked Questions

What is the main advantage of this surgical technique?

The technique allows for easier acquisition of wide negative margins and reduces the spread of tumor tissue.

How does this method impact R0 resection rates?

It aims to maximize R0 resection rates, potentially leading to better patient outcomes.

What training is recommended for surgeons?

Surgeons should have appropriate training in open surgeries to effectively perform this laparoscopic technique.

What tools are used in this procedure?

A harmonic scalpel is used for dissection, along with medium-sized hemostatic clips for ligation.

How many liver segments can be resected using this method?

This technique can be used for resection of four to five liver segments.

What are the postoperative benefits of this technique?

It reduces perioperative complications and the risk of postoperative recurrence and metastasis.

Numerous studies have demonstrated the advantages of anatomic resection. Nonetheless, whether anatomic resection can increase R0 resection rates remains controversial. Consequently, the present study describes an innovative procedure involving the en bloc concept combined with anatomic resection in laparoscopic hepatectomy, which can reduce postoperative recurrence and metastasis.

With this minimally invasive method obtaining a wide range of negative margins is easier and avoids the spread of tumor tissue. This method helps in maximizing R0 resection, and avoiding perioperative complications. This technique can be used in laparoscopic hepatic resection surgeries involving resection of four to five segments.

Because this minimally invasive surgical method requires experience in open surgeries, appropriate open surgery training is recommended. After preparing the patient for the procedure, pull the fundus of the gallbladder upward, and use a harmonic scalpel for Calot's Triangle Dissociation. Take care to ligate the cystic duct and artery with medium-sized hemostatic clips.

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