Theory of Relativity for Posterosuperior Segments of the Liver
- 21 Downloads
The accessibility to posterosuperior segments of the liver has traditionally constituted a restrain to adopt the laparoscopic approach in this setting. To overcome this challenge, multiple approaches have been reported in literature. Total transabdominal approach has been previously described for this purpose, even though the rationale to standardly adopt it and a technical depiction of how to achieve an optimal mobilization has never been specifically addressed.
Total transabdominal purely laparoscopic approach to posterosuperior segments of the liver is presented, with detailed emphasis to the rotational motions targeted in laparoscopy. A literature review is presented to summarize all other possible accesses to posterosuperior area of the liver. The institutional series for the laparoscopic approach to Sg 7, Sg 6+7, and Sg8 is retrospectively described.
Three rotational motions of the liver are specifically addressed in a video presentation and described for the laparoscopic total-transabdominal approach; the local institutional series using this approach is presented. Other miscellaneous approaches identified from literature encompassing variations in operative position, transabdominal, transthoracic, and combined approaches are described.
Complete mobilization of the ligaments of the liver leads to a rotation of the transection line in front of the operator’s view, allowing to achieve a safe total trans-abdominal laparoscopic approach to the posterosuperior ligaments of the liver, without compromising the vascular inflow control, the possibility to convert to open approach, nor requiring potentially harmful decubitus.
LA, GF: conception and design; FC, FR, GF, LC: acquisition of data; FR: data analysis and interpretation; GF, FR: manuscript writing; LA, MP, MC: critical review for intellectual content; GF, FR, FC, LC, MC, MP, LA: final approval. All authors are accountable for all aspects of the work and ensure proper investigation and resolution on any question related to the accuracy or the integrity of the manuscript.
The material has not been previously published or submitted elsewhere for publication and will not be sent to another journal until a decision is made concerning publication. All listed authors have participated in the study and have approved the final manuscript. There is no personal conflicts of interest or financial disclosure for any of the authors. The present study is not based on any previous communication to a society or a meeting.
Supplementary material 1 (MP4 132967 kb)
- 1.Okuno M, Goumard C, Mizuno T, Omichi K, Tzeng CD, Chun YS, Aloia TA, Fleming JB, Lee JE, Vauthey JN, Conrad C. Operative and short-term oncologic outcomes of laparoscopic versus open liver resection for colorectal liver metastases located in the posterosuperior liver: a propensity score matching analysis. Surg Endosc. 2018;32(4):1776–86. https://doi.org/10.1007/s00464-017-5861-x.CrossRefGoogle Scholar
- 3.D’Hondt M, Tamby E, Boscart I, Turcotte S, Parmentier I, Pottel H, Lapointe R, Ovaere S, Vansteenkiste F, Vandenbroucke-Menu F. Laparoscopic versus open parenchymal preserving liver resections in the posterosuperior segments: a case-matched study. Surg Endosc. 2018;32(3):1478–85. https://doi.org/10.1007/s00464-017-5835-z.CrossRefGoogle Scholar
- 4.Inoue Y, Suzuki Y, Fujii K, Kawaguchi N, Ishii M, Masubuchi S, Yamamoto M, Hirokawa F, Hayashi M, Uchiyama K. Laparoscopic liver resection using the lateral approach from intercostal ports in segments vi, vii, and viii. J Gastrointest Surg. 2017;21(12):2135–43. https://doi.org/10.1007/s11605-017-3516-9.CrossRefGoogle Scholar
- 5.Jin H, Yin Z, Zhou Y, Ma T, Jian Z. Safety and feasibility of a laparoscopy-assisted non-anatomic resection technique for hepatocellular carcinoma located at right posterior segments in cirrhotic patients: a case-controlled study with propensity score matching. Dig Surg. 2017. https://doi.org/10.1159/000480359.Google Scholar
- 7.Scuderi V, Barkhatov L, Montalti R, Ratti F, Cipriani F, Pardo F, Tranchart H, Dagher I, Rotellar F, Abu Hilal M, Edwin B, Vivarelli M, Aldrighetti L, Troisi RI. Outcome after laparoscopic and open resections of posterosuperior segments of the liver. Br J Surg. 2017;104(6):751–9. https://doi.org/10.1002/bjs.10489.CrossRefGoogle Scholar
- 10.Lee W, Han HS, Yoon YS, Cho JY, Choi Y, Shin HK, Jang JY, Choi H, Jang JS, Kwon SU. Comparison of laparoscopic liver resection for hepatocellular carcinoma located in the posterosuperior segments or anterolateral segments: a case-matched analysis. Surgery. 2016;160(5):1219–26. https://doi.org/10.1016/j.surg.2016.05.009.CrossRefGoogle Scholar
- 13.Giuliani A, Aldrighetti L, Di Benedetto F, Ettorre GM, Bianco P, Ratti F, Tarantino G, Santoro R, Felli E. Total abdominal approach for postero-superior segments (7, 8) in laparoscopic liver surgery: a multicentric experience. Updates Surg. 2015;67(2):169–75. https://doi.org/10.1007/s13304-015-0305-4.CrossRefGoogle Scholar
- 26.Abu Hilal M, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R, Aroori S, Belli G, Besselink M, Briceno J, Gayet B, D’Hondt M, Lesurtel M, Menon K, Lodge P, Rotellar F, Santoyo J, Scatton O, Soubrane O, Sutcliffe R, Van Dam R, White S, Halls MC, Cipriani F, Van der Poel M, Ciria R, Barkhatov L, Gomez-Luque Y, Ocana-Garcia S, Cook A, Buell J, Clavien PA, Dervenis C, Fusai G, Geller D, Lang H, Primrose J, Taylor M, Van Gulik T, Wakabayashi G, Asbun H, Cherqui D. The Southampton Consensus Guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. 2018;268(1):11–8. https://doi.org/10.1097/sla.0000000000002524.CrossRefGoogle Scholar