Glissonean Pedicle Transection Method For Hepatic Resection

This book presents a concept of hepatic segmentation with respect to the Glissonean pedicle tree. It also outlines surgical procedures for segmentectomy and cone-unit resection. Detailed illustrations depict every important action a surgeon must consider while performing these operations.

This book comprehensibly describes the clinical details of anatomic hepatic resection using the Glissonean pedicle approach for hepatocellular carcinoma. It includes all aspects of the surgical anatomy of the liver, preoperative management of patients, surgical techniques, and intraoperative key points to prevent postoperative complications. The first three chapters provide a general introduction to the clinical anatomy of the liver, preoperative management of patients with hepatocellular carcinoma, basic techniques for hepatic resection using the Glissonean approach, and the application of dye staining in anatomic hepatic resection. Subsequent chapters present the technical details of anatomical segmentectomy (Couinaud’s classification), sectionectomy and hemi-hepatectomy for hepatocellular carcinoma using the modified suprahilar Glissonean approach. All of these hepatectomies can be performed using simple and easily available surgical instruments. In addition, it discusses precise transection of the deepest hepatic parenchyma guided by methylene blue staining. It is a useful and timely reference for hepatobiliary surgeons, clinical staff, and medical students.

Aim of this book is to present the main minimally invasive approaches to the Glissonean pedicles. This kind of technique for hepatectomy has been gaining interest in recent years and may represent the ideal method to achieve anatomical liver resections. Currently the most performed procedure for liver surgery is still the classic intrafascial approach in which, after entering the Glissonean sheath, the portal triad elements are singularly dissected and isolated. However, this is a quite challenging technique to pursue in a minimally invasive setting. Nowadays the laparoscopic and robotic approach for liver resections are increasing worldwide and the intra or extra hepatic Glissonean approach, in which the portal triad elements are dissected and isolated “en bloc” without entering the Glissonean sheath, can facilitate the surgical technique. Furthermore this strategy allows better identification of the ischemic area and could decrease blood loss during dissection, as the liver inflow is kept under control. This book includes a step-by-step description of each pedicle isolation and section, with original laparoscopic and robotic pictures and videos. HPB surgeons who are interested in this technique may find these pages, written in cooperation with some of the most prominent worldwide experts, to be highly informative and valuable.

This book comprehensibly describes the clinical details of anatomic hepatic resection using the Glissonean pedicle approach for hepatocellular carcinoma. It includes all aspects of the surgical anatomy of the liver, preoperative management of patients, surgical techniques, and intraoperative key points to prevent postoperative complications. The first three chapters provide a general introduction to the clinical anatomy of the liver, preoperative management of patients with hepatocellular carcinoma, basic techniques for hepatic resection using the Glissonean approach, and the application of dye staining in anatomic hepatic resection. Subsequent chapters present the technical details of anatomical segmentectomy (Couinaud?s classification), sectionectomy and hemi-hepatectomy for hepatocellular carcinoma using the modified suprahilar Glissonean approach. All of these hepatectomies can be performed using simple and easily available surgical instruments. In addition, it discusses precise transection of the deepest hepatic parenchyma guided by methylene blue staining. It is a useful and timely reference for hepatobiliary surgeons, clinical staff, and medical students.

The objective of The Posterior Intrahepatic Approach in Liver Surgery is to describe techniques, as the more routine application today of split liver, living donor transplantation has continued to teach us more about the anatomy of the liver and its applications. Furthermore, laparoscopic surgery in general has grown space and it is important to show the application of the posterior approach in laparoscopic liver surgery as well.

This book describes the diagnoses; staging and management of patients with colorectal liver metastases initially considered unresectable and portrays the different strategies to increase resectability along with their tactics and tricks. Colorectal carcinoma is the third most commonly diagnosed cancer in the world and according to recent cancer statistics around 1.23 million patients are diagnosed each year. Of these patients, approximately 50% will develop liver metastases during the course of their disease and around 15-25% are found to have stage IV disease at diagnosis. Liver resection has been recognized as the treatment of choice for these patients, offering overall 5-year survival rates of up to 50-60% and the only hope for cure. However, at diagnosis only 10-20% of these patients are possibly amenable to surgical resection with curative intent. The possibility to achieve an R0 resection is many times limited by the amount and quality of the future liver remnant (FLR), being posthepatectomy liver failure (PHLF) the most feared and severe complication after major liver resections. With the years, diverse strategies have been developed with the intention to increase resectability by increasing the future liver remnant and/or reducing tumor size, e.g. ALPPS. Along with these techniques, associated surgeries are developed including multivisceral resections, which broadens even more the resectability for patients.

Ultrasound guidance of liver surgery is a very sophisticated approach that permits the performance of otherwise unfeasible operations, discloses the true extent of tumors, increases the indications for hepatectomy, and renders surgery safer. Despite this, it has remained relatively neglected in the literature over the past two decades, during which time much progress has been achieved. This is the first atlas on the subject, and it is comprehensive in scope. The state of the art in the use of ultrasound for resection guidance is carefully documented, and new techniques for exploration of the biliary tract and facilitation of transplant surgery are presented. Further important topics include the role of ultrasound in laparoscopic approaches, the use of contrast agents for diagnosis and staging, and developments in the planning of surgical strategy. The editor is a leading authority whose group has been responsible for a variety of advances in the field. He has brought together other experts whose aim throughout is to provide clear information and guidance on the optimal use of ultrasound when performing liver surgery. This atlas is intended especially for hepatobiliary surgeons but will also be of considerable value for general surgeons.

This unique textbook provides a concise and practical approach to clinical dilemmas involving the liver, pancreas, and biliary tree. Six major sections encompass (1) Hepatic, (2) Biliary, (3) Pancreas, (4) Transplantation, (5) Trauma, and (6) Innovative Technology. Each topic is written by recognized experts from an "e;experiential"e; viewpoint combined with evidence-based medicine. The book contains over 170 chapters and over 350 contributors. It is relevant to Surgical Oncologists, Hepato-Pancreato-Biliary (HPB) Surgeons, Transplant Surgeons, Traumatologists, HPB Interventionalists, General Surgeons, and trainees and students. The title of each chapter is in a form of a clinical scenario and each chapter begins with a Case Scenario and ends with Salient Points. Special debates are included in each section. There are numerous compelling images, detailed illustrations, comprehensive tables, thorough algorithms, and other adjunctive tools that enhance learning. The authors emanate from different corners of the world. The book is a valuable resource for faculty, students, surgical trainees, fellows, and all health care providers in the HPB/Trauma/Transplant/Oncology fields.