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SEGMENT ORIENTED  LIVER RESECTIONS I. Popescu CENTER OF GENERAL SURGERY AND LIVER TRANSPLANTATION  FUNDENI CLINICAL INSTITUTE BUCHAREST
[object Object],[object Object],[object Object],[object Object],[object Object]
 
1954 CLAUDE  COUINAUD
TYPES OF SEGMENT ORIENTED LIVER RESECTIONS ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Segment oriented liver resections have been promoted especially by French and Asian authors.  * * Castaing D, GArden OJ, Bismuth H. – Ann Surg 1989;  210: 20-23 Lui W et al. – Arch Surg 1995; 130: 1090-1097 Hasegawa H, Yamasaki S, Makuuchi M – J Chir Paris 1991; 128: 343-350 ,[object Object],[object Object],[object Object],[object Object],[object Object]
INDICA TIONS FOR SEGMENT ORIENTED LIVER RESECTIONS ,[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],OPERATION OBJECTIVES
1.01.1995 -  1 . 03 .200 3 569 hepatectomi es 552  patients 30 5   anatomical hepatectomies 137 segment  oriented resections
13 7  segment oriented  liver resections   11 9   non-cirrhotic patients 18  cirrhotic patients
SURGICAL TECHNIQUE ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Segmentectomi es
Segment I 8 cases
Hemangiom a
Segment I  – 8 cases ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Segment I I  – 1 case Metasta sis from colonic cancer
Segment III
Segment III –  5  ca ses Hepatocellular carcinoma associated with cirrhosis
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Segment III –  5  ca ses
Segment IV
Segment V 8 ca ses Hepatic adenoma
Segment V- 8 ca ses Indications Benign lesions 3 Inflammatory tumor 1 Focal nodular hyperplasia 1 Hepatic adenoma 1 Malignant lesions 5 Hepatocellular carcinoma 2 1 ci rrhosis Metasta sis from colon cancer 2 Metasta sis from breast cancer  1
Segment VI 1 case ,[object Object]
Segment V II  -  1 case Hemangioma
Segment VIII  -  3 ca ses FNH
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Segment VIII 3 ca ses
Bisegmentectomi es
Left lateral sectorectomy  (II, III) Intraparenchymal vascular approach
Extrahepatic vascular approach HCC with cirrhosis Left lateral sectorectomy  (II, III)
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Left lateral sectorectomy  (II, III)   64 cases
Laparoscopic resection  – 1 ca se Liver metastasis from breast cancer Left lateral sectorectomy
Harvesting of segments II-III from a living donor for a pediatric liver transplantation
Right lateral sectorectomy (VI, VII) 23 cases
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],Right lateral sectorectomy (VI, VII) 23 ca ses
Bisegmentectom y  IVb, V  5 ca ses Gallbladder  cancer  sta ge  II
Indica tions B enign  lesions 2 Hemangiom a 1 Hamartom a 1 Mal ign ant lesions 3 Gallbladder cancer 3 Bisegmentectom y  IVb, V – 5 ca ses
Right medial sectorectomy  (V, VIII)   1   case   Inflammatory tumor
Bisegmentectom y  V, VI – 9 ca ses Liver m etasta sis   from  colonic  cancer   S IV S VIII S IV S VIII
Bisegmentectom y  V, VI – 9 ca ses ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
Trisegmentectomi es
I nflam m ator y tumor with central necrosis located in  segment s  IV, V, VIII Total hepatic volume 1752,2 cm 3 Tumor volume 292  cm 3 3-D RECONSTRUCTION C entral  hepatectomy   3 ca ses 2 inflammatory tumors 1 metastasis from colonic cancer
 
 
Transverse hepatectomy  (IVb, V, VI) Gallbladder  cancer Sta ge  IVa 3 cases 2  gallbladder  cancer 1 metasta sis breast cancer
Sub segmentectom ies
Segment IV b – 2 cases 1  non-parasitic cyst 1  metastasis from breast cancer IVb IVb IVb IVb
[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],MORBIDITY  - 10%   ( 1 4/ 137 )
Morbidity  10% Mortality  0 Morbidity ,  mortality  0-7,6% Hemming A.W. – Am J Surg 1993; 165: 621-624 0 1 3 CH 0 0 3 TH 0 2 9 V, VI 0 0 5 IVb,V 0 0 1 RMS 0 5 23 RLS 0 3 64 LLS 0 0 1 II 0 1 3 VIII 0 0 1 VII 0 0 1 VI 0 0 8 V 0 0 2 IVb 0 0 5 III 0 2 8 I Deaths Complications Total Resection type
Conclusions ,[object Object],[object Object],[object Object],[object Object],[object Object],[object Object],[object Object]
[object Object],[object Object],[object Object],[object Object],[object Object],Conclusions
Segment oriented liver resections are well standardized operations, with a high level of difficulty but with proved benefits for the patient.  Conclusion

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15

  • 1. SEGMENT ORIENTED LIVER RESECTIONS I. Popescu CENTER OF GENERAL SURGERY AND LIVER TRANSPLANTATION FUNDENI CLINICAL INSTITUTE BUCHAREST
  • 2.
  • 3.  
  • 4. 1954 CLAUDE COUINAUD
  • 5.
  • 6.
  • 7.
  • 8. 1.01.1995 - 1 . 03 .200 3 569 hepatectomi es 552 patients 30 5 anatomical hepatectomies 137 segment oriented resections
  • 9. 13 7 segment oriented liver resections 11 9 non-cirrhotic patients 18 cirrhotic patients
  • 10.
  • 12. Segment I 8 cases
  • 14.
  • 15. Segment I I – 1 case Metasta sis from colonic cancer
  • 17. Segment III – 5 ca ses Hepatocellular carcinoma associated with cirrhosis
  • 18.
  • 20. Segment V 8 ca ses Hepatic adenoma
  • 21. Segment V- 8 ca ses Indications Benign lesions 3 Inflammatory tumor 1 Focal nodular hyperplasia 1 Hepatic adenoma 1 Malignant lesions 5 Hepatocellular carcinoma 2 1 ci rrhosis Metasta sis from colon cancer 2 Metasta sis from breast cancer 1
  • 22.
  • 23. Segment V II - 1 case Hemangioma
  • 24. Segment VIII - 3 ca ses FNH
  • 25.
  • 27. Left lateral sectorectomy (II, III) Intraparenchymal vascular approach
  • 28. Extrahepatic vascular approach HCC with cirrhosis Left lateral sectorectomy (II, III)
  • 29.
  • 30. Laparoscopic resection – 1 ca se Liver metastasis from breast cancer Left lateral sectorectomy
  • 31. Harvesting of segments II-III from a living donor for a pediatric liver transplantation
  • 32. Right lateral sectorectomy (VI, VII) 23 cases
  • 33.
  • 34. Bisegmentectom y IVb, V 5 ca ses Gallbladder cancer sta ge II
  • 35. Indica tions B enign lesions 2 Hemangiom a 1 Hamartom a 1 Mal ign ant lesions 3 Gallbladder cancer 3 Bisegmentectom y IVb, V – 5 ca ses
  • 36. Right medial sectorectomy (V, VIII) 1 case Inflammatory tumor
  • 37. Bisegmentectom y V, VI – 9 ca ses Liver m etasta sis from colonic cancer S IV S VIII S IV S VIII
  • 38.
  • 40. I nflam m ator y tumor with central necrosis located in segment s IV, V, VIII Total hepatic volume 1752,2 cm 3 Tumor volume 292 cm 3 3-D RECONSTRUCTION C entral hepatectomy 3 ca ses 2 inflammatory tumors 1 metastasis from colonic cancer
  • 41.  
  • 42.  
  • 43. Transverse hepatectomy (IVb, V, VI) Gallbladder cancer Sta ge IVa 3 cases 2 gallbladder cancer 1 metasta sis breast cancer
  • 45. Segment IV b – 2 cases 1 non-parasitic cyst 1 metastasis from breast cancer IVb IVb IVb IVb
  • 46.
  • 47. Morbidity 10% Mortality 0 Morbidity , mortality 0-7,6% Hemming A.W. – Am J Surg 1993; 165: 621-624 0 1 3 CH 0 0 3 TH 0 2 9 V, VI 0 0 5 IVb,V 0 0 1 RMS 0 5 23 RLS 0 3 64 LLS 0 0 1 II 0 1 3 VIII 0 0 1 VII 0 0 1 VI 0 0 8 V 0 0 2 IVb 0 0 5 III 0 2 8 I Deaths Complications Total Resection type
  • 48.
  • 49.
  • 50. Segment oriented liver resections are well standardized operations, with a high level of difficulty but with proved benefits for the patient. Conclusion

Notas del editor

  1. Este de obicei indicată pentru tumori cu această localizare. Alte indicaţii sunt tumorile cu extensie la acest nivel sau neoplasmul de căi biliare. Segmentectomia I este extrem de dificilă. Necesită de regulă EVT.
  2. Morbiditate: 2 Mortalitate: nulă Complicatii Abces cavitate restanta 1 Hemoperitoneu 1 – operat
  3. Fratila CHC, Martalogu Meta din leiomiosarcom, Pascu CHC si CH, Popa metastaza sarcom, Stanga CHH
  4. Morbiditate, mortalitate: nule
  5. Burduja, Ficu, Geadau, Gherghines, Licu, Mihai, Tapurica , Titioaca
  6. Burduja, Ficu, Geadau, Gherghines, Licu, Mihai, Tapurica, Titioaca Morbiditate, mortalitate: nule
  7. Soare Ion are caseta video
  8. Hemangiomul de anul asta facut de Doina
  9. Poleac, Rusu, Sendrescu HNF, CHC, Hemangiom (cu ligatura de v. hepatica dreapta)
  10. Morbiditate: 1 Mortalitate: 0
  11. Denumită şi lobectomia stâmgă Este una dintre cele mai frecvente rezecţii hepatice. Este o rezecţie facilă datorită demarcaţiei atât pe faţa diafragmatică a ficatului prin lig. Falciform, cât şi pe faţa viscerală prin fisura ombilicală.
  12. Morbiditate: 3 - tromboflebita 1, litiaza coledociana restanta, evisceratie blocata Mortalitate: nulă
  13. Inntroducere film
  14. Morbiditate : 5 Mortalitate : nulă Complicatii Hematom interhepatofrenic 1 – operat Abces subfrenic drept 3 Pleurezie bazala 1 - punctie
  15. Copaci Constanta, Baltes, Knizel, Lemac, Popa Ecaterina
  16. Morbiditate, mortalitate: nule
  17. RM, b, 47 ani
  18. Bejan, Bostan, Botel, Ciuperca, Glavan, Graur, Luncasu, Minica, Petrescu
  19. Bejan, Bostan, Botel, Ciuperca, Glavan, Graur, Luncasu, Minica, Petrescu Morbiditate: 2 Mortalitate: nulă Complicatii Abces subfrenic 2
  20. VI, b , 15 a ni Complicatie Abces subfrenic 1
  21. GR, f, 58 ani
  22. Micu Valerica (Chist hepatic tapetat cu epiteliu), Pur n ichi (Meta mamar) Morbiditate, mortalitate nule Subsegmentul IVb este cunoscut sub numele de lob pătrat. Are ca indicaţie particulară de rezecţie în tumorile Klatskin pentru a expune bifurcaţia canalelor biliare.
  23. hemoragie postoperatorie la nivelul tranşei hepatice 20 ( 4 %) colecţii subfrenice 17 ( 3 %) insuficienţă hepatică acută 19 ( 4 %) coleperitoneu 3 ( 0,6 %) hemoragie digestivă superioară 5 ( 1 %) peritonită (ascită infectată, postcolectomie) 3 ( 0,6 %) fistula biliară 11 ( 2 %) Abces subfrenic 1 icter mecanic 1 ( 0,2 %) hemoperitoneu de diverse cauze 2 ( 0,4 %) ocluzie intestinală 3 ( 0,6 %) complicaţii pulmonare 26 ( 5 %) tromboflebită membre inferioare 3 ( 0,6 %)