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Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS

In-situ splitting of the liver before extended resection has gained broad attention. This two-step procedure requires several measures to make an effective and safe procedure. Although the procedure is performed in many institutions, there is no consensus on a uniform technique. The two steps can be...

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Autores principales: Alexander, Andrea, Lehwald-Tywuschik, Nadja, Rehders, Alexander, Dizdar, Levent, Fluegen, Georg, Safi, Sami Alexander, Knoefel, Wolfram Trudo
Formato: Online Artículo Texto
Lenguaje:English
Publicado: MDPI 2023
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046923/
https://www.ncbi.nlm.nih.gov/pubmed/36975462
http://dx.doi.org/10.3390/curroncol30030249
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author Alexander, Andrea
Lehwald-Tywuschik, Nadja
Rehders, Alexander
Dizdar, Levent
Fluegen, Georg
Safi, Sami Alexander
Knoefel, Wolfram Trudo
author_facet Alexander, Andrea
Lehwald-Tywuschik, Nadja
Rehders, Alexander
Dizdar, Levent
Fluegen, Georg
Safi, Sami Alexander
Knoefel, Wolfram Trudo
author_sort Alexander, Andrea
collection PubMed
description In-situ splitting of the liver before extended resection has gained broad attention. This two-step procedure requires several measures to make an effective and safe procedure. Although the procedure is performed in many institutions, there is no consensus on a uniform technique. The two steps can be divided into different parts and a standardized technique may render the procedure safer and the results will be easier to evaluate. In this paper, we describe a detailed approach to in-situ splitting that allows making both procedures safe, avoids liver necrosis, and is easily reproducible. In the first procedure the portal branches to segments I and IV to VIII are divided, the arterial branches and bile ducts to these segments are preserved and encircled and the parenchyma between segments II/III and IVa/b is divided. This avoids necrosis and bile leaks of segments I and IV and avoids urgent completion operations. In particular, the handling of vital structures close to the dissection line seems important to us. Complete splitting and securing the right and middle hepatic vein will make the second step of this procedure a minimal-risk procedure at a stage where the patient is still recovering from the more demanding first step.
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spelling pubmed-100469232023-03-29 Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS Alexander, Andrea Lehwald-Tywuschik, Nadja Rehders, Alexander Dizdar, Levent Fluegen, Georg Safi, Sami Alexander Knoefel, Wolfram Trudo Curr Oncol Technical Note In-situ splitting of the liver before extended resection has gained broad attention. This two-step procedure requires several measures to make an effective and safe procedure. Although the procedure is performed in many institutions, there is no consensus on a uniform technique. The two steps can be divided into different parts and a standardized technique may render the procedure safer and the results will be easier to evaluate. In this paper, we describe a detailed approach to in-situ splitting that allows making both procedures safe, avoids liver necrosis, and is easily reproducible. In the first procedure the portal branches to segments I and IV to VIII are divided, the arterial branches and bile ducts to these segments are preserved and encircled and the parenchyma between segments II/III and IVa/b is divided. This avoids necrosis and bile leaks of segments I and IV and avoids urgent completion operations. In particular, the handling of vital structures close to the dissection line seems important to us. Complete splitting and securing the right and middle hepatic vein will make the second step of this procedure a minimal-risk procedure at a stage where the patient is still recovering from the more demanding first step. MDPI 2023-03-13 /pmc/articles/PMC10046923/ /pubmed/36975462 http://dx.doi.org/10.3390/curroncol30030249 Text en © 2023 by the authors. https://creativecommons.org/licenses/by/4.0/Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https://creativecommons.org/licenses/by/4.0/).
spellingShingle Technical Note
Alexander, Andrea
Lehwald-Tywuschik, Nadja
Rehders, Alexander
Dizdar, Levent
Fluegen, Georg
Safi, Sami Alexander
Knoefel, Wolfram Trudo
Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS
title Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS
title_full Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS
title_fullStr Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS
title_full_unstemmed Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS
title_short Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe—A Standardized Approach to ISLT or ALPPS
title_sort optimizing growth of the future liver remnant and making in-situ liver transsection safe—a standardized approach to islt or alpps
topic Technical Note
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC10046923/
https://www.ncbi.nlm.nih.gov/pubmed/36975462
http://dx.doi.org/10.3390/curroncol30030249
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