Cargando…
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...
Autores principales: | , , , , , , |
---|---|
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 |
_version_ | 1785013793466613760 |
---|---|
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. |
format | Online Article Text |
id | pubmed-10046923 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2023 |
publisher | MDPI |
record_format | MEDLINE/PubMed |
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 |
work_keys_str_mv | AT alexanderandrea optimizinggrowthofthefutureliverremnantandmakinginsitulivertranssectionsafeastandardizedapproachtoisltoralpps AT lehwaldtywuschiknadja optimizinggrowthofthefutureliverremnantandmakinginsitulivertranssectionsafeastandardizedapproachtoisltoralpps AT rehdersalexander optimizinggrowthofthefutureliverremnantandmakinginsitulivertranssectionsafeastandardizedapproachtoisltoralpps AT dizdarlevent optimizinggrowthofthefutureliverremnantandmakinginsitulivertranssectionsafeastandardizedapproachtoisltoralpps AT fluegengeorg optimizinggrowthofthefutureliverremnantandmakinginsitulivertranssectionsafeastandardizedapproachtoisltoralpps AT safisamialexander optimizinggrowthofthefutureliverremnantandmakinginsitulivertranssectionsafeastandardizedapproachtoisltoralpps AT knoefelwolframtrudo optimizinggrowthofthefutureliverremnantandmakinginsitulivertranssectionsafeastandardizedapproachtoisltoralpps |