Anatomical Right Posterior Sectionectomy of the Liver by IOUS-Guided Finger Compression
Study Details
Study Description
Brief Summary
The use of intraoperative ultrasound (IOUS) allows us to perform new conservative hepatectomies. The investigators previously reported the systematic subsegmentectomy by IOUS-guided finger compression for segments 2-3, which is currently applied for patients with hepatocellular carcinoma (HCC)on cirrhosis. The investigators herein describe a novel technique, which consists in the systematic right posterior sectionectomy by IOUS-guided finger compression.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
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Detailed Description
A novel technique for the demarcation of the resection area by means of IOUS-guided finger compression to accomplish a right posterior sectionectomy is described. Dissection or encirclement of the sectional pedicles for resection area demarcation is thus avoided. Ten patients underwent this technique successfully without mortality or major morbidity. IOUS-guided finger compression of sectional portal pedicle feeding the right posterior section is a feasible, safe, and effective method.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Right posterior section group Patients with tumors in the right posterior section of the liver (segments 6-7) |
Procedure: Anatomical right posterior sectionectomy of the liver by IOUS-guided finger compression.
The technique consists in IOUS-guided finger compression of the right posterior portal pedicle at the level closest to the tumor but oncologically suitable. This method allows us to anatomically mark the area of resection with nor hilar plate nor IOUS-guided puncture of vessels, which are up to date the only two techniques available to perform anatomical right posterior sectionectomy - namely the removal of segment 6 and 7.
Other Names:
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Outcome Measures
Primary Outcome Measures
- The primary outcome is the safety of the anatomical right posterior sectionectomy performed IOUS-guided finger compression. [6 months]
Secondary Outcome Measures
- The secondary outcome is the efficacy of the anatomical right posterior sectionectomy performed by IOUS-guided finger compression. [1 year]
Eligibility Criteria
Criteria
Inclusion Criteria:
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Patients with tumors at least at 1 cm distally to the bifurcation of the right portal vein (bifurcation of P5-8 and P6-7) eligible for right posterior sectionectomy, namely the anatomical removal of segment 6 and 7, were considered potential candidates to this procedure. Precisely, these criteria were adopted:
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Patients with hepatocellular carcinoma (HCC) with infiltrative growing pattern in contact with P6-7;
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Patients with any type of HCC in contact with P6-7 with distal bile duct dilation;
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Patients with colorectal liver metastasis (CLM) in contact with P6-7.
Exclusion Criteria:
- Exclusion criteria for carrying out the herein described procedure was considered the presence of tumoral thrombosis in P6-7.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | University of Milan School of Medicine, IRCCS Istituto Clinico Humanitas | Rozzano | Milan | Italy | 20089 |
Sponsors and Collaborators
- University of Milan
Investigators
- Principal Investigator: Guido Torzilli, MD, PhD, University of Milan School of Medicine, IRCCS Istituto Clinico Humanitas
Study Documents (Full-Text)
None provided.More Information
Publications
- Launois B, Jamieson GG. The posterior intrahepatic approach for hepatectomy or removal of segments of the liver. Surg Gynecol Obstet. 1992 Feb;174(2):155-8.
- Makuuchi M, Hasegawa H, Yamazaki S. Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet. 1985 Oct;161(4):346-50.
- Takasaki K, Kobayashi S, Tanaka S, Saito A, Yamamoto M, Hanyu F. Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg. 1990 Apr-Jun;75(2):73-7.
- Torzilli G, Donadon M, Marconi M, Botea F, Palmisano A, Del Fabbro D, Procopio F, Montorsi M. Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Ann Surg. 2008 Apr;247(4):603-11. doi: 10.1097/SLA.0b013e31816387d7.
- Torzilli G, Donadon M, Montorsi M. The surgical margin in liver resection for hepatocellular carcinoma: a real problem or not? Ann Surg. 2007 Oct;246(4):690-1; author reply 691-2.
- Torzilli G, Makuuchi M. Ultrasound-guided finger compression in liver subsegmentectomy for hepatocellular carcinoma. Surg Endosc. 2004 Jan;18(1):136-9. Epub 2003 Nov 21.
- Torzilli G, Montorsi M, Del Fabbro D, Palmisano A, Donadon M, Makuuchi M. Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence. Br J Surg. 2006 Oct;93(10):1238-46.
- Torzilli G, Montorsi M, Donadon M, Palmisano A, Del Fabbro D, Gambetti A, Olivari N, Makuuchi M. "Radical but conservative" is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg. 2005 Oct;201(4):517-28.
- IOUS-Compression