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Файл:Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_794_Библиотеки_им_академика_М_И_Перельмана.pdf
Chapter • Robotic-Assisted Minimally Invasive Esophagectomy (RAMIE): Ivor Lewis
Step6 (continued)
. Fig.38.10
Immediate Postoperative Care
Patients are extubated in the operating room and remain overnight in a step-down unit. Early
ambulation on postoperative day1 is routine. Tube feeding is begun on postoperative day2 and
is slowly advanced. Nasogastric tubes are le in place for 5 to 7days. Upon removal of the nasogastric tubes, an esophagram is performed to assess for anastomotic leak, and a liquid diet is
begun. Patients are typically discharged on day7, with cycled tube feeding and a graded schedule
of advancement to a mechanical so diet without tube feeding. e perianastomotic Jackson-Pratt
drain and the feeding jejunostomy are usually removed at the rst postoperative clinic visit, which
occurs 2 to 3weeks aer discharge.
Liver
Pierre-Alain Clavien, Yuman Fong
Chapter 39 Introduction: Liver – 347
Pierre-Alain Clavien, Yuman Fong
Chapter 40 Terminology of Liver Anatomy and Resections:
The Brisbane 2000 Terminology – 349
Steven M. Strasberg
Chapter 41 Techniques of Vascular Clamping, Vascular Exclusion,
and Caval Resection in Liver Surgery – 353
Përparim Limani, Mickaël Lesurtel
III
Chapter 42 Hanging Maneuver for Anatomic Hemihepatectomy
(Including Living-Donor Liver Transplantation) – 363
Jacques Belghiti
Chapter 43 Anterior Approach for Liver Resections – 367
See Ching Chan, Sheung Tat Fan
Chapter 44 Techniques of Liver Parenchyma Transection – 377
Christoph Tschuor, Mickaël Lesurtel
Chapter 45 Liver Resections – 385
Dimitri A. Raptis, Pierre-Alain Clavien
Chapter 46 Right Hemihepatectomy – 387
Christoph Tschuor, Pierre-Alain Clavien
Chapter 47 Left Hemihepatectomy – 397
Christopher Soll, Pierre-Alain Clavien
Chapter 48 Extended Hemihepatectomy – 405
Stefan Heinrich, Pierre-Alain Clavien
Chapter 49 Segmentectomies, Sectionectomies,
and Wedge Resections – 413
Norihiro Kokudo, Masatoshi Makuuchi
Chapter 50 Laparoscopic Liver Resection – 429
Michael D. Kluger, Daniel Cherqui
Chapter 51 Cryosurgery – 441
Keh Min Ng, DavidL. Morris
Chapter 52 ALPPS (Associating Liver Partition with Portal Vein
Ligation for Staged Hepatectomy) – 447
Erik Schadde, Pierre-Alain Clavien
Chapter 53 Ablation Therapy of Liver Tumors – 457
Michael A. Choti, MichelleL. de Oliveira
Chapter 54 Selective Hepatic Intra-arterial Chemotherapy – 469
Diane Goéré, Dominique Elias
Chapter 55 Unroong and Resection for Benign
Nonparasitic Liver Cysts – 477
Juan M. Sarmiento, David M. Nagorney
Chapter 56 Pericystectomy for Hydatid Liver Cyst – 483
Lucas McCormack
Chapter 57 Special Maneuvers in Liver Trauma – 487
Denis Castaing, Olivier Scatton, Antonio Sa Cunha, Marius Keel
Chapter 58 Robotic Hepatectomy – 497
Hari Nathan, Yuman Fong
Chapter 59 Technique of Multi-Organ Procurement
(Liver, Pancreas, and Intestine) – 507
Jan Lerut, Michel Mourad, Tom Darius
Chapter 60 Orthotopic Liver Transplantation – 519
Jan Lerut, Robert J. Porte, Philipp Dutkowski
Chapter 61 Partial Cadaveric Liver Transplantation: Donor
Procedure and Implantation – 535
Massimo Del Gaudio, Xavier Rogiers, Daniel Azoulay
Chapter 62 Right Living-Donor Hepatectomy – 545
Gregory Sergeant, Pierre-Alain Clavien
Chapter 63 Living-Donor Transplantation: Left Hemiliver
Donor Procedure and Implantation – 553
Hiroto Egawa, Masakazu Yamamoto
Chapter 64 Auxiliary Liver Transplantation – 569
Chapter Directory-1_Part
Karim Boudjema, Laurent Sulpice
Chapter 65 Double Transplantation – 577
Sung-Gyu Lee, Jung-Man Namgoong
III
Introduction: Liver
Pierre-Alain Clavien, Yuman Fong
Liver surgery was considered until the early 1980s as a “heroic” eld of medicine associated with
much blood loss, and high patient morbidity and mortality. With such a reputation, only lifethreatening conditions were usually referred for liver surgery.
As surgeons acquired a better understanding of surgical anatomy and physiology, a better
understanding of peri- and intraoperative management, and importantly formal training periods
in this eld, hepatic surgery began to enjoy rapid expansion and high credibility among colleagues
and patients. Today, liver surgery is one of the most complex and successful areas of medicine
with the availability of a variety of highly sophisticated procedures for many indications including complex liver resection or transplantation of only one part of the liver from a living donor.
Compared to the rst edition, we have separated non transplant (Chapters 40–58) from transplant (Chapters 59–65) procedures with signicant changes in about a third of the chapters. Particularly, the part on laparoscopic liver resection was updated and new technology such as microwave ablation or the use of electroporation ablation (NanoKnife) was introduced. A new chapter
is dedicated to the emerging and challenging two-stage hepatectomy described with the acronym
“ALPPS.” On the side of liver transplantation, the challenging use of double living donor gra,
in situ/ex situ splitting of cadaveric liver gra, and gra aer cardiac arrest are newly described.
e rst chapter presents a comprehensive approach to the terminology of liver anatomy and
resection (Brisbane 2000 terminology), according to an international eort including leaders from
all continents. e next three chapters present available techniques for vascular exclusion, parenchyma dissection and the “hanging” maneuver, which may enable better exposure for anatomic
resections. e hepatic surgeon must be familiar with all these techniques, which may be of great
help in many dicult situations. en, the focus turns to formal anatomic and non-anatomic liver
resections, including laparoscopic approaches, which are gaining increasing popularity. As liver
resection is oen not possible due to local dicult situations (poor liver reserve or location of a
tumor) or poor general condition of the patient, alternative techniques are presented including
the new two-staged liver resection ALPPS, cryosurgery, radiofrequency ablation, the nanoknife
technique and selective intra-arterial chemotherapy. Benign and infectious cysts require particular
strategies, which are well covered in two separate chapters. A chapter also comprehensively covers
the available strategies for liver trauma in the modern area of “damage control injury.” Emerging
robotic liver resection is introduced in a separate chapter. e last seven chapters cover various
aspects of liver transplantation from organ procurement to partial living or cadaveric orthotopic
liver transplantation, double transplant as well as auxiliary liver transplantation.
While there is no substitute for experience in performing complex surgical procedures, we
hope that this section, prepared by worldwide experts, will clarify standards and limitations for
surgeons in performing hepatic surgery.
P.-A. Clavien, M. G. Sarr, Y. Fong, M. Miyazaki (Eds.), Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surger y,
DOI 10.1007/978-3-662-46546-2_39, © Springer-Verlag Berlin Heidelberg 2016
Terminology of Liver Anatomy and Resections:
The Brisbane 2000 Terminology
Steven M. Strasberg
The Brisbane 2000 Terminology of Hepatic Anatomy and Liver
Resections
In December 1998, at its meeting in Berne, Switzerland, the Scientic Committee of the International Hepato-Pancreato-Biliary Association (IHPBA) established a Terminology Committee
to deal with the confusion in terminology of hepatic anatomy and liver resections. e impetus
for doing so came from an article published in 1997, which challenged the existing terminology.
Aer nearly 18months of work, the recommendations of the committee were presented to the
Scientic Committee at the biannual meeting of the IHPBA in Brisbane, Australia, in May, 2000.
ese recommendations, consisting of a new terminology, e Brisbane 2000 Terminology of
Liver Anatomy and Resections, were unanimously accepted by the Scientic Committee of the
IHPBA and were presented to the membership as the ocial terminology of the IHPBA. e
recommendations were published in the ocial journal of the IHPBA in 2000, and it has recently
been shown that they have been widely adopted throughout the world. e terminology shown is
based on the universally accepted anatomy of the ramication of the hepatic artery and bile duct,
which is coincident with the ramication of the portal vein as described by Goldsmith and Woodburne. Although a terminology based on the division of the portal vein according to Couinaud
was added as an addendum in the original description, it is not presented here.
e terminology is presented as a set of ve gures. e liver is divided into successive orders.
e following notes serve as a guide to the gures.
Note1. Couinaud segments are indicated in short form as Sg1–8 (e. g., Sg6). “Sg” was chosen
rather than “S” to avoid confusing “segment” with “section.” Arabic numerals are chosen rather
than Roman numerals because many non-Western nations do not use Roman numerals.
Note2. Wherever the word “OR” (uppercase, bold) appears, it indicates equally acceptable
terminology: for example, “right hemiliver”
bold) appears, it indicates that the rst term is preferred but that the second is acceptable: for
example, “right trisectionectomy” or “extended right hepatectomy.” In this case, “extended” is less
desirable because some surgeons use the adjective “extended” to indicate any degree of extension
of a resection beyond the midplane, which in some cases is less than a whole section. us the
terms containing the word “extended” are less precise.
Note3. When segment1 is resected as part of a procedure, it should be stated as in the fol-
lowing example: “le hemihepatectomy with resection of segment1” or “le hemihepatectomy
extended to segment1.” For clarity, the position of Sg1 is shown only in
Note4.
It is correct to refer to any resection by its segments. For instance, “right hepatectomy”
and “resection Sgs5–8” are equally acceptable. Similarly, “le lateral sectionectomy” and “resection Sgs2,3” are equally acceptable.
OR “right liver.” Wherever the word “or” (lowercase,
. Fig. 40.1c.
P.-A. Clavien, M. G. Sarr, Y. Fong, M. Miyazaki (Eds.), Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surger y,
DOI 10.1007/978-3-662-46546-2_40, © Springer-Verlag Berlin Heidelberg 2016
1
2
3
4
5
6
7
8
9
Section III • Liver: Nontransplant Procedures
10
11
12
13
14
15
16
40
18
19
20
. Fig.40.1 Overall view of successive orders of division based on the hepatic artery or bile ducts. This is also the
order of division of the portal vein according to Goldsmith and Woodburne. aFirst-order division of the liver into
hemilivers or livers. The midplane of the liver is shown in red. bSecond-order division of the liver into sections. The
intersectional planes are shown in green. cThird-order division into the numbered segments of Couinaud
. Table40.1 Resectional terminology for excision of a hemiliver or liver
Anatomical term Couinaud segments Term for surgical
Right liver
OR
Hemiliver
Sg5–8
resection
Right hepatectomy
OR
Right hemihepatectomy
Diagram (pertinent area is shaded)
21
22
23
Left liver
OR
Hemiliver
Sg2–4
Left hepatectomy
OR
Left hemihepatectomy
Chapter • Terminology of Liver Anatomy and Resections: The Brisbane Terminology
. Table40.2 Resectional terminology for excision of a section
40
Anatomical term Couinaud
Right anterior
section
Right posterior
section
Left medial section Sg4 Left medial sectionectomy
Left lateral section Sg2,3 Left lateral sectionectomy
segments
Sg5,8 Right anterior sectionec-
Sg6,7 Right posterior sectionec-
Term for surgical resection
Add (ectomy)- to any of
the anatomical terms
tomy
tomy
Diagram (pertinent area
is shaded)
. Table40.3 Resectional terminology for excision of a segment
Anatomical term Couinaud
Segments1–8 Any one of
Two contiguous
segments
segments
Sg1–8
Any one of
Sg1–8 in
continuity
Term for surgical
resection
Segmentectomy (e. g.,
segmentectomy6)
Bisegmentectomy (e. g.,
bisegmentectomy5,6)
Diagram (pertinent area
is shaded)
Section III • Liver: Nontransplant Procedures
1
2
3
4
5
6
7
8
9
10
. Table40.4 Terminology for extended resections (trisectionectomies).
Couinaud segments Term for surgical resection Diagram (pertinent area
is shaded)
Sg4–8 Right trisectionectomy (preferred term)
or
Extended right hepatectomy
or
Extended right hemihepatectomy
Sg2,3,4,5,8 Left trisectionectomy (preferred term)
or
Extended left hepatectomy
or
Extended left hemihepatectomy
11
12
13
14
15
16
40
18
19
20
21
22
23
Techniques of Vascular Clamping, Vascular Exclusion,
and Caval Resection in Liver Surgery
Përparim Limani, Mickaël Lesurtel
Vascular exclusion techniques in liver surgery include continuous inflow occlusion (. Fig. 41.1a)
(rst described by J. H. Pringle in 1908), intermittent inflow occlusion (.
scribed by M. Makuuchi in the late 1970s), ischemic preconditioning (.
tinuous) total vascular exclusion. e use of inflow occlusion varies considerably among centers:
some use it routinely, whereas others use it only exceptionally. When using inflow occlusion, a low
central venous pressure (CVP) (< 5 mm Hg) needs to be maintained to reduce bleeding caused by
backow from the hepatic veins. e eect of a low CVP associated with a Pringle maneuver can
be equivalent to total vascular exclusion. Total vascular exclusion, on the other hand, can lead to
cardiovascular instability by reducing cardiac preload. erefore, adequate volume loading with
a high CVP (> 10 mm Hg) must be maintained, or a venovenous bypass is sometimes required
in this setting.
Fig. 41.1b
Fig. 41.1c
) (rst de-
) and (con-
Indications
. Table41.1 Maximum safe duration (min) of hepatic inow occlusion with dierent techniques
Normal liver Cirrhotic liver
Continuous inow occlusion 60 30
Ischemic preconditioning 75 ?
Intermittent clamping > 90 > 60
. Fig.41.1
Indications and Contraindications
Reduction of blood loss during parenchymal dissection
-
Dissection in proximity of major vascular structures
-
Tumor invading vena cava or all hepatic veins, central hepatectomy (for total vascular exclu-
-
sion)
Contraindications
Technical reasons (adhesions, etc.)
-
Cardiac failure (for total vascular exclusion)
-
P.-A. Clavien, M. G. Sarr, Y. Fong, M. Miyazaki (Eds.), Atlas of Upper Gastrointestinal and Hepato-Pancreato-Biliary Surger y,
DOI 10.1007/978-3-662-46546-2_41, © Springer-Verlag Berlin Heidelberg 2016