The application of the extraglissonian approach for selective hepatic inflow occlusion during laparoscopic anatomical segmentectomy

Objective:Laparoscopic anatomical hepatectomy has been proven to be achievable for segmentectomy,subsegmentectomy and multi-segmentectomy.The extraglissonian approach in the context of selective hepatic inflow ocdlusion has been skilled under laparoscopy.This study aims to examine the suitability of the technique stated above for laparoscopic anatomical hepatectomy.Methods:This retrospective study analyzed the dinical data of 114 patients diagnosed with hepatocel-lular carcinoma who underwent laparoscopic anatomical hepatectomy using the extraglissonian hepatic inflow occlusion technique at the Faculty of Hepato-Pancreato-Biliary Surgery,Chinese PLA General Hospital between September 2020 and December 2022.Results:The success rate of achieving the ischemic area using the described methods was determined to be 74.6%.Out of the 85 cases that underwent laparoscopic anatomical hepatectomy,34 cases involved segmentectomy,5 cases involved subsegmentectomy,and 46 cases involved multi-segmentectomy.The average duration of the operation,blood loss volume,and postoperative hospi-tal stay were 229.0±85.0 min,133.0±112.0 mL,and 5.4±1.7 d,res pectively.Notably,no intraoperative blood transfusions were necessary,and no postoperative complications were observed.Conclusion:The extraglissonian hepatic inflow occlusion technique exhibits a notable advantage in terms of a high success rate,effectively guiding the selection process during laparoscopic parenchymal tran-section.Moreover,this technique has demonstrated safety,reproducibility,and significant potential for broader clinical adoption.

Course of major paravertebral vessels and the positional relationship to the vertebral bodies in healthy Chinese subjects： a CT-based study

Background Several studies,including those done in China,report that paravertebral vascular injury during posterior spinal surgery can greatly harm patients,though it is a relatively rare complication.However,few studies have examined their course and anatomic relationship to the spine.The aim of this study was to measure the course of the major paravertebral vessels and their positional relationships to the vertebral bodies in Chinese subjects using computed tomography.Methods We studied a total of fifty subjects who underwent thoracolumbar computed tomography from T1-S1 at our institution.We measured the theoretical distance,actual distance,theoretical angle,and actual angle of the paravertebral vessels at each thoracolumbar intervertebral disc.Results The paravertebral artery actual angle at T4-L4 ranged from-11.41 to 79.75° and the actual distance from 16.98 to 52.53 mm.The actual angle of the inferior vena cava at L1-L5 intervertebral disc ranged from-40.75 to 34.50° and the actual distance from-36.63 to 61.69 mm.There was no significant difference in the actual angle of the paravertebral vein or in the actual distance in the thoracic segments according to gender （P ＞0.05）.However,the actual distance in the lumbar segments were significantly different according to gender （P ＜0.05）.Conclusions The major paravertebral vessels＇ course is closer to the mid-sagittal plane as they move posterior along the vertebrae,and the actual distance of the paravertebral artery and azygos vein increase,while the actual distance of the inferior vena cava decreases.The course of the lumbar paravertebral vessels varies,especially at L4/L5,and may be more prone to intraoperative injury in female subjects.

From open to laparoscopic adrenalectomy: a review of 16-year experience

Objective To review the experience with adrenal surgery which was associated with significant morbidity and notable mortality in the past, although laparoscopic approach is beginning to be accepted as the procedure of choice Methods The indications and results of adrenalectomy in 104 patients (36 men, 68 women) over the past 16 years were reviewed Any potential improvement of surgical results over time was analyzed Results Ninety three patients (89%) had functional problems while malignancy was present in 11 patients (11%) Anterior approach was employed in 27 patients, posterior in 56, lateral in 10, and laparoscopic in 11 One patient required conversion from laparoscopic to anterior approach No operative mortality was seen, but the morbidity occurred in 16 7% Complication rate decreased significantly in this study period (1981 1990 versus 1991 1996, 22% versus 5%; P =0 02) Laparoscopic adrenalec^tomy was successfully performed for 59% of the patients requiring adrenalectomy recently, compared to 68% of posterior adrenalectomy in the past Conclusions Adrenal surgery is a safe procedure, associated with acceptable morbidity, which has decreased over time Laparoscopic adrenalectomy is becoming the preferred approach for the majority of patients requiring adrenalectomy