- Clinique MUST
- Chirurgie du foie
- Chirurgien digestif pour résection des métastases hépatiques à Paris: Groupe MUST.
Chirurgien digestif pour résection des métastases hépatiques à Paris: Groupe MUST.
Les chirurgiens Digestifs du Groupe MUST à Paris ont été précurseurs dans la prise en charge des métastases hépatiques par abord mini-invasif (coelioscopie). Le Pr Claude Tayar a publié en 2013 une étude innovante permettant d'aider les chirurgiens digestifs à mieux prendre en charge les patients avec des métastases hépatiques dont l'accès chirurgical par coelioscopie pure est difficile. Le Pr Tayar a mis au point un algorythme décisionnel pour les localisations métastastiques postérieures du foie (segments VII, VIII, IVa) par un double abord mini-invasif: coelioscopie + thoracoscopie avec abord trans-diaphragmatique. Les chirurgiens digestifs du groupe MUST à Paris vous proposent cette technique innovante pour le prise en charge des métastases hépatiques.
“Combined Laparoscopic and Trans-Thoracic Approach” for Limited Liver Resections Salceda Juan*, Laurent Alexis, Cherqui Daniel, Azoulay Daniel and Tayar Claude Digestive and Hepato-Biliary Surgery Department, Henri Mondor Hospital, Paris-Est Créteil University, France
Abstract Background: Since the very first report and through to the last two decades, laparoscopy has demonstrated to be an effective tool for liver surgery, especially limited resections. Despite increasing experience worldwide and the multitude of instruments and energy based devices for parenchymal transection, some locations remain difficult for limited laparoscopic resections. Posterior and upper right segments of the liver (segments 7 and 8) are still tricky to be exposed properly while using a standard laparoscopic approach. We present a new technique with a Combined Laparoscopic and Trans-Thoracic Approach (CLTTA) to reach difficult locations in the liver enabling limited resections while conserving the advantages of minimally invasive surgery. Methods: Three patients underwent limited liver resection through a CLTTA. The first patient had liver metastasis of colonic cancer, the second an inflammatory liver adenoma and the third a liver nodule suspected to be a HCC with underlying cirrhosis. All lesions were located between segments 7 and 8. Results: All procedures were performed using CLTTA. Four ports were placed in the abdomen and two supplementary 5 mm ports were placed through the right pleural cavity. Parenchymal transection was done in every case using either harmonic scalpel (Ultracision, Ethicon Endo-surgery, Cincinnati, OH) or vessel sealing device (Ligasure, Covidien-Valleylab, Boulder, CO) for the first two superficial centimetres and then Ultrasonic Surgical Aspirator (Sonosurg, Olympus, Tokyo, Japan) for deeper transection. Haemostasis was achieved using bipolar coagulator and clips when necessary. Chest tube was left in place for two days after surgery. No patient was transfused. No conversion, morbidity or mortality was observed. Conclusions: We report our early experience with this new technique that seems to be feasible and safe for the laparoscopic limited resections of upper and posterior right segments of the liver. Further experience is needed in order to confirm these data.
Juan et al., J Liver 2013, 2:2
http://dx.doi.org/10.4172/2167-0889.1000123
“Combined Laparoscopic and Trans-Thoracic Approach” for Limited Liver Resections Salceda Juan*, Laurent Alexis, Cherqui Daniel, Azoulay Daniel and Tayar Claude Digestive and Hepato-Biliary Surgery Department, Henri Mondor Hospital, Paris-Est Créteil University, France
Abstract Background: Since the very first report and through to the last two decades, laparoscopy has demonstrated to be an effective tool for liver surgery, especially limited resections. Despite increasing experience worldwide and the multitude of instruments and energy based devices for parenchymal transection, some locations remain difficult for limited laparoscopic resections. Posterior and upper right segments of the liver (segments 7 and 8) are still tricky to be exposed properly while using a standard laparoscopic approach. We present a new technique with a Combined Laparoscopic and Trans-Thoracic Approach (CLTTA) to reach difficult locations in the liver enabling limited resections while conserving the advantages of minimally invasive surgery. Methods: Three patients underwent limited liver resection through a CLTTA. The first patient had liver metastasis of colonic cancer, the second an inflammatory liver adenoma and the third a liver nodule suspected to be a HCC with underlying cirrhosis. All lesions were located between segments 7 and 8. Results: All procedures were performed using CLTTA. Four ports were placed in the abdomen and two supplementary 5 mm ports were placed through the right pleural cavity. Parenchymal transection was done in every case using either harmonic scalpel (Ultracision, Ethicon Endo-surgery, Cincinnati, OH) or vessel sealing device (Ligasure, Covidien-Valleylab, Boulder, CO) for the first two superficial centimetres and then Ultrasonic Surgical Aspirator (Sonosurg, Olympus, Tokyo, Japan) for deeper transection. Haemostasis was achieved using bipolar coagulator and clips when necessary. Chest tube was left in place for two days after surgery. No patient was transfused. No conversion, morbidity or mortality was observed. Conclusions: We report our early experience with this new technique that seems to be feasible and safe for the laparoscopic limited resections of upper and posterior right segments of the liver. Further experience is needed in order to confirm these data.
Juan et al., J Liver 2013, 2:2
http://dx.doi.org/10.4172/2167-0889.1000123
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