Skip to main content
SpringerLink
Log in

Technische Aspekte der laparoskopischen Leberchirurgie

Transfer von der offenen zur laparoskopischen Leberchirurgie

Technical aspects of laparoscopic liver surgery

Transfer from open to laparoscopic liver surgery

  • Übersichten
  • Published:
Der Chirurg Aims and scope Submit manuscript

Zusammenfassung

Hintergrund

Nachdem die laparoskopische Chirurgie in vielen Kliniken zur Standardtechnik in weiten Teilen der Viszeralchirurgie geworden ist, werden zunehmend auch Leberresektionen laparoskopisch durchgeführt. Die Vorteile der laparoskopischen Technik wurden für die Leberchirurgie in vielen Fallserien und nun auch in einer randomisierten Studie belegt.

Zielsetzung

Ziel dieser Übersichtsarbeit ist, die aktuellen Techniken darzustellen, die für die laparoskopische Leberchirurgie (LLC) zur Verfügung stehen.

Material und Methodik

Es werden die in der Literatur beschriebenen Varianten sowie die eigenen Erfahrungen mit der technischen Umsetzung der LLC präsentiert.

Ergebnisse

Die Lagerung des Patienten und Positionierung der Trokare sind essenziell für das laparoskopische Vorgehen und ergeben sich aus der geplanten Operation. Insbesondere für die Resektion der apikalen und dorsalen Lebersegmente wurden verschiedene Lagerungen und somit auch Trokarpositionen beschrieben. Analog der offenen Leberchirurgie vermindern ein intraoperativ restriktives Volumenmanagement sowie ein laparoskopisches Pringle-Manöver den Blutverlust. Viele aus der offenen Leberchirurgie bekannte Dissektionstechniken finden auch bei der laparoskopischen Resektion Anwendung. Insbesondere für die Präparation in der Nähe großer Gefäßstrukturen empfiehlt sich die Verwendung des CUSA®-Systems (Cavitron Ultrasound Surgical Aspirator), da dieses eine exakte Dissektion mit größtmöglicher Schonung der Gefäßstrukturen erlaubt.

Schlussfolgerungen

Die Entwicklungen in der minimal-invasiven Chirurgie ermöglichen heutzutage auch komplexe Leberresektionen, die in vergleichbarer Weise wie in der offenen Chirurgie durchgeführt werden können. Es ist zu hoffen, dass sich diese Technik auch in Deutschland weiter durchsetzt.

Abstract

Background

Laparoscopic surgery has become the standard for most visceral surgery procedures in many hospitals. Now, liver resections are also being increasingly carried out laparoscopically. The advantages of the laparoscopic technique have been demonstrated in numerous case series and in a recent randomized controlled trial.

Aims

The aim of this review article is to present the available techniques for laparoscopic liver surgery (LLS).

Methods

The technical variations reported in the literature as well as the own experience with LLS are reported.

Results

Optimal patient and trocar positions are crucial for successful LLS and they are chosen according to the planned type of liver surgery: the literature offers several options in particular for surgery of the cranial and dorsal liver segments. As for open liver surgery, a restrictive volume management and the application of the Pringle maneuver are helpful to reduce intraoperative blood loss in LLS. In addition, several dissection techniques have been adopted from open liver surgery. The Cavitron Ultrasound Surgical Aspirator (CUSA™) is particularly suitable for parenchymal dissection close to major vascular structures, since it guarantees a meticulous parenchymal dissection with minimal vascular injuries.

Conclusion

The developments of minimally invasive surgery nowadays allow complex liver resections, which can mostly be performed comparable to open liver surgery. Hopefully, minimally invasive liver surgery will further develop in Germany in the near future, since it offers several advantages over open liver surgery.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Abb. 1
Abb. 2
Abb. 3
Abb. 4
Abb. 5

Literatur

  1. Heinrich S, Lang H (2014) Neoadjuvant chemotherapy or primary surgery for colorectal liver metastases : Pro primary surgery. Chirurg 85(1):17–23

    Article  CAS  PubMed  Google Scholar 

  2. Fromer MW, Gaughan JP, Atabek UM, Spitz FR (2017) Primary malignancy is an independent determinant of morbidity and mortality after liver resection. Am Surg 83(5):436–444

    PubMed  Google Scholar 

  3. Hughes MJ, Ventham NT, Harrison EM, Wigmore SJ (2015) Central venous pressure and liver resection: a systematic review and meta-analysis. HPB 17(10):863–871

    Article  PubMed  PubMed Central  Google Scholar 

  4. Heinrich S, Tripke V, Huber T, Mittler J, Lang H (2017) A match-pair analysis of open versus Laparoscopic liver surgery. JSLS 21(4):e2017.00061

    Article  PubMed  PubMed Central  Google Scholar 

  5. Han HS, Shehta A, Ahn S, Yoon YS, Cho JY, Choi Y (2015) Laparoscopic versus open liver resection for hepatocellular carcinoma: case-matched study with propensity score matching. J Hepatol 63(3):643–650

    Article  PubMed  Google Scholar 

  6. Wakabayashi G (2016) What has changed after the Morioka consensus conference 2014 on laparoscopic liver resection? Hepatobiliary Surg Nutr 5(4):281–289

    Article  PubMed  PubMed Central  Google Scholar 

  7. Halls MC, Berardi G, Cipriani F, Barkhatov L, Lainas P, Harris S et al (2018) Development and validation of a difficulty score to predict intraoperative complications during laparoscopic liver resection. Br J Surg. https://doi.org/10.1002/bjs.10821

    Article  PubMed  Google Scholar 

  8. Fretland AA, Dagenborg VJ, Bjornelv GMW, Kazaryan AM, Kristiansen R, Fagerland MW et al (2017) Laparoscopic versus open resection for colorectal liver metastases: the OSLO-COMET randomized controlled trial. Ann Surg. https://doi.org/10.1097/SLA.0000000000002353

    Article  PubMed  Google Scholar 

  9. Martinez-Cecilia D, Fontana M, Siddiqi NN, Halls M, Barbaro S, Abu-Hilal M (2017) Laparoscopic parenchymal sparing resections in segment 8: techniques for a demanding and infrequent procedure. Surg Endosc. https://doi.org/10.1007/s00464-017-5897-y

    Article  PubMed  Google Scholar 

  10. Ikeda T, Toshima T, Harimoto N, Yamashita Y, Ikegami T, Yoshizumi T et al (2014) Laparoscopic liver resection in the semiprone position for tumors in the anterosuperior and posterior segments, using a novel dual-handling technique and bipolar irrigation system. Surg Endosc 28(8):2484–2492

    Article  PubMed  PubMed Central  Google Scholar 

  11. Fuks D, Gayet B (2015) Laparoscopic surgery of postero-lateral segments: a comparison between transthoracic and abdominal approach. Updates Surg 67(2):141–145

    Article  PubMed  Google Scholar 

  12. Cipriani F, Shelat VG, Rawashdeh M, Francone E, Aldrighetti L, Takhar A et al (2015) Laparoscopic parenchymal-sparing resections for nonperipheral liver lesions, the diamond technique: technical aspects, clinical outcomes, and oncologic efficiency. J Am Coll Surg 221(2):265–272

    Article  PubMed  Google Scholar 

  13. Tranchart H, O’Rourke N, Van Dam R, Gaillard M, Lainas P, Sugioka A et al (2015) Bleeding control during laparoscopic liver resection: a review of literature. J Hepatobiliary Pancreat Sci 22(5):371–378

    Article  PubMed  Google Scholar 

  14. Buell JF, Koffron AJ, Thomas MJ, Rudich S, Abecassis M, Woodle ES (2005) Laparoscopic liver resection. J Am Coll Surg 200(3):472–480

    Article  PubMed  Google Scholar 

  15. Buell JF, Gayet B, Han HS, Wakabayashi G, Kim KH, Belli G et al (2013) Evaluation of stapler hepatectomy during a laparoscopic liver resection. HPB 15(11):845–850

    Article  PubMed  PubMed Central  Google Scholar 

  16. Otsuka Y, Kaneko H, Cleary SP, Buell JF, Cai X, Wakabayashi G (2015) What is the best technique in parenchymal transection in laparoscopic liver resection? Comprehensive review for the clinical question on the 2nd International Consensus Conference on Laparoscopic Liver Resection. J Hepatobiliary Pancreat Sci 22(5):363–370

    Article  PubMed  Google Scholar 

  17. Hilal AM, Aldrighetti L, Dagher I, Edwin B, Troisi RI, Alikhanov R et al (2017) The Southampton consensus guidelines for laparoscopic liver surgery: from indication to implementation. Ann Surg. https://doi.org/10.1097/SLA.0000000000002524

    Article  PubMed  Google Scholar 

  18. Ohtani H, Tamamori Y, Arimoto Y, Nishiguchi Y, Maeda K, Hirakawa K (2012) A meta-analysis of the short- and long-term results of randomized controlled trials that compared laparoscopy-assisted and open colectomy for colon cancer. J Cancer 3:49–57

    Article  PubMed  PubMed Central  Google Scholar 

  19. Vennix S, Pelzers L, Bouvy N, Beets GL, Pierie JP, Wiggers T et al (2014) Laparoscopic versus open total mesorectal excision for rectal cancer. Cochrane Database Syst Rev. https://doi.org/10.1002/14651858.CD005200.pub3

    Article  PubMed  Google Scholar 

  20. Nomi T, Fuks D, Kawaguchi Y, Mal F, Nakajima Y, Gayet B (2015) Learning curve for laparoscopic major hepatectomy. Br J Surg 102(7):796–804

    Article  CAS  PubMed  Google Scholar 

  21. Tomassini F, Scuderi V, Colman R, Vivarelli M, Montalti R, Troisi RI (2016) The single surgeon learning curve of laparoscopic liver resection: A continuous evolving process through stepwise difficulties. Medicine (Baltimore) 95(43):e5138

    Article  Google Scholar 

  22. Ratti F, Barkhatov LI, Tomassini F, Cipriani F, Kazaryan AM, Edwin B et al (2016) Learning curve of self-taught laparoscopic liver surgeons in left lateral sectionectomy: results from an international multi-institutional analysis on 245 cases. Surg Endosc 30(8):3618–3629

    Article  PubMed  Google Scholar 

  23. Takahashi Y, Katagiri S, Ariizumi SI, Kotera Y, Egawa H, Wakabayashi G et al (2017) Laparoscopic hepatectomy: current state in Japan based on the 4th nationwide questionnaire. Gastroenterol Res Pract 2017:6868745

    Article  PubMed  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Klinik f. Allgemein‑, Viszeral- und Transplantationschirurgie, Universitätsmedizin Mainz, Langenbeckstraße 1, 55131, Mainz, Deutschland

    S. Heinrich, J. Mittler, V. Tripke &  H. Lang

Authors
  1. S. Heinrich
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. J. Mittler
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. V. Tripke
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. H. Lang
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to H. Lang.

Ethics declarations

Interessenkonflikt

S. Heinrich, J. Mittler, V. Tripke und H. Lang geben an, dass kein Interessenkonflikt besteht.

Dieser Beitrag beinhaltet keine von den Autoren durchgeführten Studien an Menschen oder Tieren.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Heinrich, S., Mittler, J., Tripke, V. et al. Technische Aspekte der laparoskopischen Leberchirurgie. Chirurg 89, 984–992 (2018). https://doi.org/10.1007/s00104-018-0684-4

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00104-018-0684-4

Schlüsselwörter

Keywords

Search

Navigation