Charis Kyriakides

Isolated laparoscopic caudate lobe resection.

The local anatomy of the caudate lobe of the liver, between the hepatic hilum and the inferior vena cava, presents a surgical challenge when an isolated resection is attempted. The video of the laparoscopic technique is presented in a 20-year-old woman with a 60×40 mm lesion.

Laparoscopic resection of a giant exophytic liver haemangioma with the laparoscopic Habib 4× radiofrequency device

Haemangiomas are the most common solitary benign neoplasm of the liver with an incidence ranging from 5% to 20%. Although usually small and asymptomatic, they may reach considerable proportions and rarely give rise to life-threatening complications. Surgical intervention is required for incapacitating symptoms, established complications, and diagnostic uncertainty. The resection of haemangiomas demands meticulous surgical technique, owing to their high vascularity and the concomitant risk of intra-operative haemorrhage. Laparoscopic resection of giant haemangiomas is even more challenging, and has only been reported twice. We here report the case of a giant 10 cm liver haemangioma which was successfully resected laparoscopically using the laparoscopic HabibTM 4×, a bipolar radiofrequency device, without clamping major vessels and with minimal blood loss. Transfusion of blood or blood products was not required. The patient had an uneventful recovery and was asymptomatic at 7-mo follow-up.

Radiofrequency-Assisted Hepatic Resection

BackgroundThe only curative procedure to date for liver tumors is surgical resection, which remains a major procedure with marked morbidity and mortality. Radiofrequency (RF) has increasingly been used for both ablation and resection. On the basis of this technique, a new bipolar RF device, Habib 4X, has been developed and used clinically. We present our technique of liver resection with this device in a patient with colorectal liver metastases.MethodsA patient with situs inversus who had colorectal liver metastases in her left lobe underwent left lateral segmentectomy with the new device, a four-electrode bipolar resection device that uses RF energy for tissue necrosis. After laparotomy and intraoperative ultrasound, the plane resection was marked 1 cm away from the edge of the lesion. Coagulative desiccation was performed along this plane using this sealer connected to a RF generator. The necrosed band of parenchyma was then divided with a scalpel and resection completed.ResultsThe length of the procedure was 105 minutes; resection time was 35 minutes. Total blood loss was 100 ml. No blood transfusions were required, and the patient was not admitted to the intensive care unit after surgery. The patient was discharged 10 days after surgery without any surgical complications.ConclusionsWe think that RF-assisted liver resection with this new device is safe and effective. It is quicker than conventional RF and may reduce overall hospital stay in liver resection patients.

Surgery remains the best option for the management of pain in patients with chronic pancreatitis: A systematic review and meta-analysis

Controversy related to endoscopic or surgical management of pain in patients with chronic pancreatitis remains. Despite improvement in endoscopic treatments, surgery remains the best option for pain management in these patients.

Recurrent Dedifferentiated Liposarcoma Arising from the Small Bowel Mesentery: A Case Report

A 71-year-old man who was otherwise fit and well except for taking 5 mg of warfarin daily for atrial fibrillation over the previous 5 years presented with severe central abdominal pain and distension. A non-contrast CT scan showed a large mesenteric mass adjacent to the duodenojejunal (DJ) flexure measuring 9.2×8.2×8.8 cm, which appeared to be involving a loop of small bowel (Fig. 1). There was extensive stranding in the perilesional fat and a large amount of free fluid within the abdomen and around the liver. His INR level was 8 with otherwise normal biochemical and haematological indices. In view of his clinical features and CT findings, an urgent laparotomy was performed for the evacuation of what preoperatively was diagnosed as a ruptured giant haematoma in the root of the mesentery. At operation, a large amount of free blood was seen together with a large clot measuring 21×18× 20 cm in the root of the small bowel mesentery involving jejunum. During the operation, it became clear that this clot consisted of fatty material. Intraoperative frozen section confirmed this being a fibrofatty tumour of unknown type. The operation was changed from evacuation of haematoma to excision of a ruptured tumour with resection of a loop of jejunum 50 cm from the DJ flexure attached to the tumour and formation of a side-to-side jejunojejunal anastomosis. Postoperatively, the patient had an uneventful recovery and was discharged home on warfarin 10 days post-laparotomy. The histology showed that it was a dedifferentiated liposarcoma. Post-operative CT scanning revealed a residual mass sizing approximately 3 cm in the root of the mesentery on the right terminal branch of the superior mesenteric vein. This was due to the proximity of the tumour to major vessels and the inability to define a surgical plane because of the large amount of blood clot at the first laparotomy. The patient was scheduled for Cyberknife treatment 3 months after his initial surgery. However, on the day of labelling of the tumour for Cyberknife treatment, repeat CT showed a rapid increase in the size of this mass to 5×6 cm. Cyberknife treatment was abandoned, and a decision was made for further surgical debulking. Under general anaesthesia, laparotomy was performed via the previous midline incision. After careful mobilisation, the DJ flexure was exposed together with the tumour. The tumour was arising from the root of the small bowel mesentery grossly displacing the superior mesenteric vein to the right side and invading into the mesentery of the jejunum 5 cm distal to the DJ flexure. Extreme care was taken to mobilise the back of the tumour away from the small bowel mesentery as well as protecting the superior mesenteric vein and artery. After careful dissection, vessels were skeletonised and the large tumour (10×9×7 cm) was removed from the root of the small bowel mesentery whilst achieving preservation of the major vasculatures therein. Then the loop of jejunum involved was resected en bloc. After resection, a side-to-side jejunal anastomosis was formed and the base of the tumour—where the tumour had been attached to the small mesenteric vessels—was marked with markers for post-operative Cyberknife treatment. Histological findings suggest a high-grade sarcoma similar to those noted in the first histology consistent with a dedifferentiated liposarcoma.

Open Hepatic Transection Using Habib™ 4X

Liver resection is the principle treatment for primary and secondary malignancies as well as various benign diseases. The challenge of safely and efficiently transecting the hepatic parenchyma remains however. New technology, and specifically energy devices, have transformed the management of liver disease and the technique of liver resection, offering better hemostatic control and simplifying nonanatomical resection. The Habib 4X is a radiofrequency device used in resection of liver; the device and technique are presented.

Laparoscopic Hepatic Transection Using Habib™ 4X

Laparoscopic surgery has undergone a major transformation in the last two decades, with the advancement of new instruments, new techniques, and increased surgical experience and skill. Laparoscopic hepatic surgery is now not only feasible and safe, but depending on the indication, preferable, decreasing perioperative morbidity and hospital stay. Nevertheless, laparoscopic liver resection remains a highly challenging surgical procedure because of the risk of massive bleeding during liver transection and the complicated biliary and vascular anatomy of the liver. The Laparoscopic Habib™ 4X is a device specifically designed to address these issues. The device and technique of hepatic transection using the Laparoscopic Habib™ 4X are described.