|VL03 Video Liver: Miscellaneous
|Selection of Video Presentations from Abstract Submissions
|VL03-01 ||Laparoscopic Right Adrenalectomy and Diaphagmatic Resection for Recurrent Colorrectal Cancer Metastasis after Right Hepatectomy
Lara M Dominguez, Spain
L.M. Dominguez1, F. Kunzler Maia2, N. Lad3, N.D. Machado4, R.E. Jimenez2, H. J Asbun3, K.-W. Ma5
1General Surgery, Hospital of Povisa, Spain, 2Miami Cancer Institute, United States, 3Hepatobiliary and Pancreas Surgery, Miami Cancer Institute, United States, 4University of Porto, Portugal, 5Saint Mary Hospital, Hong Kong
Introduction: A 35-year-old male diagnosed with right colon mucinous adenocarcinoma, stage IIb, underwent a right colectomy followed by adjuvant chemotherapy. Right hepatic lobe metastasis were detected 18 months after the end of chemotherapy. The treatment was resumed and radioembolization performed prior to an open right hepatectomy. He developed a local recurrence after 3 months.
Methods: The patient was positioned in a modified left lateral decubitus position. A 5 mm optical insufflating port was placed through a left upper quadrant incision to enter the cavity and establish the pneumoperitoneum. A total of 5 ports were placed under direct visualization as the adhesion lysis was undertaken.
As expected, a significant amount of adhesions was present. Adhesion lysis was performed. After clearly exposing the right kidney the dissection was carried medially and the cava was identified and isolated. The dissection was then continued gradually exposing all pertinent anatomic structures. Meticulous dissection was performed progressively separating the mass in the adrenal, first from the cava, and then from the portal vein.
As the mass was attached to the diaphragm and the lung and these areas were excised en bloc. The diaphragm was reconstructed with a Gote-Tex mesh. Frozen section margins were negative.
Results: The patient went home on the 5th postoperative day without any complications. Pathology confirmed metastatic mucinous adenocarcinoma involving the adrenal and adjacent periadrenal soft tissue.
Conclusions: It is feasible to approach local colorectal metastasis recurrence by laparoscopy, even after two open surgeries in expert hands.
|VL03-02 ||Laparoscopic Liver Abscess Drainage using Thoracic Drain as a Safe and Effective Procedure
Adeodatus Yuda Handaya, Indonesia
A. Yuda Handaya1, V.A.P. Werdana2
1Surgery, Gadjah Mada University/Sardjito Hospital, Indonesia, 2Gadjah Mada University/Sardjito Hospital, Indonesia
Liver abscess is an infection and collection of pus in the liver
parenchyma. Incidence of liver abscess ranging from 2.3 - 275.4 case per
100.000 hospital admission around the world, while the mortality ranging from
10% - 40%. Management of liver abscess can be done by surgical and non-surgical
treatment. In the bigger liver abscess or complicated liver abscess, the
surgical drainage can be performed. The minimal invasive procedure has been the
choice to treat liver abscess.
Here is the step-by-step to perform liver drainage using thoracic
drain. The first step is umbilical port incision, insert port 1 and laparoscope.
After that, identify the liver and abscess site using laparoscopic lighting as transillumination
to guide drainage. Proceed to the liver abscess puncture using abbocath needle,
make sure the liver contain abscess. Insert 28 Fr thoracic drain to drainage
the abscess. Evaluate the perihepatic spillage using laparoscope. Wash the abdominal
and insert the subhepatic drain to prevent perihepatic abscess. One week of evaluation
shows a good result, without complication and residual liver abscess.
The use of thoracic drain guided by the laparoscopic lighting as
transillumination can facilitate surgeon in determining the location of liver
abscess and allow effective penetration with exact placement, effective
drainage, and safe procedure.
|VL03-03 ||Laparoscopic Segment IV Liver Cyst Excision (Cystopericystectomy)
Dhaivat Vaishnav, India
GI and HPB Surgery, Zydus Hospital, Ahmedabad, India
56 yr old male
cystic lesion probably arising from liver
• CECT scan (abdomen)
20 cm large cystic lesion arising from segment IV of liver extending to segment
II and III , displacing stomach as well as indenting neck of pancreas
hepatic artery was splaying over cyst
he underwent laparoscopic cystopericystectomy.