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Techniques of Liver Surgery
Vinay Kumaran
CHAPTER 1:
Indications for Liver Resection
INTRODUCTION
Nomenclature
Brisbane Terminology
Anatomical versus Nonanatomical Resection
Advantages of Anatomical Resection
Exceptions in Malignant Lesions for Nonanatomical Resection
Remnant Future Liver Volume
Indications
PRIMARY LIVER TUMOR
Primary Hepatocellular Carcinoma
Bilobar HCC
Recurrent HCC
Contraindication for Liver Resection in HCC
Laparoscopic Liver Resection
Recommendations
METASTATIC LIVER TUMORS
Colorectal Liver Metastases
Recurrent Liver Metastases
INDICATIONS FOR RESECTION IN BENIGN CONDITIONS
Hydatid Cyst of Liver
Advantages of Radical Procedure
CONCLUSION
CHAPTER 2:
Techniques for Transection of the Liver
INTRODUCTION
IDEAL METHOD FOR PARENCHYMAL DIVISION
CLASSIFICATION OF TRANSECTION METHODS
Finger Fracture/Kelly Clasis
Crushing Clamp
Ultrasonic Shears
Ultrasonic Dissector Aspirator
Water Jet/Hydro Jet
ERBE Helix Hydrojet and ERBEJET 2
Monopolar Floating Ball
Habib RF Device
Bipolar Forceps
TRANSCOLLATION RF TECHNOLOGY
Aquamantys (Medtronic)
Bipolar Vessel Sealing Device
Plasma-Knife
Thunderbeat (Olympus)
Staplers
Argon Plasma Coagulator
ABC–ConMed, Argon Coagulation–Covidien, ERBE
Chang's Needle
COMPARISON OF DIFFERENT TRANSECTION METHODS
Liver Transection in Donor Hepatectomy
Adjuncts to Transection
Intraoperative Ultrasound
Vascular Occlusion
Intermittent Inflow Occlusion versus Ischemic Preconditioning
CONCLUSION
CHAPTER 3:
Operations for Benign Lesions of the Liver
INTRODUCTION
HEMANGIOMA
Morphology
Clinical Presentation
Diagnosis
Management
HEPATOCELLULAR ADENOMA
Morphology
Etiology
Clinical Presentation
Diagnosis
Treatment
FOCAL NODULAR HYPERPLASIA
Morphology
Etiology
Clinical Presentation
Diagnosis
Treatment
HYDATID CYST DISEASE
Life Cycle
Morphology
Complications
Compression
Infection
Biliary Communication
Bronchial Communication
Presentation
Diagnosis
Laboratory Investigations
Serology
Radiology
Treatment
Medical Treatment
Percutaneous Treatment
Surgical Treatment
Conservative Surgery
Radical Surgery
Postoperative Complications
Biliary Fistula
Biliary Stricture
Recurrence
Laparoscopy
SUMMARY
Hemangioma
Hepatic Adenoma
Focal Nodular Hyperplasia
Hepatic Hydatid Cyst
Surgery
Facilities Available
Facilities not Available
CHAPTER 4:
Operations for Carcinoma of the Gallbladder
INTRODUCTION
GALLBLADDER CARCINOMA
Role of Staging Laparoscopy
Extent of Resection According to the Stage
Extent of Liver Resection
Incidental Gallbladder Cancer
Lymph Node Dissection
Bile Duct Resection
Adjacent Organ Resection
Results
T1 Tumors
T2 Tumors
T3 Tumors
Incidental Gallbladder Cancer
Palliative Procedure
GALLBLADDER POLYPS
CONCLUSION
CHAPTER 5:
Operations for Carcinoma of the Bile Ducts
BACKGROUND
HILAR CHOLANGIOCARCINOMA
Clinical Presentation
Diagnosis
Staging
Surgical Technique: Right Trisegment- ectomy for Hilar Cholangiocarcinoma
POSTOPERATIVE CARE
SPECIAL ISSUES IN SURGERY FOR CHOLANGIOCARCINOMA
Preoperative Biliary Drainage
Portal Vein Embolization
Outcomes and Role of Adjuvant Therapy
SUMMARY
CHAPTER 6:
Operations for Hepatocellular Carcinoma
BACKGROUND
TREATMENT OPTIONS FOR HEPATOCELLULAR CARCINOMA
Evaluation of a Patient with HCC
Clinical Presentation
Diagnosis
Staging
PREPARATION FOR SURGERY
Operative Steps
Margin of Resection
Left Hepatectomy
Sectoral Resections
Caudate Lobe Resections
POSTOPERATIVE MANAGEMENT
Outcomes of Liver Resections
Laparoscopic Liver Resections
SUMMARY
CHAPTER 7:
Operations for Colorectal Liver Metastases
INTRODUCTION
PORTAL VEIN EMBOLIZATION
STAGED LIVER RESECTION
MARGIN OF RESECTION
LYMPH NODE DISSECTION
Resection after Recurrence in the Liver
The Role of Chemotherapy
CHAPTER 8:
Liver Transplant: Procurement of the Liver from a Deceased Donor
INTRODUCTION
TECHNICAL ASPECTS
Before Leaving for Donor Hospital
Arrival at Donor Center
Surgical Procedure
Positioning
Incision
Mobilization of Colon
EXPOSURE OF AORTA/ILIAC ARTERIES AND IVC
Dissection around SMA Origin
Liver and Pancreas Mobilization
Cannulation for Cold Flush
Cross Clamp and Cold Perfusion
Retrieving Abdominal Organs
Removal of Lymph Nodes
Removing Iliac and other Vessels
Back Table Flush
Donation after Cardiac Death (DCD)/Non Heart Beating Donor (NHBD)
Back Table Preparation
Variant Anatomy
CHAPTER 9:
Liver Transplant: Recipient Hepatectomy
INTRODUCTION
Living Donor Liver Transplant
Deceased Donor Liver Transplant
Special Situations
Steps of the Procedure
Recipient Hepatectomy
Position and Incision
Mobilization of the Right Lobe and Vena Cava
Dissection of the Porta
Dissection of the Porta
Anterior Cava Dissection
CHAPTER 10:
Liver Transplant: Implantation of a Whole Liver
INTRODUCTION
RECIPIENT HEPATECTOMY
Incision and Liver Mobilization
PORTAL DISSECTION
VENOVENOUS BYPASS
Implantation of the Cadaveric Liver
Piggyback Caval Reconstruction
Portal Vein Anastomosis
Classical Reconstruction
Side to Side Cavo-Caval Reconstruction
Arterial Anastomosis
Bile Duct Anastomosis
Roux en Y Bilio-enteric Anastomosis
Hemostasis and Closure
CHAPTER 11:
Living Donor Liver Transplant: Donor Hepatectomy
INTRODUCTION
DONOR EVALUATION
Ideal Donor
PSYCHIATRY ASSESSMENT
Anesthesiology Assessment
Liver Attenuation Index
Liver Volumetry
OPERATIVE STEPS
Anesthesia and Positioning
Incision and Laparotomy
Right Lobe Graft Retrieval
Mobilization
Hilar Dissection
Parenchymal Transection and Identification of Middle Hepatic Vein
Graft Retrieval
Stump Closure
Left Lobe Graft
Mobilization
Hilar Dissection and Parenchymal Transection
Graft Retrieval
Left Lateral Segment Retrieval
Bench Preparation of the Graft
Perfusion
Postoperative Care of the Donor
CHAPTER 12:
Living Donor Liver Transplant: Implantation of the Graft
INTRODUCTION
BASIC PREREQUISITES TO IMPLANTATION
STEPS OF IMPLANTATION
IVC Clamping
Hepatocaval Anastomosis Technique
Types of Right Liver Graft
Portal Venous Anastomosis
Portal Venous Anastomosis Technique
Reperfusion
Arterial Reconstruction
Technique of Hepatic Arterial Anastomosis (the W Technique)
Bile Duct Anastomosis
Types of Biliary Anastomosis
Technique for D-D anastomosis
INDEX
TOC
Index
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