Standardization of surgical procedures for laparoscopic Spiegel lobectomy: A single-institutional experience
Standardization of surgical procedures for laparoscopic Spiegel lobectomy: A single-institutional experience
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DOI：
10.1111/ases.12609
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发表时间：
2019-04-01
影响因子：
1
通讯作者：
Yamaue, Hiroki
中科院分区：
文献类型：
--
作者：
Hayami, Shinya;Ueno, Masaki;Yamaue, Hiroki
前言：Spiegel肺叶切除术因其解剖位置较深，手术技术难度较大。腹腔镜Spiegel肺叶切除术尚未被标准化或广泛报道。在本研究中，我们对腹腔镜Spiegel肺叶切除术进行了技术改进，包括肝脏悬吊手法。此外，我们还证明了这种手术的安全性和可行性。材料和外科技术我们连续对6名患者进行了腹腔镜Spiegel肺叶切除术：5名肝细胞癌患者和1名结直肠癌肝转移患者。作为肝实质切除前的准备，对Spiegel叶进行了必要和充分的松动。从肺门板显露出几个Spiegel叶的Glissson蒂，并将其分开，以减少流入Spiegel叶的血流量。之后，在悬空动作中使用了血管胶带。在肝实质切除术中，将胶带向前拉，使切面产生适度的张力。在肝实质横切术中，提起这条胶带可以提供更好的暴露，以确定正确的切面。中位手术时间207分钟(147~240分钟)，术中出血量15~85毫升(35毫升)。没有严重的术后并发症。讨论我们安全地实施了腹腔镜Spiegel肺叶切除术。为了保持足够的手术视野，尤其是在肝实质切除术中，悬吊手法可能是一种有用的技术。这项关于标准化腹腔镜Spiegel肺叶切除术技术改进的单中心研究显示了良好结果的潜力。
IntroductionSurgical techniques for Spiegel lobectomy remain technically difficult because of its deep anatomical location. Laparoscopic Spiegel lobectomy has not yet been standardized or widely reported. In the current study, we introduce technical improvements, including the liver hanging maneuver, to laparoscopic Spiegel lobectomy. Additionally, we demonstrate the safety and feasibility of this procedure.Materials and Surgical TechniqueWe performed consecutive laparoscopic Spiegel lobectomy on six patients: five with hepatocellular carcinoma and one with colorectal liver metastasis. As preparation before liver parenchymal resection, necessary and sufficient mobilization of the Spiegel lobe was performed. A few Glissonian pedicles of the Spiegel lobe were exposed from the hilar plate and divided to reduce the inflow to the Spiegel lobe. After that, vessel tape was used in the hanging maneuver. The tape was pulled forward to give the cutting plane moderate tension during liver parenchymal resection. Lifting this tape provided better exposure for determining the correct cutting plane during liver parenchymal transection. The median operation time was 207min (range, 147-240min) and the median intraoperative blood loss was 35mL (range, 15-85mL). There were no severe postoperative complications.DiscussionWe safely performed laparoscopic Spiegel lobectomy. To maintain a sufficient surgical view, especially during liver parenchymal resection, the hanging maneuver may be a useful technique. This single-center investigation into standardized laparoscopic Spiegel lobectomy featuring improvements in technique showed potential for favorable results.