Division of Hepatobiliary and General Surgery, Department of Surgery, IRCCS Humanitas Research Hospital, Via Manzoni 56, Rozzano, 20089, Milan, Italy.
Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Milan, Italy.
Updates Surg. 2022 Feb;74(1):373-377. doi: 10.1007/s13304-021-01128-x. Epub 2021 Jul 25.
Laparoscopic liver surgery has a wide diffusion worldwide, but the reproducibility of a parenchyma-sparing approach with a minimally invasive technique is still to explore. Intraoperative ultrasound (IOUS) is a mandatory tool to guarantee safety (transection plane) and oncological adequacy (margin) of minor but complex resections for deep-located tumors. The hooking technique has been developed exactly with this aim: once a vessel is isolated and encircled, the surgeon applies gentle traction on the tape surrounding the vessel and, under IOUS vision, "recognizes" the vessel and the adequate level of section. At present, advanced IOUS-guided maneuvers have limited application to laparoscopic liver surgery. We report the first application of the hooking maneuver during laparoscopic hepatectomy in three consecutive patients. In all cases, it was successfully performed and allowed to section the proper vessel at the right level. No procedure-related complications occurred and no ischemic areas of the remnant liver were evident. All resections had a negative surgical margin. Even if technically demanding, the laparoscopic hooking technique is a further step toward the standardization of a minimally invasive approach to advanced parenchyma-sparing liver surgery.
腹腔镜肝手术在全球范围内得到了广泛应用，但微创技术中小范围保留肝实质的方法的可重复性仍有待探索。术中超声（IOUS）是保证安全（切割平面）和肿瘤学适当性（边缘）的强制性工具，对于位于深部的小而复杂的肿瘤切除。钩技术正是出于这个目的而开发的：一旦隔离和包围了血管，外科医生就会在 IOUS 视野下，在环绕血管的胶带上轻轻施加拉力，并“识别”血管和适当的切割水平。目前，先进的 IOUS 引导操作在腹腔镜肝切除术中的应用有限。我们报告了在连续三例腹腔镜肝切除术中首次应用钩操作的情况。在所有情况下，该操作均成功完成，并允许在正确的水平上对适当的血管进行分段。没有发生与操作相关的并发症，也没有明显的残余肝缺血区。所有切除均有阴性手术切缘。尽管技术要求较高，但腹腔镜钩技术是微创技术向高级保留肝实质肝切除术标准化的又一进步。
