A 75-year-old male with history of chronic HCV- related hepatitis, in regular follow-up and sustained viral response (SVR), presented at our Emergency Department for sudden epigastric pain. Urgency CT scan and subsequent abdominal MRI revealed a 2,5cm monofocal HCC in S5 with surrounding hepatic hematoma (7cm of extension) and hemoperitoneum layer. The procedure consisted in laparoscopic exploration, lysis of tenacious adhesions between hepatic hematoma and the right colic flexure, intraoperative ultrasound to assess tumor extension, preparation of Pringle Maneuver and parenchyma transection with ultrasound dissector combined with colecistectomy.
Specialty: Hepatobiliary Surgery
Laparoscopic Coledocoscopy
A 47-year-old male, with a history of multiple cholelithiasis and multiple choledochal lithiasis, who presented with multiple episodes of cholangitis for which endoscopic treatment (ERCP + stenting) was performed. After 4 unsuccessful attempts to resolve the bile duct by endoscopic approach, it was decided to perform minimally invasive laparoscopic surgery.
In this video we can observe the Choledochotomy, followed by extraction of stones and biliary mud. Subsequently, a choledochoscopy is performed with the laparoscopic camera (10 mm) with infusion of sterile Physiological Solution since the patient had a very dilated bile duct. Choledochorrhaphy is then performed.
A Novel Technique for Reconstruction of Right and Left Hepatic Arteries in Pancreaticoduodenectomy
A 55yo lady undergoing open pancreaticoduodenectomy for duodenal adenocarcinoma was intra-operatively found to have macroscopic tumour involvement of the proper hepatic artery and its bifurcation. The diseased segment was resected and a novel technique for reconstruction was performed- the remnant common hepatic artery was anastomosed to the remnant right hepatic artery, and the left gastric to the remnant left hepatic artery. Doppler ultrasound confirmed patency of all anastomoses prior to closure. Synthetic function of the liver and bilirubin recovered to appropriate levels postoperatively, and the patient was planned for adjuvant chemotherapy.
Laparoscopic Common Bile Duct Exploration for Mirizzi Syndrome: Technical Tips
Mirizzi syndrome, the mechanical obstruction of the common hepatic duct secondary to extrinsic compression of stones impacted in the gallbladder neck or the cystic duct, is a rare complication of cholelithiasis (0.2% to 1.5% of patients). Up to 50% of patients are diagnosed intra-operatively.
We describe technical tips of laparoscopic treatement of Mirizzi Syndrome, including laparoscopic cholecystectomy, common bile duct exploration and stone extraction. Often it is best to fashion the ductotomy over the palpable stone. T tube cholangiogram is also invaluable.
In conclusion, laparoscopic treatment may be used for Mirizzi Syndrome.
Contributor:Dr. Manish Parikh
Laparoscopic Treatment for Hydatid Cyst of the Liver
Authors:
Maja Odovic M.D, Dider Roulin M.D, Nermin Halkic PD MER
Correspondence to:
Maja Odovic M.D.
Department of Visceral Surgery
University Hospital of Lausanne (CHUV)
E-mail: Maja.Odovic@chuv.ch
Didier Roulin M.D
Department of Visceral Surgery
University Hospital of Lausanne (CHUV)
E-mail: Dider.Roulin@chuv.ch
Nermin Halkic PD MER
Department of Visceral Surgery
University Hospital of Lausanne (CHUV)
E-mail: Nermin. Halkic@chuv.ch
This is a video of surgical technique for laparoscopic pericystectomie. The video describes all the steps of the procedure and pays special attention to the pitfalls.