ObjectiveTo evaluate whether radiofrequency-assisted associating liver partition and portal vein ligation for staged hepatectomy (RALPPS) is a safer and more effective modified treatment for patients with cirrhosis-related hepatocellular carcinoma (HCC). MethodsRALPPS were performed in patients with HCC and insufficient volume of future liver remnant (FLR<40%). Data of the patients during perioperative period such as operative morbidity, mortality, operative time, blood loss, percent increase in FLR, and interval between operations, were analyzed to assess the effectiveness and safety of the operation. ResultsA total of 8 patients were performed the RALPPS operation, and 6 cases completed both stages, 2 cases of postoperative complications or tumor metastasis did not complete the two phase of surgery. The average first and second stages operative time was (214.3±35.7) min, (266.7±46.0) min, respectively, and the average two stages blood loss during the operation was (218.8±113.2) mL,(501.7±224.5) mL, respectively. The mean preoperative FLR was (26.4±7.1)%, and the mean FLR before the second stage was (46.2±4.6)%. The average percentage increase in FLR during the interval time was 35%-113%, and the mean time interval between operations were (22.2±6.4) days. One case died of renal failure and severe pulmonary infection after two operation. Seven patients were followed-up (11.6+2.0) months (8-15 months). Two patients who had not completed the two-stage operation died within 3 months after discharge. Three patients who had completed the two-stage operation were tumor recurrence in 3-9 months after discharged from hospital and supplemented interventional therapy, 1 of them died,and 2 patients were followed-up to now without recurrence. ConclusionsRALPPS is equivalent to ALPPS for treating patients with cirrhosis-related HCC and insufficient FLR volume.
ObjectiveTo explore technical essentials and safety of laparoscopic cholecystectomy (LC) guided by gallbladder ampulla localization on an imaginary clock for cholecystitis.MethodsA retrospective study of 8 707 continuous patients with mild cholecystitis who underwent LC from July 1998 to February 2018 at a single institution was conducted. Among them, 3 168 patients were treated by the traditional LC from July 1998 to February 2007 (a traditional LC group), 5 539 patients were treated by the LC with the guidance of the gallbladder ampulla localization on an imaginary clock from March 2007 to February 2018 (a gallbladder ampulla localization group). The conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury, operative time, intraoperative blood loss, and postoperative hospital stays were compared between the traditional LC group and the gallbladder ampulla localization group.ResultsThere were no significant differences in the gender, age, course of disease, and type of cholecystitis between these two groups (P>0.050). The rates of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding, bile leakage without bile duct injury and the operative time, intraoperative blood loss and postoperative hospital stays in the traditional LC group were 3.00% (95/3 168), 0.13% (4/3 168), 0.09% (3/3 168), 0.03% (1/3 168), (43.6±12.6) min, (18.7±3.3) mL, (3.6±2.7) d, respectively, which in the gallbladder ampulla localization group were 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), 0 (0/5 539), (32.2±10.5) min, (12.4±3.5) mL, (3.5±2.8) d, respectively. The differences of conversion to open surgery, bile duct injury, return to the operating room due to postoperative massive abdominal bleeding rates, and the operative time and intraoperative blood loss were statistically significant between these two groups (P<0.050). The differences of the bile leakage without bile duct injury rate and postoperative hospital stays were not statistically significant between the two groups (P>0.050).ConclusionThis study shows that gallbladder ampulla localization on an imaginary clock is useful for ductal identification so as to reduce bile duct injury and improve safety of LC in case of no conversion to open surgery.