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- W2895762635 abstract "Introduction: A large hepatocellular carcinoma (HCC) can sometimes directly invade a large area of pericardium. There were few discussions about minimally invasive hepatectomy for this situation. Method: For a large HCC of left liver penetrating inferior pericardium, laparoscopic transection of liver parenchyma was performed by caudal to cranial approach until the middle and left hepatic vein trunk was exposed intraparenchymally. A window of diaphragm and pericardium were opened through a tumour-free zone ventral to these veins. When laparoscope inspected the heart in pericardial space through this window, pneumoperitoneum was avoided to decrease the pressure from intraperitoneal to pericardial space. A subxiphoid mini-laparotomy was then created to enhance caudal traction of diaphragm and pericardium. It made more space for a gasless laparoscopic view of pericardium surface (Fig. 1). When laparoscopic en bloc resection finished, the whole specimen was removed through the mini-laparotomy wound. By the laparoscopic magnified view and by different needle holders through subxiphoid wound, the wide (≅10 cm ) pericardial defect and the even wider diaphragmatic defect were repaired with ePTFE membrane and mesh. Movement of needle holders through the mini-laparotomy wound was excellently flexible. At the same time, gasless laparoscopy still provided a wide view of the space behind the sternum and costal margin, which a mini-laparotomy could not offer. Such manoeuvre helped precise placement of many needles of sutures through the narrow edges of pericardium defect near a beating heart. Results: No accidental cardiac puncture. Free tumour margin. Good patient recovery. Conclusions: A safe and time-saving method." @default.
- W2895762635 created "2018-10-12" @default.
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- W2895762635 date "2018-09-01" @default.
- W2895762635 modified "2023-09-30" @default.
- W2895762635 title "A simple method for repairing a large pericardial and diaphragmatic wound after minimally invasive hepatectomy for a large liver tumour which penetrated pericardium" @default.
- W2895762635 doi "https://doi.org/10.1016/j.hpb.2018.06.1821" @default.
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