The anterior approach liver resection has advantages compared to conventional liver resection. Mobilization during conventional liver resection may cause local pressure on the tumor which could lead to tumor cell dissemination or even to tumor rupture. Furthermore, hemodynamic parameters tend to deteriorate during mobilization due to compression or twisting of the inferior vena cava. In addition, the left liver lobe often is compressed which can lead to tissue damage of the residual parenchyma. The risk of these complications can be reduced by the anterior approach technique which is facilitated by the so-called liver hanging maneuver. Appropriate indications for this technique are large tumors of the right liver lobe, tumors with infiltration of the right hepatic vein and infiltration of the vena cava from the right side, tumors with infiltration of the diaphragm and tumors of the right lobe after previous resections of the right lobe.

"Anterior approach" mit dem "Hanging liver maneuver". Technik und Indikationen.

DONATI, MARCELLO ANGELO ALFREDO;
2012

Abstract

The anterior approach liver resection has advantages compared to conventional liver resection. Mobilization during conventional liver resection may cause local pressure on the tumor which could lead to tumor cell dissemination or even to tumor rupture. Furthermore, hemodynamic parameters tend to deteriorate during mobilization due to compression or twisting of the inferior vena cava. In addition, the left liver lobe often is compressed which can lead to tissue damage of the residual parenchyma. The risk of these complications can be reduced by the anterior approach technique which is facilitated by the so-called liver hanging maneuver. Appropriate indications for this technique are large tumors of the right liver lobe, tumors with infiltration of the right hepatic vein and infiltration of the vena cava from the right side, tumors with infiltration of the diaphragm and tumors of the right lobe after previous resections of the right lobe.
Die „Anterior-approach-Leberresektion“ hat gegenüber der konventionellen Leberresektion besonders bei Tumoren im rechten Leberlappen potenzielle Vorteile. So wird bei der konventionellen Resektion während der Mobilisation Druck auf den Tumor im rechten Leberlappen ausgeübt, der zu einer vermehrten Tumorzellaussaat oder gar bei sehr großen Tumoren zu einer Tumorruptur führen kann. Ferner können sich während der Mobilisation des rechten Leberlappens die hämodynamischen Parameter des Patienten durch Kompression oder „Zudrehen der V. cava“ verschlechtern. Zusätzlich wird der linke Leberlappen komprimiert, was zu einer Parenchymschädigung dieses Leberlappens führen kann. Durch die Anterior-approach-Technik kann das Risiko dieser Komplikationen reduziert werden. Das sog. „Liver-hanging-Manöver“ erleichtert die technische Durchführung der Anterior-approach-Leberresektion. Gute Indikationen für diese Technik stellen große Tumoren des rechten Leberlappens, Tumoren mit Infiltration der rechten Lebervene und Infiltration der V. cava von rechts, Tumoren mit Infiltration des Zwerchfells sowie Tumoren des rechten Leberlappens nach vorangegangener Rechtsresektion dar. Die Anterior-approach-Leberresektion sollte besonders bei großen rechtsseitigen Lebertumoren gegenüber der konventionellen Resektionstechnik bevorzugt werden.
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Utilizza questo identificativo per citare o creare un link a questo documento: https://hdl.handle.net/20.500.11769/60195
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