Impact of anthropometric data on technical difficulty of laparoscopic liver of resections of segments 7 and 8: the CHALL
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and Other Interventional Techniques
Impact of anthropometric data on technical difficulty of laparoscopic liver of resections of segments 7 and 8: the CHALLENGE index Nadia Russolillo1 · Cecilia Maina1 · Serena Langella1 · Roberto Lo Tesoriere1 · Michele Casella1 · Alessandro Ferrero1 Received: 8 April 2020 / Accepted: 14 September 2020 © Springer Science+Business Media, LLC, part of Springer Nature 2020
Abstract Background The high technical difficulty of using a laparoscopic approach to reach the posterosuperior liver segments is mainly associated with their poor accessibility. This study was performed to analyze correlations between anthropometric data and intraoperative outcomes. Study design All patients who underwent segmentectomy or wedge laparoscopic liver resection (LLR) of segments seven and/or eight from June 2012 to November 2019 were retrospectively analyzed. The exclusion criteria were intrahepatic cholangiocarcinoma, associated resection, multiple concomitant LLR, redo resection, and lack of preoperative imaging. Anthropometric data were correlated with intraoperative outcomes. Results Forty-one patients (wedge resection, n = 32; segmentectomy, n = 9) were analyzed. A strong correlation was found between the craniocaudal liver diameter (CCliv) and liver volume (r = 0.655, p 250 mL). Predictive factors of high intraoperative blood loss were analyzed.
Anthropometric data The following abdominal and liver morphological parameters were measured on preoperative imaging (Fig. 1). Abdominal diameters • Anteroposterior abdominal diameter (APabd), measured in the axial projection at the diaphragmatic caval hiatus and extending from the inner fascia to the anterior vertebral face.
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Surgical Endoscopy
• Laterolateral abdominal diameter (LLabd), measured in the axial projection at the diaphragmatic caval hiatus and extending from the inner fascia of the right quadrant to that of the left quadrant. Liver diameters • Maximum anteroposterior liver diameter (APliv), meas-
ured in the axial projection.
• Maximum laterolateral liver diameter (LLliv), measured
in the axial projection.
• Craniocaudal liver diameter (CCliv), measured on the
hepatocaval confluence plane from the dome edge in the cranial projection. In patients with subglissonian lesions, the CCliv was included in the measurement. • Liver dome height, measured in the cranial projection from the hepatocaval confluence plane. In patients with subglissonian lesion, the liver dome height was included in the measurement. Liver volume was calculated with the following equation [13]:
Liver volume = (APliv × LLliv × CCliv)∕2.6.
Perioperative management The indication for a laparoscopic approach was assessed for each patient. An absolute contraindication was the need for vascular resection and reconstruction. All laparoscopic liver procedures were performed using deep neuromuscular block. The surgical technique of LLR at our institution has been previously described [14, 15]. For resections involving Segments seven and eight, the patient was plac
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