Abstract：
METHODS: Hepatocellular adenoma (HCA) is a benign monoclonal tumour that originates from mature hepatocytes.Liver resection is recommended in case of overt malignant transformation to hepatocellular carcinoma.However, hepatobiliary surgeries are technically challenging in patients with giant HCA (GHCA) owing to the risk of catastrophic intraoperative bleeding and difficulty with its control during laparoscopic treatment. We present a technical note on the utilization of the hepatic vein as anatomical landmarks for laparoscopic removal of giant hepatic glands, without intraoperative ultrasonography and with the aid of an augmented reality navigation system during surgery.
RESULTS: This video shows aA 37-year-old man was recommended treatment for a progressively increasing HCA (from 3 to 10 cm in a year) involving the right hepatic vein (RHV), inferior vena cava (IVC) and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers in CT. Laparoscopic hepatectomy was performed using the hepatic vein as anatomic markers in a treatment centre specialising in minimally invasive surgeries. The procedure involved fully mobilising the right liver, transecting the parenchyma along the demarcation line in the caudal-to-cranial direction, exposing the involved caudal MHV, isolating and transecting the involved RHV and preserving the integrity of the involved IVC.
CONCLUSIONS: Laparoscopic hepatectomy for intractable GHCA using the involved intrahepatic anatomic markers is feasible and effective. It reduces pre-operative haemorrhage and open conversion rates while maximising postoperative hepatic function.
RESULTS: This video shows aA 37-year-old man was recommended treatment for a progressively increasing HCA (from 3 to 10 cm in a year) involving the right hepatic vein (RHV), inferior vena cava (IVC) and middle hepatic vein (MHV), resulting in the invisibility of the above intrahepatic anatomic markers in CT. Laparoscopic hepatectomy was performed using the hepatic vein as anatomic markers in a treatment centre specialising in minimally invasive surgeries. The procedure involved fully mobilising the right liver, transecting the parenchyma along the demarcation line in the caudal-to-cranial direction, exposing the involved caudal MHV, isolating and transecting the involved RHV and preserving the integrity of the involved IVC.
CONCLUSIONS: Laparoscopic hepatectomy for intractable GHCA using the involved intrahepatic anatomic markers is feasible and effective. It reduces pre-operative haemorrhage and open conversion rates while maximising postoperative hepatic function.
摘要：
方法：肝细胞腺瘤（HCA）是一种良性单克隆肿瘤，起源于成熟的肝细胞。如果明显恶性转化为肝细胞癌，建议进行肝切除。然而,在巨大HCA（GHCA）患者中，肝胆手术在技术上具有挑战性，因为在腹腔镜治疗期间存在灾难性术中出血和控制困难的风险。我们提出了关于利用肝静脉作为腹腔镜切除巨大肝腺的解剖学标志的技术说明，无需术中超声检查，并在手术过程中借助增强现实导航系统。
结果：该视频显示，一名37岁的男性被推荐治疗涉及右肝静脉（RHV）的HCA逐渐增加（每年从3到10厘米），下腔静脉（IVC）和肝中静脉（MHV），导致上述肝内解剖标志物在CT中不可见。在专门从事微创手术的治疗中心，使用肝静脉作为解剖标记进行了腹腔镜肝切除术。这个过程包括充分调动右肝，沿分界线从尾到颅方向横切薄壁组织，暴露涉及的尾部MHV，分离和横切受累的RHV，并保持受累IVC的完整性。
结论：使用肝内解剖标志物对难治性GHCA进行腹腔镜肝切除术是可行和有效的。它可以减少术前出血和开放转换率，同时最大限度地提高术后肝功能。
结果：该视频显示，一名37岁的男性被推荐治疗涉及右肝静脉（RHV）的HCA逐渐增加（每年从3到10厘米），下腔静脉（IVC）和肝中静脉（MHV），导致上述肝内解剖标志物在CT中不可见。在专门从事微创手术的治疗中心，使用肝静脉作为解剖标记进行了腹腔镜肝切除术。这个过程包括充分调动右肝，沿分界线从尾到颅方向横切薄壁组织，暴露涉及的尾部MHV，分离和横切受累的RHV，并保持受累IVC的完整性。
结论：使用肝内解剖标志物对难治性GHCA进行腹腔镜肝切除术是可行和有效的。它可以减少术前出血和开放转换率，同时最大限度地提高术后肝功能。
