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Article: Revisiting the Institut Mutualiste Montsouris Difficulty Classification of Laparoscopic Liver Resection with the Data from a Personal Series-Evaluations for the Difficulty of Left Medial Sectionectomy and Length of Hospital Stay.

Morise, Zenichi

2024 Volume 14, Issue 3

Abstract: The IMM (Institut Mutualiste Montsouris) difficulty classification for laparoscopic liver resection is based only on the type of surgical procedure. It is useful for assessing outcomes and setting benchmarks in a group sharing the same indications. There ...

Abstract	The IMM (Institut Mutualiste Montsouris) difficulty classification for laparoscopic liver resection is based only on the type of surgical procedure. It is useful for assessing outcomes and setting benchmarks in a group sharing the same indications. There is, however, no left medial sectionectomy in the system. Its difficulty was evaluated using the same methodology as IMM with the data from a personal series. Furthermore, length of hospital stay was evaluated as the representative of short-term outcomes. IMM scores of our right and left hemihepatectomies, right anterior sectionectomy, and segment 7 or 8 segmentectomies are 3. That of left medial sectionectomies is 2, the same as right posterior sectionectomy and segment or less anatomical resections. Those of left lateral sectionectomy and partial resection are 0. The group with a score of 3 was divided into two groups-with and without extended hospital stays (extended only for right hemihepatectomies and right anterior sectionectomies). The difficulty of medial sectionectomy was positioned at the same level as posterior sectionectomy and segment or less anatomical resections. The result from the second evaluation may indicate that there are other factors with an impact on difficulty related to short-term outcomes, other than intraoperative surgical difficulty from the procedure itself.
Language	English
Publishing date	2024-02-22
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2662248-8
ISSN	2075-4426
ISSN	2075-4426
DOI	10.3390/jpm14030232
Database	MEDical Literature Analysis and Retrieval System OnLINE

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Article: Editorial (Preface) for the Special Issue on Advances in Minimally Invasive Liver Resection for Cancer Therapies.

Morise, Zenichi

Cancers

2023 Volume 15, Issue 13

Abstract: After the initial reports of laparoscopic liver resection (LLR) in the early 1990s, minimally invasive liver resection has been rapidly developing based on technical and instrumental improvements [ ... ]. ...

Abstract	After the initial reports of laparoscopic liver resection (LLR) in the early 1990s, minimally invasive liver resection has been rapidly developing based on technical and instrumental improvements [...].
Language	English
Publishing date	2023-07-06
Publishing country	Switzerland
Document type	Editorial
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15133520
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Article ; Online: Current status of minimally invasive liver surgery for cancers.

Morise, Zenichi

World journal of gastroenterology

2022 Volume 28, Issue 43, Page(s) 6090–6098

Abstract: Hepatocellular carcinoma (HCC) patients have chronic liver disease with functional deterioration and multicentric oncogenicity. Liver surgeries for the patients should be planned on both oncological effects and sparing liver function. In colorectal ... ...

Abstract	Hepatocellular carcinoma (HCC) patients have chronic liver disease with functional deterioration and multicentric oncogenicity. Liver surgeries for the patients should be planned on both oncological effects and sparing liver function. In colorectal patients with post-chemotherapy liver injury and multiple bilateral tumors, handling multiple tumors in a fragile/easy-to-bleed liver is an important issue. Liver surgery for biliary tract cancers is often performed as a resection of large-volume functioning liver with extensive lymphadenectomy and bile duct resection/reconstruction. Minimally invasive liver surgery (MILS) for HCC is applied with the advantages of laparoscopic for cases of cirrhosis or repeat resections. Small anatomical resections using the Glissonian, indocyanine green-guided, and hepatic vein-guided approaches are under discussion. In many cases of colorectal liver metastases, MILS is applied combined with chemotherapy owing to its advantage of better hemostasis. Two-stage hepatectomy and indocyanine green-guided tumor identification for multiple bilateral tumors are under discussion. In the case of biliary tract cancers, MILS with extensive lymphadenectomy and bile duct resection/reconstruction are developing. A robot-assisted procedure for dissection of major vessels and handling fragile livers may have advantages, and well-simulated robot-assisted procedure may decrease the difficulty for biliary tract cancers.
MeSH term(s)	Humans ; Carcinoma, Hepatocellular/surgery ; Indocyanine Green ; Liver Neoplasms/surgery ; Biliary Tract Neoplasms
Chemical Substances	Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2022-12-02
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v28.i43.6090
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Article ; Online: Laparoscopic repeat liver resection.

Morise, Zenichi

Annals of gastroenterological surgery

2020 Volume 4, Issue 5, Page(s) 485–489

Abstract: Recurrence of liver cancers inside the liver are often treated with liver resection (LR). However, increased risks of complications and conversion during operation were reported in laparoscopic repeat LR (LRLR). The indication is still controversial. One ...

Abstract	Recurrence of liver cancers inside the liver are often treated with liver resection (LR). However, increased risks of complications and conversion during operation were reported in laparoscopic repeat LR (LRLR). The indication is still controversial. One multi-institutional propensity score matching analysis of LRLR vs open repeat LR for hepatocellular carcinoma, two propensity score matching analyses for colorectal metastases, and two meta-analyses including hepatocellular carcinoma, intrahepatic cholangiocarcinoma, metastases, and other tumors have been reported to date. LRLR was reported with better to comparable short-term and similar long-term outcomes. Furthermore, the shorter operation time and the smaller amount of intraoperative bleeding for LRLR was reported for the patients who had undergone laparoscopic rather than open LR as an earlier procedure. The speculations are presented, that complete dissection of adhesion can be dodged and laparoscopic minor repeated LR can minimize the liver functional deterioration in cirrhotic patients. LRLR, as a powerful local therapy, could contribute to the long-term outcomes of those with deteriorated liver function. However, the procedure is now in its developing stage worldwide and further accumulation of experiences and evaluation are needed.
Language	English
Publishing date	2020-06-10
Publishing country	Japan
Document type	Journal Article ; Review
ISSN	2475-0328
ISSN (online)	2475-0328
DOI	10.1002/ags3.12363
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Article ; Online: Developments and perspectives of laparoscopic liver resection in the treatment of hepatocellular carcinoma.

Morise, Zenichi

Surgery today

2019 Volume 49, Issue 8, Page(s) 649–655

Abstract: Laparoscopic liver resection (LLR) was introduced in the early 1990s, initially for partial resection of the anterolateral segments, from where it has expanded in a stepwise fashion. Movement restriction makes bleeding control demanding. Managing ... ...

Abstract	Laparoscopic liver resection (LLR) was introduced in the early 1990s, initially for partial resection of the anterolateral segments, from where it has expanded in a stepwise fashion. Movement restriction makes bleeding control demanding. Managing pneumoperitoneum pressure with inflow control can inhibit venous bleeding and create a dry surgical field for easier hemostasis. Since the lack of overview leads to disorientation, simulation and navigation with imaging studies have become important. Improved direct access to the liver inside the rib cage can be obtained in LLR, reducing destruction of the associated structures and decreasing the risk of refractory ascites and liver failure, especially in patients with a cirrhotic liver. Although LLR can be performed as bridging therapy to transplantation for severe cirrhosis, its impact on expanding the indications of liver resection (LR) and the consequent survival benefits must be evaluated. For repeat LR, LLR is advantageous by producing fewer adhesions and reducing the need for adhesiolysis. The laparoscopic approach facilitates better access in a small operative field between adhesions. Further evaluations are needed for repeat anatomical resection, since alterations of the anatomy and surrounding scars and adhesions of major vessels have a larger impact.
MeSH term(s)	Carcinoma, Hepatocellular/surgery ; Hepatectomy/methods ; Hepatectomy/trends ; Humans ; Laparoscopy/methods ; Laparoscopy/trends ; Liver/surgery ; Liver Cirrhosis/surgery ; Liver Failure/prevention & control ; Liver Neoplasms/surgery ; Postoperative Complications/prevention & control ; Reoperation ; Treatment Outcome
Language	English
Publishing date	2019-01-16
Publishing country	Japan
Document type	Journal Article ; Review
ZDB-ID	1115435-4
ISSN	1436-2813 ; 0941-1291
ISSN (online)	1436-2813
ISSN	0941-1291
DOI	10.1007/s00595-019-1765-9
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Article: Status and perspective of laparoscopic repeat liver resection.

Morise, Zenichi

World journal of hepatology

2018 Volume 10, Issue 7, Page(s) 479–484

Abstract: Liver resection (LR) is now actively applied to intrahepatic recurrence of liver metastases and hepatocellular carcinoma. Although indications of laparoscopic LR (LLR) have been expanded, there are increased risks of intraoperative complications and ... ...

Abstract	Liver resection (LR) is now actively applied to intrahepatic recurrence of liver metastases and hepatocellular carcinoma. Although indications of laparoscopic LR (LLR) have been expanded, there are increased risks of intraoperative complications and conversion in repeat LLR. Controversy still exists for the indication. There are 16 reports of small series to date. These studies generally reported that repeat LLR has better short-term outcomes than open (reduced bleedings, less or similar morbidity and shorter hospital stay) without compromising the long-term outcomes. The fact that complete adhesiolysis can be avoided in repeat LLR is also reported. In the comparison of previous procedures, it is reported that the operation time for repeat LLR was shorter for the patients previously treated with LLR than open. Furthermore, it is speculated that LLR for minor repeat LR of cirrhotic liver can be minimized the deterioration of liver function by LR. However, further experience and evaluation of anatomical resection or resections exposing major vessels as repeat LLR, especially after previous anatomical resection, are needed. There should be a chance to prolong the overall survival of the patients by using LLR as a powerful local therapy which can be applied repeatedly with minimal deterioration of liver function.
Language	English
Publishing date	2018-05-24
Publishing country	United States
Document type	Journal Article ; Review
ZDB-ID	2573703-X
ISSN	1948-5182
ISSN	1948-5182
DOI	10.4254/wjh.v10.i7.479
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Article: Laparoscopic liver resection for the patients with hepatocellular carcinoma and chronic liver disease.

Morise, Zenichi

Translational gastroenterology and hepatology

2018 Volume 3, Page(s) 41

Abstract: Liver resection (LR), liver transplantation (LT), transarterial chemoembolization, and local ablation therapy are the treatment options for hepatocellular carcinoma (HCC). Although LR, LT and local ablation therapy (only for small tumor) provide the best ...

Abstract	Liver resection (LR), liver transplantation (LT), transarterial chemoembolization, and local ablation therapy are the treatment options for hepatocellular carcinoma (HCC). Although LR, LT and local ablation therapy (only for small tumor) provide the best hope for cure, most patients with HCC have also chronic liver disease (CLD) backgrounds, including HCV-liver cirrhosis. Therefore, they are at high risk for development of postoperative complications-sometimes fatal-and metachronous multicentric recurrent tumors occurring from the preneoplastic CLD background. Appropriate treatment is selected for HCC patients, on the combined evaluations of tumor condition and liver function. However, not small number of patients cannot undergo any treatment option due to poor liver function and/or complicated tumor condition. After repeated treatments, it can happen more often. It is thought that the features of laparoscopic LR could lead to the expansion of the LR indication to those patients, in the settings of severe CLD, repeat LR and bridging to LT. In our experience, Child-Pugh (CP) score is one of the promising candidates as a selection indicator which correlates well to our indication criteria of surface small laparoscopic LR to severe CLD patients, patient's performance status, and prognosis. Portal hypertension should be also counted in the selection criteria.
Language	English
Publishing date	2018-07-16
Publishing country	China
Document type	Journal Article ; Review
ISSN	2415-1289
ISSN	2415-1289
DOI	10.21037/tgh.2018.07.01
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Article ; Online: Laparoscopic liver resection for posterosuperior tumors using caudal approach and postural changes: A new technical approach.

Morise, Zenichi

World journal of gastroenterology

2016 Volume 22, Issue 47, Page(s) 10267–10274

Abstract: Laparoscopic liver resection (LLR) for tumors in the posterosuperior liver [segment (S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space (rib cage), with the large and heavy right liver ... ...

Abstract	Laparoscopic liver resection (LLR) for tumors in the posterosuperior liver [segment (S) 7 and deep S6] is a challenging clinical procedure. This area is located in the bottom of the small subphrenic space (rib cage), with the large and heavy right liver on it when the patient is in the supine position. Thus, LLR of this area is technically demanding because of the handling of the right liver which is necessary to obtain a fine surgical view, secure hemostasis and conduct the resection so as to achieve an appropriate surgical margin in the cage. Handling of the right liver may be performed by the hand-assisted approach, robotic liver resection or by using spacers, such as a sterile glove pouch. In addition, the operative field of posterosuperior resection is in the deep bottom area of the subphrenic cage, with the liver S6 obstructing the laparoscopic caudal view of lesions. The use of intercostal ports facilitates the direct lateral approach into the cage and to the target area, with the combination of mobilization of the liver. Postural changes during the LLR procedure have also been reported to facilitate the LLR for this area, such as left lateral positioning for posterior sectionectomy and semi-prone positioning for tumors in the posterosuperior segments. In our hospital, LLR procedures for posterosuperior tumors are performed
MeSH term(s)	Hepatectomy/adverse effects ; Hepatectomy/methods ; Humans ; Laparoscopy/adverse effects ; Liver Neoplasms/pathology ; Liver Neoplasms/surgery ; Patient Positioning ; Postoperative Complications/etiology ; Prone Position ; Treatment Outcome
Language	English
Publishing date	2016-12-21
Publishing country	United States
Document type	Editorial
ZDB-ID	2185929-2
ISSN	2219-2840 ; 1007-9327
ISSN (online)	2219-2840
ISSN	1007-9327
DOI	10.3748/wjg.v22.i47.10267
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Article ; Online: Is laparoscopic surgery beneficial and minimally invasive? How does the approach work and where does it lead?

Zenichi Morise

Fujita Medical Journal, Vol 2, Iss 2, Pp 22-

2016 Volume 24

Abstract: Since the first introduction of laparoscopic cholecystectomy, the field of laparoscopic surgery has expanded rapidly to include surgery for other organs, and more complex and technically demanding abdominal surgery. The reduced invasiveness of ... ...

Abstract	Since the first introduction of laparoscopic cholecystectomy, the field of laparoscopic surgery has expanded rapidly to include surgery for other organs, and more complex and technically demanding abdominal surgery. The reduced invasiveness of laparoscopic surgery is seen clinically in the rapid recovery and return to normal activities that results from reduced patient pain, destruction of the abdominal wall, and damage to organs and peritoneum when exposed to air. However, the exact procedure being performed in the abdominal cavity is sometimes a more important factor affecting the invasiveness of the surgery. Complicated and technically demanding procedures, which often increase the operation time and bleeding, and alter organ function, are sometimes more invasive by their nature, which diminishes the merits of laparoscopic surgery. For example, laparoscopic liver resections (LLR) under different settings have different results with or without the merits of laparoscopic surgery. In patients with hepatocellular carcinoma with the background chronic liver disease, LLR allows the surgeon to resect the tumor-bearing area with minimal damage to the liver and the surrounding environment, and to lower the risks of postoperative ascites and liver failure. However, these findings apply specifically to this setting and results differ for others. As indications expand, the true advantages and disadvantages of specific procedures in laparoscopic surgery should be reconsidered depending on the setting of each procedure.
Keywords	laparoscopic surgery ; laparoscopic liver resection ; indication ; hepatocellular carcinoma ; chronic liver disease ; Medicine (General) ; R5-920
Subject code	610
Language	English
Publishing date	2016-05-01T00:00:00Z
Publisher	Fujita Medical Society
Document type	Article ; Online
Database	BASE - Bielefeld Academic Search Engine (life sciences selection)

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Article: Perspective of laparoscopic liver resection for hepatocellular carcinoma.

Morise, Zenichi

World journal of gastrointestinal surgery

2015 Volume 7, Issue 7, Page(s) 102–106

Abstract: Liver resection (LR) for hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD) is associated with high risks of developing significant postoperative complications and multicentric metachronous lesions, which can result in the need ... ...

Abstract	Liver resection (LR) for hepatocellular carcinoma (HCC) in patients with chronic liver disease (CLD) is associated with high risks of developing significant postoperative complications and multicentric metachronous lesions, which can result in the need for repeated treatments. Studies comparing laparoscopic procedures to open LR consistently report reduced blood loss and transfusions requirements, lower postoperative morbidity, and shorter hospital stays, with no differences in oncologic outcomes. In addition, laparoscopic LR is associated with reduced postoperative ascites and a lower incidence of liver failure for HCC patients with CLD, due to the reduced surgery-induced parenchymal injury to the residual liver and limited destruction of the collateral blood/lymphatic flow around the liver. Finally, this procedure facilitates subsequent repeat LR due to minimal adhesion formation and improved vision/manipulation between adhesions. These characteristics of laparoscopic LR may lead to an expansion of the indications for LR. This editorial is based on the review and meta-analysis presented at the 2(nd) International Consensus Conference on Laparoscopic Liver Resection in Iwate, Japan, in October 2014 (Chairperson of the congress is Professor Go Wakabayashi from the Department of Surgery, Iwate Medical University School of Medicine), which is published in the Journal of Hepato-Biliary-Pancreatic Sciences.
Language	English
Publishing date	2015-07-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	2573700-4
ISSN	1948-9366
ISSN	1948-9366
DOI	10.4240/wjgs.v7.i7.102
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