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Article: All the Routes for Laparoscopic Liver Segment VIII Resection: A Comprehensive Review of Surgical Techniques.

Anselmo, Alessandro / Sensi, Bruno / Bacchiocchi, Giulia / Siragusa, Leandro / Tisone, Giuseppe

2022 Volume 12, Page(s) 864867

Abstract: Liver surgery is highly demanding for anatomical, physiological and technical reasons, and minimally invasive approaches have been implemented at a slower rate. Today, laparoscopic liver resection is a standard of care in many occasions, yet specific ... ...

Abstract	Liver surgery is highly demanding for anatomical, physiological and technical reasons, and minimally invasive approaches have been implemented at a slower rate. Today, laparoscopic liver resection is a standard of care in many occasions, yet specific operations remain particularly challenging and generally performed in open surgery. In particular, SVIII resection may be considered one of the most difficult due to anatomical characteristics including its sub-diaphragmatic position, the deep-lying Glissonean pedicle and the close contact with the inferior vena cava and right and middle hepatic veins. Many techniques have risen to overcome technical difficulties, and today laparoscopic SVIII resection has been demonstrated to be feasible. This review provides a complete picture of current approaches, focusing on all techniques reported so far with critical appraisal of each, discussing and explaining benefits and pitfalls.
Language	English
Publishing date	2022-04-01
Publishing country	Switzerland
Document type	Journal Article ; Review
ZDB-ID	2649216-7
ISSN	2234-943X
ISSN	2234-943X
DOI	10.3389/fonc.2022.864867
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Article ; Online: Rescue liver transplantation after post-hepatectomy acute liver failure: A systematic review and pooled analysis.

Angelico, Roberta / Siragusa, Leandro / Serenari, Matteo / Scalera, Irene / Kauffman, Emanuele / Lai, Quirino / Vitale, Alessandro

Transplantation reviews (Orlando, Fla.)

2023 Volume 37, Issue 3, Page(s) 100773

Abstract: Background: Post-hepatectomy liver failure is a severe complication after major liver resection and is associated with a high mortality rate. Nevertheless, there is no effective treatment for severe liver failure. In such a setting, rescue liver ... ...

Abstract	Background: Post-hepatectomy liver failure is a severe complication after major liver resection and is associated with a high mortality rate. Nevertheless, there is no effective treatment for severe liver failure. In such a setting, rescue liver transplantation (LT) is used only in extraordinary cases with unclear results. This systematic review aims to define indication of LT in post-hepatectomy liver failure and post-LT outcomes, in terms of patient and disease-free survivals, to assess the procedure's feasibility and effectiveness. Methods: A systematic review of all English language full-text articles published until September 2022 was conducted. Inclusion criteria were articles describing patients undergoing LT for post-hepatectomy liver failure after liver resection, which specified at least one outcome of interest regarding patient/graft survival, postoperative complications, tumour recurrence and cause of death. A pseudo-individual participant data meta-analysis was performed to analyse data. Study quality was assessed with MINORS system. PROSPERO CRD42022349358. Results: Postoperative complication rate was 53.6%. All patients transplanted for benign indications survived. For malignant tumours, 1-, 3- and 5-year overall survival was 94.7%, 82.1% and 74.6%, respectively. The causes of death were tumour recurrence in 83.3% of cases and infection-related in 16.7% of LT recipients. At Cox regression, being transplanted for unconventional malignant indications (colorectal liver metastasis, cholangiocarcinoma) was a risk factor for death HR = 8.93 (95%CI = 1.04-76.63; P-value = 0.046). Disease-free survival differs according to different malignant tumours (P-value = 0.045). Conclusions: Post-hepatectomy liver failure is an emergent indication for rescue LT, but it is not universally accepted. In selected patients, LT can be a life-saving procedure with low short-term risks. However, special attention must be given to long-term oncological prognosis before proceeding with rescue LT in an urgent setting, considering the severity of liver malignancy, organ scarcity, the country's organ allocation policies and the resource of living-related donation.
MeSH term(s)	Humans ; Liver Transplantation/methods ; Neoplasm Recurrence, Local ; Hepatectomy/adverse effects ; Hepatectomy/methods ; Liver Neoplasms/surgery ; Treatment Outcome ; Risk Factors ; Liver Failure, Acute/surgery ; Liver Failure/surgery
Language	English
Publishing date	2023-06-17
Publishing country	United States
Document type	Systematic Review ; Meta-Analysis ; Journal Article ; Review
ZDB-ID	639400-0
ISSN	1557-9816 ; 0955-470X
ISSN (online)	1557-9816
ISSN	0955-470X
DOI	10.1016/j.trre.2023.100773
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Article ; Online: Early Gastric Outlet Obstruction Caused by the Free End of Barbed Sutures Following Laparoscopic Gastric Resection with Roux-en-Y Reconstruction.

Siragusa, Leandro / Usai, Valeria / Pirozzi, Brunella M / Dhimolea, Sirvjo / Franceschilli, Marzia

The American journal of case reports

2023 Volume 24, Page(s) e940661

Abstract: BACKGROUND Recent developments in surgical suture material include the use of sutures with unidirectional barbs that facilitate laparoscopic suturing thanks to self-anchoring and tension-keeping properties. Complications deriving from the use of barbed ... ...

Abstract	BACKGROUND Recent developments in surgical suture material include the use of sutures with unidirectional barbs that facilitate laparoscopic suturing thanks to self-anchoring and tension-keeping properties. Complications deriving from the use of barbed sutures have been previously reported. In this report we present the case of a patient with gastric outlet obstruction by the free end of a V-Loc™ barbed suture (Medtronic, Dublin, Ireland) following Roux-en-Y gastric resection. CASE REPORT In February 2023, a 77-year-old man who underwent laparoscopic subtotal gastrectomy for cancer followed by Roux-en-Y reconstruction developed symptoms of gastric outlet obstruction a few days after discharge. The patient was readmitted to the hospital due to vomiting 4 days after being discharged after an uneventful postoperative course. Imaging confirmed the presence of an occlusion at the level of the jejunojejunal anastomosis, with a noticeable change in caliber. During laparoscopy, a loop of bowel was entrapped around the tail of the barbed suture used to close the common enterotomy of jejunojejunal anastomosis. Following laparoscopic division of the anchoring suture, the bowel regained its normal caliber. CONCLUSIONS Although complications from the use of unidirectional barbed surgical sutures are rare, this report highlights bowel obstruction as a recognized postoperative complication. The preferred treatment is laparoscopic division of the suture's tail. To prevent complications related to barbed sutures, it is essential to ensure that all barbs of the suture are properly unfolded.
MeSH term(s)	Male ; Humans ; Aged ; Suture Techniques/adverse effects ; Gastrectomy/adverse effects ; Gastrectomy/methods ; Laparoscopy/methods ; Postoperative Complications/surgery ; Postoperative Complications/etiology ; Gastric Outlet Obstruction/etiology ; Gastric Outlet Obstruction/surgery ; Sutures/adverse effects
Language	English
Publishing date	2023-10-09
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.940661
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Article: Primary versus Salvage Liver Transplantation after Curative-Intent Resection or Radiofrequency Ablation for Hepatocellular Carcinoma: Long-Term Oncological Outcomes.

Anselmo, Alessandro / Siragusa, Leandro / Brigato, Paolo / Riccetti, Camilla / Collini, Andrea / Sensi, Bruno / Tisone, Giuseppe

Cancers

2023 Volume 15, Issue 20

Abstract: Liver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver ... ...

Abstract	Liver transplantation for hepatocellular carcinoma (HCC) may be performed ab initio, primary liver transplantation (PLT), or for HCC recurrence after previous treatments such as liver resection (LR) or radiofrequency ablation (RFA), salvage liver transplantation (SLT). The aim of this study was to evaluate the oncological outcomes of SLT vs. PLT. For this, a retrospective study was carried out on patients undergoing liver transplantation for HCC. The outcomes of PLT were compared with those of SLT. The primary outcome was disease-free survival (DFS). The secondary outcomes included overall survival (OS), cancer-specific survival (CSS), and major postoperative complications. A sub-analysis of SLT-LR and SLT-RFA was also performed. In total, 141 patients were included: 96 underwent PLT and 45 SLT. Among the SLT group, 25 patients had undergone previous LR while 20 had had RFA. There were no differences in the major postoperative complications. Unadjusted DFS was significantly longer in the PLT group (
Language	English
Publishing date	2023-10-18
Publishing country	Switzerland
Document type	Journal Article
ZDB-ID	2527080-1
ISSN	2072-6694
ISSN	2072-6694
DOI	10.3390/cancers15205030
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Article ; Online: Thoracic Duct Embolization for Delayed Chyle Leak After Lewis-Tanner Esophagectomy.

Franceschilli, Marzia / Argirò, Renato / Siragusa, Leandro / Usai, Valeria / Sibio, Simone / Di Carlo, Sara

The American journal of case reports

2022 Volume 23, Page(s) e936590

Abstract: BACKGROUND Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including chyle leak (CL). CL has an incidence rate of 1-9% and is associated with a higher ... ...

Abstract	BACKGROUND Radical esophagectomy for cancer is a potentially curative treatment that requires two/three-field lymphadenectomy. Serious complications can occur, including chyle leak (CL). CL has an incidence rate of 1-9% and is associated with a higher rate of postsurgical morbidity and mortality. It usually occurs in the early postoperative period; delayed CL is less common and is thought to be due to an occult leak or late diagnosis. CASE REPORT A 54-year-old man with adenocarcinoma of the esophagus underwent Lewis-Tanner esophagectomy after neoadjuvant chemotherapy with FLOT. During en bloc lymphadenectomy, the main thoracic duct was identified, clipped, and divided. The postoperative course was uneventful. One month after hospital discharge, he was readmitted with severe abdominal, scrotal, and lower-limb edema. A chest-abdomen CT scan revealed massive pleural effusion with left shift and compression of the mediastinum. The patient was initially treated with fasting and fat-free total parenteral nutrition, and the drain output was 2800-3000 mL/dL. Lymphoscintigraphy with ethiodized oil eventually revealed a thoracic duct leak, and lymphatic embolization was successfully performed with a 4-mm metallic spiral and glue. Drain output dramatically reduced, and after 11 days the thoracic drain was removed and the patient was safely discharged. CONCLUSIONS Thoracic duct embolization seems be an effective therapy in treating high-output (>1000 mL/dL) CL that has occurred more than 2 weeks after esophagectomy. It can be considered as a first-line treatment due to its simplicity and effectiveness.
MeSH term(s)	Chest Tubes/adverse effects ; Chyle ; Esophageal Neoplasms/complications ; Esophageal Neoplasms/surgery ; Esophagectomy/adverse effects ; Humans ; Male ; Middle Aged ; Postoperative Complications/etiology ; Thoracic Duct/surgery
Language	English
Publishing date	2022-07-22
Publishing country	United States
Document type	Case Reports ; Journal Article
ZDB-ID	2517183-5
ISSN	1941-5923 ; 1941-5923
ISSN (online)	1941-5923
ISSN	1941-5923
DOI	10.12659/AJCR.936590
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Article ; Online: Laparoscopic Left Hemihepatectomy for Intrahepatic Cholangiocellular Carcinoma: An Adequate Lymphadenectomy is Also Possible in Artery Variation.

Anselmo, Alessandro / Siragusa, Leandro / Pisani, Gennaro / Materazzo, Marco / Pirozzi, Brunella / Tisone, Giuseppe

Annals of surgical oncology

2022

Abstract: Background: Laparoscopic liver resection (LLR) is becoming essential in the treatment of malignant liver tumors but only a few reports exist about LLR for intrahepatic cholangiocarcinoma (IHCC).: Methods: We present a video of a laparoscopic left ... ...

Abstract	Background: Laparoscopic liver resection (LLR) is becoming essential in the treatment of malignant liver tumors but only a few reports exist about LLR for intrahepatic cholangiocarcinoma (IHCC). Methods: We present a video of a laparoscopic left hemihepatectomy with lymphadenectomy for IHCC. Case presentation: A 67-year-old asymptomatic male underwent a routine abdominal ultrasound, revealing a 15 × 9 mm solid nodular iso-hyperechoic lesion, located in SIII, with SII/III biliary duct dilation. Magnetic resonance imaging confirmed a 32 × 22 mm lesion in SII/III, with mild hyper-intensity on T2-weighted images and strong hypo-intensity on T1-weighted images. After administration of contrast medium, the lesion showed light peripheral enhancement on the portal and delayed phases, and hypo-intensity on the hepatospecific phase. No relevant comorbidities were reported (KPS 100). Laboratory tests showed normal liver function and normal CA19-9 levels. A laparoscopic left hemihepatectomy was indicated. Results: Operative time was 330 min. Four intermittent Pringle maneuver cycles were applied and no blood transfusions were administered. Intraoperative ultrasound confirmed preoperative findings and additionally highlighted involvement of the SIV duct. A full replacing right hepatic artery arising from the superior mesenteric artery was identified and was preserved during hilar dissection. Postoperative course was uneventful and the patient was discharged on postoperative day 3. The pathology report indicated cholangiocellular carcinoma pT1bN0. Twelve lymph nodes were retrieved. Conclusions: According to recent literature reports and our experience, laparoscopic surgery for intrahepatic cholangiocellular carcinoma should be considered feasible and safe in selected patients. Hepatic artery variations allow for adequate lymphadenectomy. Oncological long-term results require multicenter randomized studies in order to be validated.
Language	English
Publishing date	2022-03-25
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-11549-6
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Article ; Online: Indocyanine Green-Guided Laparoscopic Redo Surgery for Incidental T2a Gallbladder Cancer.

Anselmo, Alessandro / Siragusa, Leandro / Materazzo, Marco / Sforza, Daniele / Bacchiocchi, Giulia / Sensi, Bruno / Tisone, Giuseppe

Annals of surgical oncology

2022 Volume 29, Issue 9, Page(s) 5552–5553

MeSH term(s)	Cholecystectomy, Laparoscopic ; Gallbladder Neoplasms/surgery ; Humans ; Incidental Findings ; Indocyanine Green ; Laparoscopy
Chemical Substances	Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2022-06-12
Publishing country	United States
Document type	Journal Article
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-11918-1
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Article ; Online: ASO Author Reflections: Can Indocyanine Green Increase the Safety of Bile Duct Dissection and Thus Improve Regional Lymphadenectomy in Re-Do Surgery for Incidental Gallbladder Cancer?

Anselmo, Alessandro / Siragusa, Leandro / Materazzo, Marco / Sforza, Daniele / Bacchiocchi, Giulia / Sensi, Bruno / Tisone, Giuseppe

Annals of surgical oncology

2022 Volume 29, Issue 9, Page(s) 5554

MeSH term(s)	Bile Duct Neoplasms/surgery ; Bile Ducts ; Dissection ; Gallbladder Neoplasms/surgery ; Humans ; Indocyanine Green ; Lymph Node Excision
Chemical Substances	Indocyanine Green (IX6J1063HV)
Language	English
Publishing date	2022-06-23
Publishing country	United States
Document type	Journal Article ; Comment
ZDB-ID	1200469-8
ISSN	1534-4681 ; 1068-9265
ISSN (online)	1534-4681
ISSN	1068-9265
DOI	10.1245/s10434-022-12045-7
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Article ; Online: Percutaneous Tibial Nerve Stimulation Improves Lower Urinary Tract Dysfunction and Infection Rate in a Kidney Transplant Recipient With Augmentation Cystoplasty: A Case Report and Literature Review.

Orecchia, Luca / Rosato, Eleonora / Siragusa, Leandro / Tisone, Giuseppe / Finazzi Agrò, Enrico / Anselmo, Alessandro

Transplantation proceedings

2022

Abstract: Almost 20% of patients with congenital posterior urethral valves (PUV) reach end-stage kidney disease requiring kidney transplantation (KT). An augmentation cystoplasty (AC) is performed to treat significant lower urinary tract dysfunction (LUTD) which ... ...

Abstract	Almost 20% of patients with congenital posterior urethral valves (PUV) reach end-stage kidney disease requiring kidney transplantation (KT). An augmentation cystoplasty (AC) is performed to treat significant lower urinary tract dysfunction (LUTD) which can persist afterwards due to residual valve bladder and lead to recurrent urinary tract infections (UTIs) and a worse graft survival. Percutaneous tibial nerve stimulation (PTNS) is a minimally invasive second-line neuromodulation therapy approved for the treatment of non-neurogenic LUTD performed in the outpatient setting. Herein, we reported the case of significant improvement of bladder voiding pattern and yearly UTI rates through PTNS in a 32-year-old male KT recipient with a history of congenital PUV and AC. The patient was referred to our institution at the beginning of 2019 for urgency, high post-void residual volume (PVR) and recurrent clinically significant UTIs (3 to 4/y). After assessment, the patient attended once-weekly 30-minute sessions of PTNS for 12 consecutive weeks. A significant improvement of urodynamic and infectious outcomes was observed through 3-day bladder diaries, questionnaires, and laboratory exams during the subsequent 3 years of regular follow-up. The present results might be significant for the prevention of antibiotic resistance and for better graft survival in KT recipients. We successfully treated a patient with AC, implying that the technique may be appliable also in this case. Neuromodulation in KT is still an unexplored field of research, we advocate for prospective assessment of the efficacy of PTNS in these patients, as reproducible results might lead to life-changing improvements.
Language	English
Publishing date	2022-10-30
Publishing country	United States
Document type	Journal Article
ZDB-ID	82046-5
ISSN	1873-2623 ; 0041-1345
ISSN (online)	1873-2623
ISSN	0041-1345
DOI	10.1016/j.transproceed.2022.08.049
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Article ; Online: Laparoscopic synchronous CME-right colectomy and D2/3 subtotal gastrectomy following embryological-based principles - A video vignette.

Sensi, Bruno / Siragusa, Leandro / Franceschilli, Marzia / Pirozzi, Brunella / Guida, Andrea M / Sica, Giuseppe S

Colorectal disease : the official journal of the Association of Coloproctology of Great Britain and Ireland

2022 Volume 25, Issue 3, Page(s) 520–521

MeSH term(s)	Humans ; Lymph Node Excision ; Laparoscopy ; Gastrectomy ; Colectomy ; Colonic Neoplasms/surgery
Language	English
Publishing date	2022-11-14
Publishing country	England
Document type	Video-Audio Media ; Letter
ZDB-ID	1440017-0
ISSN	1463-1318 ; 1462-8910
ISSN (online)	1463-1318
ISSN	1462-8910
DOI	10.1111/codi.16359
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