Jonathan B. Koea

By Mandivavarira Maundura and Jonathan B Koea

Safe liver resection is a vital element in the management of primary and secondary hepatic malignancies. The indications for resection have evolved Over time, and this has in part been due to the ability to improve the future liver remnant (FLR). This chapter reviews the current and future methods used for assessing the future liver remnant volume and function in order to minimize the risk of post-hepatectomy liver failure (PHLF). Current and evolving methods used in augmenting the future liver remnant are also considered. Since its introduction in the 1990s, portal venous embolization (PVE) has become the most widely used method of augmenting the FLR. The factors that affect hypertrophy following embolization as well as techniques used in portal venous embolization will be reviewed. Other methods of augmentation discussed include portal vein ligation (PVL) and the emerging method of associating liver partition and portal vein ligation for staged hepatectomy (ALPPS). The chapter also considers the various methods in the context of limiting tumour progression in the future liver remnant and attempts to integrate newer techniques such as ALPPS into current treatment algorithms.

Part of the book: Updates in Liver Cancer

By Asanga Gihan Nanayakkara, Phillip Chao, Jonathan B. Koea and Sanket Srinivasa

The adoption of laparoscopic techniques for complex digestive surgical procedures, such as hepatectomy and pancreatectomy, has been slow in comparison to other areas of surgery. Laparoscopy presents the surgeon with several challenges including ergonomics, lack of haptic feedback, altered fields of vision, and teamwork meaning that there is a significant learning curve for complex laparoscopic digestive surgery, even for the surgeon experienced in open procedures. Simulation is a useful method to train surgeons in complex procedures and has been suggested as a potential mechanism to decrease the duration of the surgeon learning curve in laparoscopic surgery. This chapter will explore current concepts in simulation for complex laparoscopic digestive surgery. Readers will develop an understanding of the role of simulation in surgical procedural training and evidence-based techniques that may be implemented in their own institution.

Part of the book: Current Concepts and Controversies in Laparoscopic Surgery