Totally laparoscopic associating liver partition and portal vein ligation for staged hepatectomy using anterior approach in HCC patient with Type II portal vein anomaly

Heon Tak Ha,Young Seok Han,Jae Min Chun 한국간담췌외과학회 2017 Annals of hepato-biliary-pancreatic surgery Vol.21 No.4

Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has gradually developed because of rapid hypertrophy of the future liver remnant volume (FLR) in spite of high morbidity. To minimize the patient’s postoperative pain and morbidity including wound complication caused by two consecutive major abdominal operations, we adopted a totally laparoscopic approach and used a composite mesh graft. Also, to maximize the oncologic efficacy, we adopted the “anterior approach” technique. A 44-year-old woman with large hepatitis B-related hepatocellular carcinoma (HCC) in her right lobe was transferred to our hospital for surgical treatment. Preoperatively predicted FLR by a CT scan was 21% and type II portal vein anomaly was detected. A totally laparoscopic approach was planned. During the first stage operation, right anterior and posterior portal veins were meticulously dissected and tied. After parenchymal transection by the “anterior approach” technique, two glissonian pedicles of the right liver were individually isolated. A composite mesh graft was used to prevent severe adhesion on both liver partition surfaces. During the second-stage operation, 9 days after the first stage operation, the two isolated glissonian pedicles were initially transected. After full mobilization of the right lobe, the right hepatic vein was also transected. The right lobe was removed through the Pfannenstiel incision. She was discharged 7 days after the second stage operation. Her postoperative course was uneventful and there was no HCC recurrence for 15 months after hepatectomy. A totally laparoscopic ALPPS procedure can be a feasible technique that ensures patient safety and oncologic superiority, even in patients with complicated anatomical variation.

Totally laparoscopic right hepatectomy in HCC patients with portal vein anomaly

Heon Tak Ha,Young Seok Han,Young Yeon Choi,Dae Young Jeon,Hyung Jun Kwon,Jae Min Chun,Sang Geol Kim,Yoon Jin Hwang 한국간담췌외과학회 2016 한국간담췌외과학회 학술대회지 Vol.2016 No.4

Totally Laparoscopic Right Hepatectomy in HCC Patients with Portal Vein Anomaly

( Heon Tak Ha ),( Young Seok Han ),( Young Yeon Choi ),( Dae Young Jeon ),( Hyung Jun Kwon ),( Jae Min Chun ),( Sang Geol Kim ),( Yoon Jin Hwang ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Purpose: Laparoscopic right hepatectomy was a challenging procedure, but has been gradually changed to standard approach. Glissonian pedicle approach for hepatic inflow control has been mainly used in laparoscopic right hepatectomy because of the difficulty of separate dissection of portal vein, hepatic artery and bile duct. However, the exact glissonian pedicle approach on laparoscopic field is more difficult procedure in patients with portal vein anomaly. Such an inappropriate hepatic inflow control induces unexpected blood loss and inaccurate hepatic parenchymal transection and especially, the complication risk of left portal vein and the injury risk of hepatic duct may be increased in patients with portal vein anomaly. Methods: We performed totally laparoscopic right hepatectomy in 3 patients with type II or III portal vein anomaly by individual hepatic inflow dissection. Results: After ligation of right hepatic artery, the meticulous dissection of right posterior and anterior portal vein was performed and the inflow control can be accomplished by the clipping or ligation along with the confirmation of portal vein anomaly. In order to avoid the injury of hepatic duct, the remnant right anterior and posterior portal pedicles were respectively ligated at the distal site of separate portal vein clamping after the completion of liver parenchymal dissection. Postoperative imaging study illustrated the exact transection of portal tract. Conclusion: In summary, totally laparoscopic right hepatectomy in patients with portal vein anomaly is not feasible and safe procedure without the complete dissection of right portal tract. Therefore, the inflow control by separate portal vein dissection is more useful option than blunt hepatic glissonian pedicle approach for prevention of portal tract injury in our opinion.

Totally Laparoscopic Pancreaticoduodenectomy Using 3D Flexible Laparoscopic System

( Heon Tak Ha ),( Ja Ryung Han ),( Hyung Jun Kwon ),( Jae Min Chun ),( Sang-geol Kim ),( Yoon Jin Hwang ),( Young Seok Han ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Robotic PD has not yet been expanded due to the needs of the dedicated teams and the excessive costs. 3D flexible laparoscopic system (3D) with depth perception and spatial orientation allows the precise dissection of the dangerous site and facilitate the comfortable reconstruction. We present experiences regarding the efficacy of L-PD using 3D. Methods: Totally L-PD was attempted in 15 patients from June 2016 to June 2017. However, conversion to open PD was required in one patient with tumor invasion to the superior mesenteric vein. Pancreaticojejunostomy was completed with the dunking procedure in 1 patient and with duct-to-mucosa technique in 13 patients. Results: Mean operation time was 500 min. The replaced right hepatic artery originated from superior mesenteric artery of hepatic artery was identified in one patient and preserved well because of the precise dissection under the excellent visual field. The mean size of pancreatic duct and hepatic duct were 3 mm and 10 mm. There was no major intra-operative complications and post-operative mortality. Postoperative complications were detected in 7 patients, including pancreatic fistula (n=5), and delayed gastric emptying (n=2). All pancreatic fistula was grade A and were recovered with conservative treatment. Conclusions: In selected patients, L-PD is a safe and effective procedure with comparable surgical outcomes to open surgery. Especially, we believe that 3D will play an important role in the expansion of complicated PD surgery and will provide a bridge role for future robot systems.

신장내과 조기의뢰가 혈액투석 예후에 미치는 영향 : 단일 임상 기관 연구

강우헌 ( Woo Heon Kang ),오하영 ( Ha Young Oh ),신유정 ( You Jung Shin ),설정숙 ( Jeong Sook Seol ),강문자 ( Moon Ja Kang ),탁은영 ( Eun Young Tak ),이남선 ( Nam Sun Lee ),이미경 ( Mi Kyoung Lee ),류로사 ( Ro Sa Ryu ),송영혜 ( You 대한신장학회 2006 Kidney Research and Clinical Practice Vol.25 No.2

Ni-Cr-Sn-Bi합금의 anti-galling 특성에 미치는 Te의 영향

하헌필,김경탁,심재동,김용규,Ha Heon-Phil,Kim Kyung-Tak,Shim Jae Dong,Kim Yong Kyu 한국재료학회 2005 한국재료학회지 Vol.15 No.1

Ni-Cr-Sn-Bi alloys were prepared by air melting and sand casting method and their anti-galling behaviors were examined. Anti-galling properties were dominantly influenced by Bi-rich low temperature precipitates. Alloying effects on the anti-galling properties were investigated for several alloying elements to improve anti-galling properties of the alloy. An alloy with $1-3wt\%$ of Te showed markedly improved anti-galling properties. Metallographic and tribological tests were carried out to find out reasons for excellent properties. It was found that Te containing alloy has finely distributed precipitates of Bi-rich phase. The addition of Te changed the morphology of the Ni-rich primary phase from globular to fine dendritic. As a result, the anti-galling phase precipitated between dendrite arms with fine distribution showed excellent anti-galling properties.

Totally Laparoscopic Living Donor Right Hepatectomy in Bile Duct Anomalies

( Ja Ryung Han ),( Heon Tak Ha ),( Hyung Jun Kwon ),( Jae Min Chun ),( Sang-geol Kim ),( Yoon Jin Hwang ),( Young Seok Han ) 대한간학회 2018 춘·추계 학술대회 (KASL) Vol.2018 No.1

Aims: Decreased blood loss, less postoperative pain, shorter length of stay in hospital, and excellent cosmetic outcome have well been validated as the advantage of laparoscopic hepatectomy. However, donor safety is the most important issue in living donor hepatectomy. Hence, pure laparoscopic right lobe donor hepatectomy has been applied in donors with favorable hepatic vascular and biliary anatomy. Methods: We present the experiences for totally laparoscopic right hepatectomy in living donors with bile duct anomalies. From May 2016 to November 2017, totally laparoscopic right lobe donor hepatectomy for adult-to-adult living donor liver transplantation was performed in 24 cases. Among them, right hepatic ducts with more than 2 orifices were demonstrated in 11 patients. Results: By Nakamura classification, type 2 anomaly was identified in 5 patients, type 3a in 3 patients, and type 3b in 3 patients, respectively. All donors were recovered without vascular or biliary complication. Biliary complications occurred in four cases of 24 recipients. Anastomosis site stricture of hepatic duct was confirmed in 3 cases (1 case in type 1, 1case in type 2, and 1 case in type 3b). And bile leakage from anatomosis site was identified in one case (type 3a). All complicated recipients was improved by biliary stents by endoscopic retrograde cholangiopancreatography, or percutaneous transhepatic biliary drainage. Conclusions: Conclusively, totally laparoscopic living donor right hepatectomy is feasible and acceptable in donors with bile duct anomaly. But, to become a routine procedure, further evaluation and long-term results by highly experienced surgeons should be demanded.

The effects of the end-to-side inverted mattress pancreaticojejunostomy on postoperative pancreatic fistula

Hyung Jun Kwon,Heon Tak Ha,Young Yeun Choi,Sang Geol Kim 대한외과학회 2015 Annals of Surgical Treatment and Research(ASRT) Vol.89 No.2

Purpose: Various pancreaticojejunostomy (PJ) techniques have been devised to minimize the rate of postoperative pancreatic fistula (POPF) after pancreatoduodenectomy (PD). This study describes a modification of the mattress suture PJ technique, which we call “inverted mattress PJ (IM)”. The results of an IM group and a historical consecutive control group were compared to determine how the IM technique affected POPF. Methods: From 2003 to 2010, 186 consecutive patients underwent PD. A former group of 52 consecutive patients who underwent conventional duct-to-mucosa PJ (DM) was used as a historical control group. The IM technique was utilized for the IM group (134 patients). The clinicopathological features and surgical outcomes of the 2 groups were compared, with a particular focus on postoperative POPFs. Results: The average surgery duration was shorter in the IM group (580.3 minutes vs. 471 minutes, P < 0.001). Grades B and C POPFs occurred less frequently in the IM group, but the difference was not statistically significant (17.3% vs. 9.7%, P = 0.200). However, no grade C POPF occurred in the IM group compared with 5.8% of grade C POPFs (3/52) in the DM group (P = 0.020). Three patients died (1 in the DM group and 2 in the IM group). The causes of death were arrhythmia in 2 cases and Candida sepsis in 1 case. POPF was not causally related to the 3 deaths. Conclusion: IM end-to-side PJ shortened operation time and increased safety with no incidence of grade C POPF.

Totally Laparoscopic Associating Liver Partition and Portal Vein Ligation for Staged Hepatectomy Using Anterior Approach in HCC Patient with Type II Portal Vein Anomaly

( Young Yeon Choi ),( Young Seok Han ),( Heon Tak Ha ),( Hyung Jun Kwon ),( Jae Min Chun ),( Sang Geol Kim ),( Yoon Jin Hwang ) 대한간학회 2016 춘·추계 학술대회 (KASL) Vol.2016 No.1

Purpose: Associating liver partition and portal vein ligation for staged hepatectomy (ALPPS) has been gradually developed because of rapid hypertrophy of the future liver remnant volume (FLR) despite of high morbidity. To minimize patient’s postoperative pain and morbidity including wound complication by two consecutive major abdominal operations and bile leakage from liver cut surface due to severe adhesion after liver splitting of the first stage, we adopted totally laparoscopic approach and used composite mesh graft. Also, to maximize the oncologic efficacy, we adopted the “anterior approach” technique. Methods: The patient was a 42 years old woman with huge hepatocellular carcinoma (HCC) in right lobe. She was hepatitis B carrier. Preoperative predicted FLR by CT scan was less than 30% and type II portal vein anomaly was also demonstrated. Totally laparoscopic approach was planned. Results: In first stage, right anterior and posterior portal vein were dissected and tied. The “anterior approach” technique was applied for liver parenchymal dissection. The composite mesh graft was used to prevent severe adhesion on both liver partition surface.In second stage that performed on 9 days after the first operation, after the previously tagged two glissonian pedicles was transected, right inferior hepatic vein and hepatic vein sequentially transected. Transected right lobe was removed after complete mobilization. The patient discharged 7 days after 2nd operation and recovered without event. Conclusion: Conclusively, totally laparoscopic ALPPS procedure is a feasible technique if we make throughout preparation for patient’s safety and the onologic superiority, even in patient with complicated anatomic variation.

쇼어경도표준의 확립에 관한 연구

방건웅(G. W. Bahng),탁내형(Nae Hyung Tak),봉하헌(Ha Heon Bong) 한국열처리공학회 2002 熱處理工學會誌 Vol.15 No.3

N/A Shore hardness test was developed in 1906 to overcome the limit of Brinell hardness test. However, the detailed requirements on the tester was not clearly specified except the scale, i.e., 100 HS for high carbon steel and 10 HS for soft brass. As a result, the shore hardness was used for quite long time without well established standards. For the establishment of hardness standards, standard tester, standard procedure, and standard hardness block must be provided. So far the standard of Shore hardness was maintained by correlating Shore hardness scale to Vickers hardness through converting equation. This is the so called converted Shore hardness and it is not the true Shore hardness standard strictly. In this paper, the possibility of establishing Shore hardness standard based on the Shore standard hardness tester is reported.