Abstract
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This edition contains articles that give technical assistance to surgeons performing cholecystectomy in the face of operative bleeding 1 or previous abdominal operations, 2 safety of distal pancreatectomy in high-risk patients, 3 novel technical reports on complex hepatic resections,4,5 and a propensity score-matched study addressing laparoscopic liver resection for hepatocellular carcinoma, 6 among others.
Common problems frequently encountered by surgeons during cholecystectomy include access into the abdomen in the face of a previous midline incision and bleeding from the cystic plate. Choi et al. 2 reported on a technique for safe abdominal entry by performing an initial subcostal incision and trocar placement with insufflation of the abdomen. This method avoids difficult entry through a previous midline incision, and the authors found a decreased operative time and hospital stay for these patients. Sartelli et al. 1 performed a prospective trial to assess the efficacy of a commercially available hemostatic matrix applied to the gallbladder bed for patients undergoing cholecystectomy for acute cholecystitis. Their group found a lower conversion rate with improved hemostasis with the use of this adjunct method.
Laparoscopic distal pancreatectomy has been proven to have significant advantages over open distal pancreatectomy over the past few years. However, some surgeons are hesitant to utilize this technique for certain subsets of patients. Liao et al. 3 reported on patients with increased anesthetic risk undergoing laparoscopic distal pancreatectomy compared with conventional open surgery. Indeed, these patients also experience the same benefits over open surgery, including less operative time, less blood loss, lower complications, and shorter length of stay.
Techniques of hepatic resection have undergone a significant revolution in the past decade due to increasing safety of liver surgery and advancing technology. Included in this issue are two reports that detail advanced techniques used to perform laparoscopic-associating liver partition with portal vein ligation for staged hepatectomy, 4 as well as segmental liver resection using indocyanine green. 5 Both of these procedures are very exciting novel methods recently developed to help perform more radical and precise hepatectomy, respectively.
And finally, a group from Korea 6 published results regarding laparoscopic liver resection for hepatocellular cancer. Propensity score matching was performed to attempt to avoid bias, and the authors showed similar perioperative results as well as similar long-term survival. Although no significantly improved morbidity was noted, the authors reported faster recovery with a decreased hospital stay for the laparoscopic approach. Laparoscopic liver resection in the setting of hepatic cirrhosis can be challenging, and yet the authors showed feasibility, safety, and improved recovery as well as comparable oncologic safety.
We hope you enjoy this edition of the Journal, which addresses issues related to simple and common procedures as well as to complex and unique procedures within the field of hepatopancreaticobiliary surgery. The manuscripts within this journal represent lessons learned and technical tips applied by experienced surgeons who are hoping to extend this knowledge to others in order to improve surgical care to patients in need.