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Advances in Hepatobiliary Surgery
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Advances in Hepatobiliary Surgery

A special issue of Journal of Clinical Medicine (ISSN 2077-0383). This special issue belongs to the section "General Surgery".

Deadline for manuscript submissions: closed (20 October 2024) | Viewed by 6306

Special Issue Editor

Dr. Gianluca Rompianesi

E-Mail Website
Guest Editor
Department of Clinical Medicine and Surgery, Division of HPB, Minimally Invasive, Robotic and Transplant Surgery, Transplantation Service, Federico II University, Naples, Italy
Interests: hepatobiliary surgery; pancreatic surgery; transplant surgery; minimally-invasive surgery; robotic surgery

Special Issue Information

Dear Colleagues,

Hepatobiliary surgery is used to treat a diverse group of diseases, from benign conditions to primary and metastatic tumors, and has seen a constant expansion in recent decades. A pivotal role in this development has been played by the introduction of new techniques and technologies that now allow patients once considered affected by pathologies judged too complex or advanced to receive safe and effective treatments. These advances range from the development of new surgical techniques and devices to the applications of novel technologies, such as the expansion of minimally invasive techniques and the implementation of artificial intelligence and augmented reality, which provide hepatobiliary patients with the optimal diagnostic, therapeutic and prognostic tools, aiming at achieving the best possible outcomes.

In such a fast-developing scenario, this Special Issue has the objective of focusing on the latest advances in all aspects of hepatobiliary surgery.

Dr. Gianluca Rompianesi
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Journal of Clinical Medicine is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2600 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • hepatobiliary surgery
  • liver surgery
  • biliary surgery
  • endoscopy
  • minimally invasive surgery
  • robotic surgery
  • artificial intelligence

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Further information on MDPI's Special Issue polices can be found here.

Published Papers (4 papers)

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Research

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11 pages, 2118 KiB  
Article
Impact of Modified Blumgart Anastomosis on Pancreatic Fistula and Pancreaticojejunostomy Time During Laparoscopic Pancreaticoduodenectomy: Single-Center Experience
by Jong Woo Lee, Jae Hyun Kwon and Jung-Woo Lee
J. Clin. Med. 2025, 14(1), 90; https://doi.org/10.3390/jcm14010090 - 27 Dec 2024
Viewed by 213
Abstract
Background/Objectives: The aim of this study is to evaluate the impact of modified Blumgart anastomosis methods during pancreaticojejunostomy (PJ) on the incidence of clinically relevant postoperative pancreatic fistula (POPF) after laparoscopic pancreaticoduodenectomy (LPD). Methods: This is a retrospective cohort [...] Read more.
Background/Objectives: The aim of this study is to evaluate the impact of modified Blumgart anastomosis methods during pancreaticojejunostomy (PJ) on the incidence of clinically relevant postoperative pancreatic fistula (POPF) after laparoscopic pancreaticoduodenectomy (LPD). Methods: This is a retrospective cohort study analyzing data of patients who underwent LPD from 2018 to 2022. The primary endpoint was the incidence of grade B and C POPF based on the International Study Group on Pancreatic Fistula criteria and PJ anastomosis time. Incidence of postoperative complications (Clavien–Dindo classification grade ≥ III) was also investigated. Results: A total of 148 patients, 99 patients in a modified Blumgart group and 49 patients in a continuous suture group, were enrolled. There were no statistically significant differences in the general and intraoperative characteristics found between the two groups (p > 0.05). There was no significant difference in pancreas texture (p = 0.397) and diameter of pancreatic duct (p = 0.845). Grade B and C POPF occurred in five patients (5.1%) in the modified Blumgart group and three patients (6.1%) in the continuous suture group with no statistical difference (p = 0.781). A total of eleven patients (11.1%) in the modified Blumgart group and four patients (8.2%) in the continuous suture group had postoperative complication (Clavien–Dindo Classification grade 3 or more). Mortality within 90 days was 2 (2%) and 0 (0%), respectively. The PJ anastomosis times in the modified Blumgart group and continuous suture group were 28.8 ± 5.94 min and 35 ± 7.71 min, respectively (p = 0.003). Conclusions: This study suggests that modified Blumgart PJ showed shorter anastomosis time with comparable outcome to continuous suture methods in LPD. Full article
(This article belongs to the Special Issue Advances in Hepatobiliary Surgery)
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Figure 1

Figure 1
<p>Intraoperative images of the reconstruction of PJ anastomosis with modified Blumgart technique in LPD. (<b>a</b>): Transpancreatic suture through full-thickness pancreas to seromuscular jejunum using 3-0 Prolene with needle straightened. (<b>b</b>): Suture of posterior seromuscular wall of jejunum parallel to the long axis of the jejunum. (<b>c</b>): Tie the suture and approximation of jejunum to pancreas. (<b>d</b>): Opening of jejunum and duct-to-mucosa anastomosis with internal stent. 5-0 PDS interrupted suture was used. (<b>e</b>): Completion of duct-to-mucosa anastomosis. (<b>f</b>): Additional full-thickness pancreas suture caudal to pancreatic duct (<b>g</b>): Suture of anterior seromuscular wall of jejunum perpendicular to the long axis of the jejunum. (<b>h</b>): Anterior seromuscular jejunum suture cranial to pancreatic duct. (<b>i</b>): Completion of modified Blumgart pancreaticojejunostomy after interrupted reinforcing suture of anterior side. (<b>j</b>): Coronal view after modified Blumgart PJ anastomosis.</p> Full article ">Figure 2
<p>Postoperative follow-up period (days).</p> Full article ">
13 pages, 1322 KiB  
Article
Validation of the IWATE Criteria in Robotic-Assisted Liver Resections
by Sophia A. Lamberty, Jens Peter Hoelzen, Shadi Katou, Felix Becker, Mazen A. Juratli, Andreas Andreou, M. Haluk Morgül, Andreas Pascher and Benjamin Strücker
J. Clin. Med. 2024, 13(9), 2697; https://doi.org/10.3390/jcm13092697 - 3 May 2024
Cited by 2 | Viewed by 1694
Abstract
Background/Objectives: The IWATE criteria are well-established as a helpful tool to preoperatively estimate the difficulty and perioperative outcome of laparoscopic liver resections. We evaluated the relationship between the IWATE criteria and the perioperative outcomes in robotic-assisted liver resections (RARLs). Methods: We [...] Read more.
Background/Objectives: The IWATE criteria are well-established as a helpful tool to preoperatively estimate the difficulty and perioperative outcome of laparoscopic liver resections. We evaluated the relationship between the IWATE criteria and the perioperative outcomes in robotic-assisted liver resections (RARLs). Methods: We retrospectively analyzed the data of 58 patients who underwent robotic-assisted liver surgery at our center between July 2019 and April 2023. The operative difficulty of every patient was graded according to the IWATE criteria and compared to the perioperative outcome. Results: The median operation time was 236.5 min (range 37–671 min), and the median length of stay was 6 days (range 3–37 min). The majority had no complications (65.5%; n = 38), 18 (31.0%) patients suffered from mild complications (CD ≤ 3A) and 2 patients (3.4%) suffered from relevant complications (CD ≥ 3B). We observed no deaths within 30 postoperative days. The surgery time, postoperative ICU stay and perioperative blood transfusions increased significantly with a higher difficulty level (p = < 0.001; p < 0.001; p = 0.016). The length of stay, conversion to open surgery (n = 2) and complication rate were not significantly linked to the resulting IWATE group. Conclusions: The IWATE criteria can be implemented in robotic-assisted liver surgery and can be helpful in preoperatively estimating the difficulty of robotic liver resections. Whether there is a “robotic effect” in minimally invasive liver resections has to be further clarified. The IWATE criteria can help to develop curricula for robotic training. Full article
(This article belongs to the Special Issue Advances in Hepatobiliary Surgery)
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Figure 1

Figure 1
<p>Pie chart displaying all patients who underwent robotic-assisted liver surgery, graded according to the IWATE criteria.</p> Full article ">Figure 2
<p>Box plot chart presenting the surgery time (minutes) in relation to the four difficulty levels.</p> Full article ">Figure 3
<p>Box plot chart presenting the length of the ICU stay (days) in relation to the four difficulty levels. Statistical outliers and extreme outliers of the respective variable are displayed by asterisks in the box plot.</p> Full article ">Figure 4
<p>Bar chart displaying the perioperative blood transfusions (<span class="html-italic">n</span>) in relation to the four difficulty levels.</p> Full article ">Figure 5
<p>Bar chart displaying the Clavien–Dindo grade in relation to the four difficulty levels.</p> Full article ">
15 pages, 3051 KiB  
Article
Predicting Safe Liver Resection Volume for Major Hepatectomy Using Artificial Intelligence
by Chol Min Kang, Hyung June Ku, Hyung Hwan Moon, Seong-Eun Kim, Ji Hoon Jo, Young Il Choi and Dong Hoon Shin
J. Clin. Med. 2024, 13(2), 381; https://doi.org/10.3390/jcm13020381 - 10 Jan 2024
Cited by 2 | Viewed by 1972
Abstract
(1) Background: Advancements in the field of liver surgery have led to a critical need for precise estimations of preoperative liver function to prevent post-hepatectomy liver failure (PHLF), a significant cause of morbidity and mortality. This study introduces a novel application of artificial [...] Read more.
(1) Background: Advancements in the field of liver surgery have led to a critical need for precise estimations of preoperative liver function to prevent post-hepatectomy liver failure (PHLF), a significant cause of morbidity and mortality. This study introduces a novel application of artificial intelligence (AI) in determining safe resection volumes according to a patient’s liver function in major hepatectomies. (2) Methods: We incorporated a deep learning approach, incorporating a unique liver-specific loss function, to analyze patient characteristics, laboratory data, and liver volumetry from computed tomography scans of 52 patients. Our approach was evaluated against existing machine and deep learning techniques. (3) Results: Our approach achieved 68.8% accuracy in predicting safe resection volumes, demonstrating superior performance over traditional models. Furthermore, it significantly reduced the mean absolute error in under-predicted volumes to 23.72, indicating a more precise estimation of safe resection limits. These findings highlight the potential of integrating AI into surgical planning for liver resections. (4) Conclusion: By providing more accurate predictions of safe resection volumes, our method aims to minimize the risk of PHLF, thereby improving clinical outcomes for patients undergoing hepatectomy. Full article
(This article belongs to the Special Issue Advances in Hepatobiliary Surgery)
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Figure 1
<p>Virtual resection line is located on the right side of Middle hepatic vein (<b>A</b>). Virtual resection line on gall bladder level (<b>B</b>).</p> Full article ">Figure 2
<p>Virtual resection line is located on the left side of Middle hepatic vein (<b>A</b>). Virtual resection line on portal bifurcation level (<b>B</b>).</p> Full article ">Figure 3
<p>Explanation of residual block.</p> Full article ">Figure 4
<p>The proposed network architecture receives 23 laboratory data parameters from patients as input and produces a single output representing the liver resection area.</p> Full article ">Figure 5
<p>Explanation of K-fold validation used in our evaluation. The dataset of size <span class="html-italic">N</span> is split into k blocks with each block containing <span class="html-italic">N</span>/K data points. In each iteration, performance is measured in 3 different metrics. <span class="html-italic">P</span>, <span class="html-italic">U</span>, and <span class="html-italic">O</span> are explained in the figure. After all iterations, the average values of all <span class="html-italic">P</span>, <span class="html-italic">U</span>, and <span class="html-italic">O</span> are obtained. The rationale for applying the K-fold is to validate models with a relatively low number of data points.</p> Full article ">Figure 6
<p>Percentage of Successful Resection Volume (P) performance comparison of diverse machine learning and deep learning models against our patient data (ANOVA <span class="html-italic">p</span> &lt; 0.001).</p> Full article ">Figure 7
<p>Mean Absolute Error of Under-predicted (U) and Over-predicted (O) performance comparison of diverse machine learning and deep learning models against our patient data. Note that the lower the error, the better the performance (ANOVA <span class="html-italic">p</span> &lt; 0.001).</p> Full article ">

Other

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11 pages, 411 KiB  
Systematic Review
Robotic Vascular Resection in Pancreatic Ductal Adenocarcinoma: A Systematic Review
by Victoria Zecchin Ferrara, Alessandro Martinino, Francesco Toti, Davide Schilirò, Federico Pinto, Francesco Giovinazzo and on behalf of the SMAGEICS Group
J. Clin. Med. 2024, 13(7), 2000; https://doi.org/10.3390/jcm13072000 - 29 Mar 2024
Viewed by 1637
Abstract
(1) Background: This study comprehensively compared robotic pancreatic surgery with vascular resection (RPS-VR) to other surgical procedures in the treatment of pancreatic ductal adenocarcinoma (PDAC). (2) Methods: A systematic review of relevant literature was conducted to assess a range of crucial surgical and [...] Read more.
(1) Background: This study comprehensively compared robotic pancreatic surgery with vascular resection (RPS-VR) to other surgical procedures in the treatment of pancreatic ductal adenocarcinoma (PDAC). (2) Methods: A systematic review of relevant literature was conducted to assess a range of crucial surgical and oncological outcomes. (3) Results: Findings indicate that robotic surgery with vascular resections (VRs) significantly prolongs the duration of surgery compared to other surgical procedures, and they notably demonstrate an equal hospital stay. While some studies reported a lower conversion rate and a higher rate of blood loss and blood transfusion in the RPS-VR group, others found no significant disparity. Furthermore, RPS-VR consistently correlated with comparable recurrence rates, free margins R0, postoperative mortality, and complication rates. Concerning the last one, certain reviews reported a higher rate of major complications. Overall survival and disease-free survival remained comparable between the RPS-VR and other surgical techniques in treating PDAC. (4) Conclusions: The analysis emphasizes how RPS-VR is a resembling approach in terms of surgical outcomes and aligns with existing literature findings in this field. Full article
(This article belongs to the Special Issue Advances in Hepatobiliary Surgery)
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<p>PRISMA flow diagram.</p> Full article ">
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