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Liver mobilization and sub-diaphragmatic peritonectomy by laparoscopy
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  1. Virginie Collin-Bund1,2,
  2. Lise Lecointre1,3,4,
  3. Chris Minella1,
  4. François Faitot5 and
  5. Chérif Akladios1
    1. 1Department of Gynecology and Obstetrics, Hôpitaux Universitaires de Strasbourg, Strasbourg, France
    2. 2Laboratoire d'ImmunoRhumatologie Moléculaire, Institut National de la Santé et de la Recherche Médicale (INSERM) UMR_S 1109, Institut thématique interdisciplinaire (ITI) de Médecine de Précision de Strasbourg, Transplantex NG, Faculté de Médecine, Fédération Hospitalo-Universitaire OMICARE, Fédération de Médecine Translationnelle de Strasbourg (FMTS), Université de Strasbourg, Strasbourg, France
    3. 3I-Cube UMR 7357-Laboratoire des Sciences de L'ingénieur, de L'informatique et de L'imagerie, Université de Strasbourg, Strasbourg, France
    4. 4Institut Hospitalo-Universitaire (IHU), Institute for Minimally Invasive Hybrid Image-Guided Surgery, Université de Strasbourg, Strasbourg, France
    5. 5Department of Digestive Tract Surgery, Strasbourg University Hospitals Hautepierre Hospital, Strasbourg, France
    1. Correspondence to Dr Virginie Collin-Bund, Gynecology and Obstetrics, Les Hôpitaux Universitaires de Strasbourg Pôle de Gynécologie Obstétrique et Fertilité, Strasbourg, France; virginie.bund{at}chru-strasbourg.fr

    https://doi.org/10.1136/ijgc-2024-005463

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      This video demonstrates a surgical technique using a systematic approach to laparoscopic liver mobilization with resection of the right diaphragmatic peritoneum.

      A patient in her 50s with an advanced high-grade serous ovarian FIGO IIIC was eligible for complete laparoscopic interval debulking surgery in accordance with French guidelines1 after three cycles of neoadjuvant chemotherapy. At the end of the surgery, a laparoscopic hyperthermic intraperitoneal chemotherapy was performed.2 The length of the surgery was 5 hours. All the steps of the surgery are presented in Figure 1. The first step of dissection consists of removing adhesions between the right colon and the liver. Dissection then continues on the hepatocolic ligament which is lateral and anterior to the posterior coronary ligament.

      Figure 1
      Figure 1

      Steps of liver mobilization.

      Opening the falciform allows the introduction of a liver retractor and thus gives a view of the posterior aspect of the liver (Figure 2). This enables us to make a total resection of the triangular and coronal ligament of the liver and to detach it completely from the right colonic angle (hepatic flexture). In this case, liver traction allows access to the right diaphragmatic peritoneum carcinosis. Postoperative follow-up was uneventful and adjuvant chemotherapy was continued within 6 weeks in accordance with the current guidelines. To date, the patient has had no recurrence.

      Figure 2
      Figure 2

      Anatomical structures that can be visualized after laparoscopic mobilization of the liver (posterior view).

      Video 1 Steps of liver mobilization and sub diaphragmatic peritonectomy by laparoscopy

      The video demonstrates a minimally invasive approach following the same operative strategy as open surgery by a team trained in this type of surgery.

      Data availability statement

      No data are available.

      Ethics statements

      Patient consent for publication

      Ethics approval

      Not applicable.

      References

      1. ↵
        1. Lavoue V,
        2. Huchon C,
        3. Akladios C, et al
        . Management of epithelial cancer of the ovary, fallopian tube, and primary peritoneum. Short text of the French clinical practice guidelines issued by FRANCOGYN, CNGOF, SFOG, and GINECO-ARCAGY, and endorsed by INCa. Eur J Obstet Gynecol Reprod Biol 2019;236:214–23. doi:10.1016/j.ejogrb.2019.03.010
        OpenUrlCrossRefPubMed
      2. ↵
        1. Collin-Bund V,
        2. Lecointre L,
        3. Ross C, et al
        . Preliminary observational study of the implementation of hyperthermic intraperitoneal chemotherapy in ovarian cancer in the gynecological surgery department at the University Hospital of Strasbourg. J Gynecol Obstet Hum Reprod 2023;52:102501. doi:10.1016/j.jogoh.2022.102501
        OpenUrl

      Footnotes

      • Contributors Conceptualization: VC-B, CA, FF; methodology: VC-B; software: VC-B; validation: CA, FF, LL; formal analysis: VC-B; data curation: VC-B, LL, CM, CA, FF; writing—original-draft preparation: VC-B, CM; writing—review and editing: VC-B, LL, CA; supervision, project administration, and funding acquisition: VC-B, CA, FF. Guarantor: VC-B.

      • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

      • Competing interests None declared.

      • Provenance and peer review Not commissioned; externally peer reviewed.