0
Operative Techniques |

Laparoscopic Hepatic Artery Infusion Pump Placement

David R. Urbach, MD; Daniel M. Herron, MD; Yashodan S. Khajanchee, MBBS; Lee L. Swanström, MD; Paul D. Hansen, MD
Arch Surg. 2001;136(6):700-704. doi:10.1001/archsurg.136.6.700.
Text Size: A A A
Published online

Patients with metastatic colorectal cancer limited to the liver are candidates for regional chemotherapy with implantable hepatic artery infusion (HAI) pumps. The poor prognosis of these patients, and the requirement of a laparotomy for placement, has deterred many oncologists from referral for HAI pump implantation. Minimally invasive surgical techniques are particularly well suited for the task of HAI pump placement in patients who may not tolerate the additional physiologic stress of a major surgical intervention. Advances in laparoscopic techniques allow pumps to be implanted safely and effectively, replicating the well-described tenets of open pump placement. The principal steps of the operation include a thorough laparoscopic evaluation to exclude extrahepatic disease, complete vascular isolation of the hepatic and gastroduodenal arteries, ligation of aberrant hepatic vessels, secure cannulation of the gastroduodenal artery, and confirmation of complete hepatic perfusion without extrahepatic perfusion. We describe the procedure and briefly review our clinical experience. We believe that the benefits typically derived from minimally invasive approaches (less pain, fewer perioperative complications, shorter hospitalization, faster recovery, and potentially less immune suppression) will be seen in these patients as well. If so, a completely laparoscopic approach to regional treatment of the liver may extend survival and improve the quality of life of patients whose prognosis is poor regardless of treatment. Controlled trials will be required to evaluate the added value of a laparoscopic approach to the placement of the hepatic artery pump.

Figures in this Article

Sign In to Access Full Content

Don't have Access?

Register and get free email Table of Contents alerts, saved searches, PowerPoint downloads, CME quizzes, and more

Subscribe for full-text access to content from 1998 forward and a host of useful features

Activate your current subscription (AMA members and current subscribers)

Purchase Online Access to this article for 24 hours

Figures

Place holder to copy figure label and caption
Figure 1.

Placement of port and pump incisions.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 2.

Laparoscopic ultrasound image of a suspicious portal lymph node (LN) anterior to the common hepatic artery (CHA) and portal vein (PV).

Graphic Jump Location
Place holder to copy figure label and caption
Figure 3.

Dissected porta hepatis. In this patient, the gastroduodenal artery (GDA) originates from the right hepatic artery (RHA). The common hepatic artery (CHA) bifurcates into the left hepatic artery (LHA) and RHA.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 4.

Insertion of the catheter into the gastroduodenal artery. Two ligatures are positioned around the artery prior to inserting the catheter and are tied after the catheter is correctly positioned.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 5.

Securing the catheter in the gastroduodenal artery with a tie on each side of the bead.

Graphic Jump Location
Place holder to copy figure label and caption
Figure 6.

Completed insertion of the catheter. The catheter is secured to the gastroduodenal artery (GDA) by 3 ligatures, 2 on either side of the distal bead in the GDA, and a third on the ligated end of the GDA at the superior border of the duodenum. The common hepatic artery (CHA) and proper hepatic artery (PHA) are dissected free of any vascular communications in the porta hepatis.

Graphic Jump Location

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
NOTE:
Citing articles are presented as examples only. In non-demo SCM6 implementation, integration with CrossRef’s "Cited By" API will populate this tab (http://www.crossref.org/citedby.html).
Submit a Comment

Multimedia

Some tools below are only available to our subscribers or users with an online account.

Web of Science® Times Cited: 13

Sign In to Access Full Content

Related Content

Customize your page view by dragging & repositioning the boxes below.

Articles Related By Topic
Related Topics
PubMed Articles
Jobs
brightcove.createExperiences();