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      Navigation liver surgery for complex hydatid cyst with biliary tree communication

      case-report

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          Highlights

          • •

            The liver surgery navigation system may guide the surgeon during the resection for benign diseases such as hydatidosis.

          Abstract

          Introduction

          Today, liver surgery navigation is utilized only in high-specialized centers for patients affected by malignant diseases. However, navigated surgery may also be of great interest for benign diseases such as hydatidosis in particular if the hydatid cyst is communicating with the biliary tree. With navigation we know exactly in each moment during the surgery the relationship of the cyst with the vascular/biliary structures around it.

          Presentation of case

          Herein, we report a case of a 20-year-old W/M affected by hepatic hydatid cyst communicating with the right bile duct, causing recurrent cholangitis. The diagnosis was confirmed by endoscopic retrograde cholangiography and magnetic resonance imaging. The liver cystectomy was easily performed using a navigation system incorporating instrument tracking and three-dimensional CT-reconstruction, thus permitting a selective suture of the bile duct communicating with the cyst.

          Conclusions

          The navigated system may guide the surgeon in patients with severe and complicated hydatid cysts.

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          Most cited references18

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          Cystic hydatid disease: current trends in diagnosis and management.

          M. Bulent Tirnaksiz, İskender Sayek, Rıza Doğan (2003)
          Cystic echinococcosis is endemic in certain parts of the world. The growth of the cyst is often slow, and the liver and lungs are the most frequently involved organs. Diagnosis is based on clinical signs and symptoms and epidemiological data, while ultrasonography is important for the classification of hydatid cysts. Although certain types of hydatid cysts are successfully treated by percutaneous aspiration, injection, and reaspiration, surgery remains the treatment of choice. We reviewed the current trends in the diagnosis and management of cystic echinococcosis, with special emphasis on hepatic and pulmonary involvement.
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            Results of surgical, laparoscopic, and percutaneous treatment for hydatid disease of the liver: 10 years experience with 355 patients.

            Turgut Tufan, N Kaymakçioğlu, G Yagci … (2005)
            Selection of the most appropriate treatment to obtain the best results with the lowest rate of recurrence and minimal morbidity and mortality is mandatory for the management of hepatic hydatid disease. The surgical approach is the mainstay of treatment, and there has been a tendency toward laparoscopic surgery and, more recently, percutaneous treatment (PT), which has become increasingly popular with revolutions in techniques. We aimed to evaluate the results of current therapeutic methods in the context of a 10-year single-institution experience. Between 1992 and 2003, 355 patients with 510 hydatid cysts of the liver were treated by open operation, laparoscopic surgery, or PT. The series included 128 females and 227 males ranging in age from 10 years to 73 years. Preferred treatment modalities, perioperative complications, interventions, recurrences, and length of hospital stay were retrospectively analyzed. There were two postoperative deaths (1.08%) in the open surgery group. Biliary leakage was observed in 28 patients treated with open surgery, in 10 patients after PT, and in 2 after laparoscopic treatment. Recurrence rates were 16.2%, 3.3%, and 3.5% after open surgery, laparoscopic surgery, and percutaneous treatment, respectively. Characteristics of the cyst, presence of cystobiliary communications, and the availability of a multidisciplinary team are the factors that we believe directly affect the results. Radical surgery can be done safely for suitable cases; conventional procedures are associated with greater morbidity. Laparoscopic surgery seems effective and safe, with low morbidity and recurrence rates for type I-III cysts in accessible localizations. Our experience with PAIR (puncture, aspiration, injection, and reaspiration) and catheterization provides evidence that the procedure is an effective and safe option.
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              Innovation in hepatic alveolar echinococcosis imaging: best use of old tools, and necessary evaluation of new ones

              Wenya Liu, Éric Delabrousse, Oleg Blagosklonov … (2014)
              Hepatic Alveolar Echinococcosis (HAE), caused by larvae of Echinococcus multilocularis, is a rare but potentially lethal parasitic disease. The first diagnostic suspicion is usually based on hepatic ultrasound exam performed because of abdominal symptoms or in the context of a general checkup; HAE diagnosis may thus also be an incidental finding on imaging. The next step should be Computed Tomography (CT) or Magnetic Resonance Imaging (MRI). They play an important role in the initial assessment of the disease; with chest and brain imaging, they are necessary to assess the PNM stage (parasite lesion, neighboring organ invasion, metastases) of a patient with AE. Performed at least yearly, they also represent key exams for long-term follow-up after therapeutic interventions. Familiarity of radiologists with HAE imaging findings, especially in the endemic regions, will enable earlier diagnosis and more effective treatment. Fluorodeoxyglucose Positron Emission Tomography (FDG-PET) is currently considered to be the only noninvasive, albeit indirect, tool for the detection of metabolic activity in AE. Delayed acquisition of images (3 hrs after FDG injection) enhances its sensitivity for the assessment of lesion metabolism and its reliability for the continuation/withdrawal of anti-parasite treatment. However, sophisticated equipment and high cost widely limit PET/CT use for routine evaluation. Preliminary studies show that new techniques, such as contrast-enhanced ultrasound (US), Dual Energy CT or Spectral CT, and Diffusion-Weighted MRI, might also be useful in detecting the blood supply and metabolism of lesions. However, they cannot be recommended before further evaluation of their reliability in a larger number of patients with a variety of locations and stages of AE lesions.
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                Author and article information

                Contributors
                Fabrizio Panaro
                Journal
                Journal ID (nlm-ta): Int J Surg Case Rep
                Journal ID (iso-abbrev): Int J Surg Case Rep
                Title: International Journal of Surgery Case Reports
                Publisher: Elsevier
                ISSN (Electronic): 2210-2612
                Publication date PMC-release: 29 May 2015
                Publication date Collection: 2015
                Publication date (Electronic): 29 May 2015
                Volume: 12
                Pages: 112-116
                Affiliations
                [0005]Department of General Liver Transplant Surgery, University of Montpellier, Hôpital Saint Eloi, 80 avenue Augustin Fliche 34295, Montpellier-Cedex 5, France
                Author notes
                [* ]Corresponding author at: Department of Surgery, Liver/Pancreas Transplant Unit Montpellier University Hospital, College of Medicine 80, avenue Augustin Fliche 34295, Montpellier Cedex 5, France. Tel.: +33 4 67 33 67 33; fax: +33 4 67 33 76 23. f-panaro@ 123456chu-montpellier.fr
                [1]

                Hepato-Biliary and Pancreatic Surgical Unit, General, Digestive and Endocrine Surgery, IRCAD, IHU MixSurg, Institute for Minimally Invasive Image-Guided Surgery, University of Strasbourg, 1 place de l'Hôpital, 67091, Strasbourg, France.

                Article
                Publisher ID: S2210-2612(15)00251-5
                DOI: 10.1016/j.ijscr.2015.05.030
                PMC ID: 4486404
                PubMed ID: 26057992
                SO-VID: 083c1302-29f1-4e3e-989a-071894cb5111
                Copyright © © 2015 The Authors
                License:

                This is an open access article under the CC BY-NC-ND license (http://creativecommons.org/licenses/by-nc-nd/4.0/).

                History
                Date received : 24 March 2015
                Date revision received : 21 May 2015
                Date accepted : 25 May 2015
                Categories
                Subject: Case Report

                Keywords: hydatid disease,cystectomy,bile ducts,image-guided surgery,navigated ultrasound
                Data availability:
                Keywords: hydatid disease, cystectomy, bile ducts, image-guided surgery, navigated ultrasound

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