title: Navigation Guidance Using Polyglycolic Acid Felt in Pure Laparoscopic Partial Hepatectomy.
abstract: BACKGROUND
  Appropriate determination of the dissecting plane for removing the tumor blood flow drainage area (TBF-D area) around a hepatocellular carcinoma as well as the tumor itself is essential in pure laparoscopic hepatectomy, but it is often difficult with the usual devices. Navigation technologies have been developed in an attempt to improve the technical accuracy, but they are still under development and cannot be easily applied yet in current clinical practice. To resolve this problem, we created a novel method of using absorbable polyglycolic acid felt (PGA felt) as a navigation guide in pure laparoscopic partial hepatectomy (PLH).
  
  
  METHODS
  We used a PGA felt cut into the appropriate shape in accordance with the shape determined preoperatively by simulation computed tomography in each case. We applied the felt on the surface of the liver intraoperatively as a guide for PLH.
  
  
  RESULTS
  The PGA felt was placed on the surface of the liver, with the central portion of the felt aligned to the central portion of the tumor. The resection line was marked around the felt using monopolar electrocautery. Then, after removing the PGA felt, PLH was successfully performed along the marked line. The surgical margin was confirmed to be adequate in the resected specimen, which showed complete resection of the TBF-D area as well as of the tumor in a comparison with the preoperative computed tomography angiography images.
  
  
  CONCLUSIONS
  This new technique is easy and safe and enables resection of both the tumor(s) and the TBF-D area appropriately and accurately in PLH.
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan s-marubashi@umin.ac.jp.
authors.forename: Shigeru
authors.initials: S
authors.lastname: Marubashi
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Kunihito
authors.initials: K
authors.lastname: Gotoh
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Akita
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Hidenori
authors.initials: H
authors.lastname: Takahashi
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Keijiro
authors.initials: K
authors.lastname: Sugimura
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Norikatsu
authors.initials: N
authors.lastname: Miyoshi
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Masaaki
authors.initials: M
authors.lastname: Motoori
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Kentaro
authors.initials: K
authors.lastname: Kishi
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Shingo
authors.initials: S
authors.lastname: Noura
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Yoshiyuki
authors.initials: Y
authors.lastname: Fujiwara
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Ohue
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Yano
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Osamu
authors.initials: O
authors.lastname: Ishikawa
authors.affiliation: Osaka Medical Center for Cancer and Cardiovascular Diseases, Osaka, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Sakon
mesh_terms: D001672:Biocompatible Materials / Q000627:therapeutic use*; D003198:Computer Simulation; D006498:Hepatectomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D010535:Laparoscopy / Q000295:instrumentation*; D008297:Male; D008875:Middle Aged; D011100:Polyglycolic Acid / Q000627:therapeutic use*; D025321:Surgery, Computer-Assisted / Q000295:instrumentation*
chemical_list: D001672:Biocompatible Materials; D011100:Polyglycolic Acid
keywords: image guided surgery; simulation; surgical oncology