Publications by authors named "Hong Kyung Shin"

14 Publications

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Risk Factors for High-Grade Meningioma in Brain and Spine: Systematic Review and Meta-analysis.

World Neurosurg 2021 May 8. Epub 2021 May 8.

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address:

Background: Histologic grade has important implications for the management in meningioma. It is important to understand the risk of high-grade meningioma (grades II and III). In this article, we systematically reviewed the histologic grade of meningioma depending on the location and sex and its relationship with recurrence.

Methods: The PubMed and Embase databases were systematically searched until February 4, 2020. We included studies that were not restricted to specific anatomic locations, histologic grade, or the sizes of the tumors. The proportion of high-grade meningiomas depending on the location and sex and the odds ratio (OR) of recurrence were pooled using a random-effects model.

Results: Outcome data were analyzed for 20,336 tumors from 34 studies. We found different proportions of high-grade meningiomas in the brain (12.8%) (95% confidence interval [CI], 10.5%-15.1%) versus the spine (2.4%) (95% CI, 1.0%-3.7%) (P < 0.01). Skull base meningiomas (8.7%) (95% CI, 5.8%-11.6%) had a lower proportion of high-grade meningiomas than non-skull base meningiomas (16.5%) (95% CI, 11.9%-21.1%) (P < 0.01). In addition, high-grade meningiomas were more likely to occur in male patients (18.0%) (95% CI, 10.1%-25.9%) than female patients (7.0%) (95% CI, 3.5%-10.6%) (P = 0.01). Higher rates of recurrence (OR = 13.83) were confirmed for high-grade meningiomas than grade I meningiomas (95% CI, 4.10-46.65) (P < 0.01).

Conclusions: This meta-analysis found that intracranial, nonskull base, and male sex are risk factors for high-grade meningioma, and high-grade meningioma had a much higher recurrence rate as compared with grade I meningioma.
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http://dx.doi.org/10.1016/j.wneu.2021.04.138DOI Listing
May 2021

Relevance of Postoperative Magnetic Resonance Images in Evaluating Epidural Hematoma After Thoracic Fixation Surgery.

World Neurosurg 2017 Nov 24;107:803-808. Epub 2017 Aug 24.

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Republic of Korea. Electronic address:

Background: It is difficult to evaluate the significant findings of epidural hematoma in magnetic resonance images (MRIs) obtained immediately after thoracic posterior screw fixation (PSF).

Methods: Prospectively, immediate postoperative MRI was performed in 10 patients who underwent thoracic PSF from April to December 2013. Additionally, we retrospectively analyzed the MRIs from 3 patients before hematoma evacuation out of 260 patients who underwent thoracic PSF from January 2000 to March 2013.

Results: The MRI findings of 9 out of the 10 patients, consecutively collected after thoracic PSF, showed neurologic recovery with a well-preserved cerebrospinal fluid (CSF) space and no prominent hemorrhage. Even though there were metal artifacts at the level of the pedicle screws, the preserved CSF space was observed. In contrast, the MRI of 1 patient with poor neurologic outcome demonstrated a typical hematoma and slight spinal cord compression and reduced CSF space. In the retrospective analysis of the 3 patients who showed definite motor weakness in the lower extremities after their first thoracic fusion surgery and underwent hematoma evacuation, the magnetic resonance images before hematoma evacuation also revealed hematoma compressing the spinal cord and diminished CSF space.

Conclusions: This study shows that epidural hematomas can be detected on MRI performed immediately after thoracic fixation surgery, despite metal artifacts and findings such as hematoma causing spinal cord compression. Loss of CSF space should be considered to be associated with neurologic deficit.
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http://dx.doi.org/10.1016/j.wneu.2017.08.097DOI Listing
November 2017

Three-Dimensional Laparoscopic Anatomical Segment 8 Liver Resection with Glissonian Approach.

Ann Surg Oncol 2017 Jun 24;24(6):1606-1609. Epub 2017 Jan 24.

Department of Surgery, Chungbuk National University Hospital, Cheongju, Korea.

Background: Anatomical liver resection has been reported to have oncologic benefit over nonanatomical resection in surgery for hepatocellular carcinoma (HCC). Basic concept of anatomical resection is preventing tumor spread through the portal or venous flow. Few cases have been reported for laparoscopic anatomical segment 8 resection because of its technical difficulties. This video shows operative techniques for laparoscopic anatomical resection of segment 8, exposing middle and right hepatic vein and inferior vena cava using three-dimensional video.

Methods: A 61-year-old male was diagnosed to be a hepatitis B virus carrier 6 years ago. A 6.6-cm-sized HCC lesion was detected at segment 8 by computed tomography scan. We have used a high-definition, three-dimensional laparoscope with a deflectable tip (Olympus Medical Systems Corp., Japan), a trocar inserted in the right seventh intercostal space to obtain the optimal field of view on the superior-posterior portion of the liver. Using the Glissonian pedicle approach, we isolated and clamped the branch to the segment 8 to confirm the anatomical border of the segment 8. Segmentectomy was completed exposing the middle and right hepatic vein and inferior vena cava.

Results: Operation took 420 min. Estimated blood loss was 600 mL, and no red blood cell was transfused. Final pathology was an HCC with 0.3-cm safety margin. The patient discharged on the sixth day after operation with normal liver function test results. There was no operation-related complication from the operation day to the first outpatient visit day.

Conclusions: Laparoscopic anatomical resection of segment 8 is feasible.
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http://dx.doi.org/10.1245/s10434-017-5778-6DOI Listing
June 2017

Cauda equina lymphoma mimicking non-neoplastic hypertrophic neuropathy of the cauda equina: A case report.

Br J Neurosurg 2016 Dec 26;30(6):678-680. Epub 2015 Nov 26.

a Department of Neurological Surgery , Asan Medical Center, University of Ulsan College of Medicine , Seoul , Korea.

Spinal cauda equina lymphoma (CEL) is very rare, with only about 14 cases reported in the English medical literature. Magnetic resonance image findings and the gross appearance of CEL at surgery are similar to those of non-neoplastic hypertrophic neuropathy of the cauda equina (HNCE); however, their prognosis and treatment are very different. We report a case of CEL and discuss the differences from non-neoplastic HNCE.
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http://dx.doi.org/10.3109/02688697.2015.1111295DOI Listing
December 2016

Comparison of laparoscopic liver resection for hepatocellular carcinoma located in the posterosuperior segments or anterolateral segments: A case-matched analysis.

Surgery 2016 11 25;160(5):1219-1226. Epub 2016 Jun 25.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University, College of Medicine, Seongnam, Republic of Korea.

Background: Laparoscopic liver resection is an attractive option for treating liver tumors. Laparoscopic liver resection is more difficult for hepatocellular carcinomas located in the posterosuperior segments than for hepatocellular carcinomas in the anterolateral segments. We compared perioperative and long-term outcomes between laparoscopic liver resection for hepatocellular carcinomas located in the posterosuperior and anterolateral segments.

Methods: We retrospectively reviewed the clinical data for 230 patients who underwent laparoscopic liver resection for hepatocellular carcinomas between September 2003 and July 2014. Of these, 116 patients were selected by case-matched analysis using age, sex, tumor number and size, Child-Pugh class, and extent of liver resection. Patients were classified into 2 groups according to tumor location: the anterolateral group (n = 58) and the posterosuperior group (n = 58).

Results: Operation time (355 minutes vs 212 minutes, P < .005), intraoperative blood loss (600 mL vs 410 mL, P < .001), and hospital stay (8.5 days vs 7 days, P = .040) were significantly greater in the posterosuperior group than in the anterolateral group. The open conversion (13.8% vs 10.3%, P = .777), postoperative complication (17.2% vs 10.3%, P = .420), 5-year overall survival (88.5% vs 85.7%, P = .370), and 5-year, recurrence-free survival (47.6% vs 40.9%, P = .678) rates were not significantly different between the posterosuperior and anterolateral groups.

Conclusion: Although laparoscopic liver resection is more difficult for hepatocellular carcinomas located in the posterosuperior segment, there were no differences in the short- and long-term outcomes between the posterosuperior and anterolateral groups. The perceived impact of tumor location on patient outcomes could be overcome by experience and technical improvements.
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http://dx.doi.org/10.1016/j.surg.2016.05.009DOI Listing
November 2016

Clinical Outcomes of Gamma Knife Radiosurgery for Metastatic Brain Tumors from Gynecologic Cancer : Prognostic Factors in Local Treatment Failure and Survival.

J Korean Neurosurg Soc 2016 Jul 8;59(4):392-9. Epub 2016 Jul 8.

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Objective: Brain metastases in gynecologic cancer (ovarian, endometrial, and cervical cancer) patients are rare, and the efficacy of Gamma Knife Radiosurgery (GKRS) to treat these had not been evaluated. We assessed the efficacy of GKRS and prognostic factors for tumor control and survival in brain metastasis from gynecologic cancers.

Methods: This retrospective study was approved by the institutional review board. From May 1995 to October 2012, 26 women (mean age 51.3 years, range 27-70 years) with metastatic brain tumors from gynecologic cancer were treated with GKRS. We reviewed their outcomes, radiological responses, and clinical status.

Results: In total 24 patients (59 lesions) were available for follow-up imaging. The median follow-up time was 9 months. The mean treated tumor volume at the time of GKRS was 8185 mm(3) (range 10-19500 mm(3)), and the median dose delivered to the tumor margin was 25 Gy (range, 10-30 Gy). A local tumor control rate was 89.8% (53 of 59 tumors). The median overall survival was 9.5 months after GKRS (range, 1-102 months). Age-associated multivariate analysis indicated that the Karnofsky performance status (KPS), the recursive partitioning analysis (RPA) classification, and the number of treated lesions were significant prognostic factors for overall survival (HR=0.162, p=0.008, HR=0.107, p=0.038, and HR=2.897, p=0.045, respectively).

Conclusion: GKRS is safe and effective for the management of brain metastasis from gynecologic cancers. The clinical status of the patient is important in determining the overall survival time.
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http://dx.doi.org/10.3340/jkns.2016.59.4.392DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4954889PMC
July 2016

Laparoscopic resection of hilar cholangiocarcinoma.

Ann Surg Treat Res 2015 Oct 25;89(4):228-32. Epub 2015 Sep 25.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seoul, Korea.

Laparoscopic resection of hilar cholangiocarcinoma is technically challenging because it involves complicated laparoscopic procedures that include laparoscopic hepatoduodenal lymphadenectomy, hemihepatectomy with caudate lobectomy, and hepaticojejunostomy. There are currently very few reports describing this type of surgery. Between August 2014 and December 2014, 5 patients underwent total laparoscopic or laparoscopic-assisted surgery for hilar cholangiocarcinoma. Two patients with type I or II hilar cholangiocarcinoma underwent radical hilar resection. Three patients with type IIIa or IIIb cholangiocarcinoma underwent extended hemihepatectomy together with caudate lobectomy. The median (range) age, operation time, blood loss, and length of hospital stay were 63 years (43-76 years), 610 minutes (410-665 minutes), 650 mL (450-1,300 mL), and 12 days (9-21 days), respectively. Four patients had a negative margin, but 1 patient was diagnosed with high-grade dysplasia on the proximal resection margin. The median tumor size was 3.0 cm. One patient experienced postoperative biliary leakage, which resolved spontaneously. Laparoscopic resection is a feasible surgical approach in selected patients with hilar cholangiocarcinoma.
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http://dx.doi.org/10.4174/astr.2015.89.4.228DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4595825PMC
October 2015

Hybrid Repair of Suprarenal Abdominal Aortic Aneurysm: Antegrade Debranching with Endovascular Aneurysm Repair.

Vasc Specialist Int 2014 Dec 31;30(4):151-4. Epub 2014 Dec 31.

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

We report a hybrid repair approach to the treatment of abdominal aortic aneurysm in patients with complex anatomies when typical endovascular aneurysm repair is limited due to juxtarenal involvement. A 63-year-old man presented with a 3-day history of fever and abdominal pain. He was diagnosed with acute cholecystitis along with incidental findings of two separate aneurysms of the abdominal aorta: a 3.7 cm saccular aneurysm at the suprarenal level, and a 6.6 cm fusiform aneurysm above the iliac bifurcation. He was treated with a hybrid technique involving an open approach for antegrade debranching of the superior mesenteric artery, and renal arteries and endovascular stent placement for treatment of an abdominal aortic aneurysm. The procedure was successfully completed with no adverse events as of the most recent 6-month outpatient follow-up.
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http://dx.doi.org/10.5758/vsi.2014.30.4.151DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480320PMC
December 2014

In Situ Aortic Reconstruction with Femoral Vein after Post-EVAR Infection.

Vasc Specialist Int 2014 Jun 30;30(2):72-5. Epub 2014 Jun 30.

Department of Surgery, Seoul National University Bundang Hospital, Seongnam, Korea.

A 78-year-old male presented with early gastric cancer and a 5.5 cm-sized infrarenal abdominal aortic aneurysm, detected during regular screening. Endovascular aneurysm repair (EVAR) was performed first, followed by laparoscopic distal gastrectomy. After gastrectomy, the patient underwent computed tomography (CT) scan due to persistent fever, which showed increased perigraft fluid collection around the right iliac limb graft. Echocardiography also revealed mitral valve vegetation, consistent with infective endocarditis. Despite intensive antibiotic treatment, the patient had persistent fever and showed fluid extension to the psoas muscle on CT scan. On the 49th post operative day (POD) after EVAR, stent graft explantation and aortic reconstruction with the left superficial femoral vein was performed. Ligation of the right iliac artery for infection control and simultaneous femoro-femoral bypass was also performed. The patient was discharged on the 46th POD after graft removal without any events.
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http://dx.doi.org/10.5758/vsi.2014.30.2.72DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4480309PMC
June 2014

Intraoperative direct puncture and embolization (IOPE) using a glue material for spinal cord arteriovenous fistula: a case report.

Eur Spine J 2015 May 1;24 Suppl 4:S594-9. Epub 2015 Feb 1.

Department of Neurological Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea.

Introduction: Spinal arteriovenous fistula (AVF) is treated by embolization or surgery. However, transarterial embolization or surgery is difficult in rare cases when the fistula site is very complicated to access especially as in fistular nidus supplied by posterior and anterior spinal artery. We present the case which was treated with intraoperative direct puncture and embolization (IOPE) using glue material, since the usual transarterial or transvenous neurointerventional approach was difficult to embolize the AVF.

Methods: A 36-year-old woman presented with progressive leg weakness and pain after a 20-year history of lower back pain. She had pelvic and spinal AVF combined with arteriovenous malformation (AVM). Despite prior treatment of the pelvic lesion with radiotherapy and coil embolization, the spinal lesion persisted and caused repeated subarachnoid hemorrhages. A spinal angiogram revealed a tortuous and long feeder of the AVF which had growing venous sac, as well as AVM. Two embolization trials failed because of the long tortuosity and associated anterior spinal artery. Four months later, drastic leg weakness and pain occurred, and IOPE was performed using a glue material.

Results: The subsequent recovery of the patient was rapid. One month later, the use of a strong opioid could be discontinued, and the patient could walk with aid. A follow-up spinal angiogram revealed that the venous sac of the AVF had disappeared.

Conclusion: In spinal AVF which is not feasible to access by usual intervention approach and to dissect surgically, IOPE with glue material can be considered for the treatment.
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http://dx.doi.org/10.1007/s00586-015-3773-9DOI Listing
May 2015

Role of gadoxetic acid-enhanced magnetic resonance imaging in the preoperative evaluation of small hepatic lesions in patients with colorectal cancer.

World J Surg 2015 May;39(5):1161-6

Department of Surgery, Seoul National University Bundang Hospital 300 Gumi-dong, Bundang-gu, Gyeonggi-do, Seongnam, 463-707, Republic of Korea,

Background: The initial abdominal computed tomography (CT) scans of patients with colorectal cancer (CRC) sometimes reveal equivocal hepatic lesions. In this study, we evaluated the outcomes of equivocal hepatic lesions found by abdominal CT and the diagnostic accuracy of subsequent liver magnetic resonance imaging (MRI).

Methods: We evaluated data of patients who underwent CRC resection between January 1, 2009 and December 31, 2009. Equivocal hepatic lesions of <1 cm in size on preoperative staging CT scans were included in this study. Gadoxetic acid-enhanced liver MRI was subsequently performed in all patients. Hepatic lesions that grew during the follow-up period (≥ 3 years) were considered potential metastases.

Results: Overall, 121 equivocal hepatic lesions were detected on preoperative staging CT in 65 out of 494 patients (13.2 %) who underwent colorectal surgery. Based on subsequent MRI, 11 lesions were classified as definitive metastatic lesions and 100 were classified as definitive benign lesions, including simple cysts or hemangiomas. Findings in the other 10 lesions were still inconclusive even after examining CT and MRI. Of the 11 lesions that were classified as metastatic by MRI and were resected, 10 were pathologically confirmed as metastases and one lesion was a pathologically benign nodule. All 100 benign lesions were stable on follow-up imaging and were classified as benign. Of the 10 equivocal lesions, 6 increased in size during the follow up, suggesting they were early metastases, while 4 were stable. The sensitivity and specificity for detecting liver metastases by gadoxetic acid-enhanced MRI of small equivocal hepatic lesions found by CT were 100 % (16/16) and 95.2 % (100/105), respectively, if MRI was equivocal or indicated definite metastasis. The negative predictive value was 100 % (100/100).

Conclusion: Gadoxetic acid-enhanced MRI is a useful diagnostic tool for assessing equivocal hepatic lesions on preoperative CT of CRC patients that allows increased diagnostic accuracy and detection of additional colorectal liver metastasis lesions.
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http://dx.doi.org/10.1007/s00268-015-2944-5DOI Listing
May 2015

Total laparoscopic living donor right hepatectomy.

Surg Endosc 2015 Jan 4;29(1):184. Epub 2014 Jul 4.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, 463-707, Gyeonggi-do, Republic of Korea.

Background: Right lobe living donor liver transplantation (LDLT) is the predominant form of adult-to-adult LDLT. Accordingly, cosmetic and functional demand by young donors is increasing. We developed the world first total laparoscopic donor right hepatectomy (LDRH) in adult living donors.

Methods: Total LDRH was performed in two young donors without vascular clamping. Modified extended right graft (right liver including all the middle hepatic vein branches) was retrieved from suprapubic transverse incision.

Findings: After full mobilization of right liver, hilar dissection was done. First, right portal vein was isolated under retracting common bile duct laterally. Right hepatic artery was cautiously dissected and isolated without injuring. An exact transection line was drawn during transient clamping of the hepatic artery and portal vein on the right side of the liver using bulldog clamp. Dissection was meticulously performed along the right side of the middle hepatic vein until the origin of middle hepatic vein until exposure of the hilar plate. Anterior section vein branches (V5 and V8) were finely dissected and were reconstructed using an artificial vascular graft. A modified extended right graft with preservation of the middle hepatic vein branches was extracted through the suprapubic incision. There was no complication in both donors and recipients. Postoperative hospital stay of donors was 10 and 8 days, respectively. After follow-up of more than 1 year, all donors and recipients live well with normal liver function.

Conclusion: Total LDRH was feasible in selected adult donors. If this procedure will be more standardized, then total LDRH will be new option for adult LDLT, which meets demand by donors and diminish guilty feeling by recipients.
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http://dx.doi.org/10.1007/s00464-014-3649-9DOI Listing
January 2015

Laparoscopic treatment of hepatic cysts located in the posterosuperior segments of the liver.

Ann Surg Treat Res 2014 May 24;86(5):232-6. Epub 2014 Apr 24.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.

Purpose: Laparoscopy is considered the treatment of choice for hepatic cysts, especially those located in anterolateral segments (AL; segments II, III, IVb, V, and VI) because of the ease of laparoscopic access. Here, we evaluated the feasibility and safety of laparoscopic treatment of hepatic cysts in posterosuperior segments (PS; segments I, IVa, VII, and VIII).

Methods: We retrospectively analyzed clinical data for 34 patients who underwent laparoscopic treatment of hepatic cysts between September 2004 and December 2012. Patients were divided into two groups depending on whether the main largest cyst was located in AL (n = 20) or PS (n = 14). Laparoscopic cyst unroofing was performed in 29 patients with symptomatic simple cysts. Laparoscopic resection was performed in 5 patients with suspected cystic neoplasms.

Results: There were no deaths or major complications. The mean operation time was 110 minutes and the mean hospital stay was 4.4 days. The mean cyst size was not significantly different (P = 0.511) but the frequency of multiple cysts was significantly greater in group PS (P = 0.003). The predominant type of resection was unroofing in both groups (P = 0.251). The mean blood loss (P = 0.747), mean hospital stay (P = 0.812), mean operation time (P = 0.669), morbidity rate (P = 0.488), and relapse rate (P = 0.448) were not significantly different. Relapse occurred in one patient who underwent reunroofing 17 months later. The median follow-up is 62 months.

Conclusion: Laparoscopy is a safe procedure for hepatic cysts located in posterosuperior segments.
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http://dx.doi.org/10.4174/astr.2014.86.5.232DOI Listing
http://www.ncbi.nlm.nih.gov/pmc/articles/PMC4024932PMC
May 2014

Role of intercostal trocars on laparoscopic liver resection for tumors in segments 7 and 8.

J Hepatobiliary Pancreat Sci 2014 Aug 19;21(8):E65-8. Epub 2014 May 19.

Department of Surgery, Seoul National University Bundang Hospital, Seoul National University College of Medicine, 300 Gumi-dong, Bundang-gu, Seongnam-si, Gyeonggi-do, 463-707, Korea.

Performing laparoscopic liver resection for lesions located in segment 7 and 8 is technically difficult, as the operative field is far from the conventional trocar site, and the liver impedes free motion of the laparoscopic instrument. Inserting the port through the intercostal space (ICS) may facilitate liver resection for these lesions. From January 2012 to July 2013, five patients (four men and one woman) underwent laparoscopic S7 or 8 segmentectomy for liver metastasis and hepatocellular carcinoma (HCC). Ports were inserted at the 7th and 9th ICS, respectively, in addition to conventional abdominal ports. The mean age was 58 ± 10 (45-74) years; operation time, 197 ± 68 (110-300) minutes; blood loss, 161 ± 138 (40-320) ml; and length of hospital stay, 7 ± 3 (4-12) days. Pathologic findings revealed three, one, and one case(s) of colon cancer metastasis, breast cancer metastasis, and HCC, respectively. The mean tumor size and tumor-free margin were 2.2 ± 1.1 cm and 5.8 ± 1.9 mm, respectively. There were no postoperative complications. Laparoscopic liver resection using intercostal trocars could be a useful method for tumors located in segments 7 and 8 of the liver in selected patients.
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http://dx.doi.org/10.1002/jhbp.123DOI Listing
August 2014