Hauke Lang’s research while affiliated with Johannes Gutenberg University Mainz and other places

Background Liver resection and lymphadenectomy is a standard procedure in patients with incidental gallbladder cancer. Data regarding laparoscopic approach in this setting are scarce. The aim of this study was to compare laparoscopic and open approach in this population. Methods This was a multicenter retrospective study including 177 patients. The primary outcome measure was overall survival (OS). The secondary outcomes measures were recurrence-free survival (RFS), lymph node yield, operative time, postoperative complications and length of hospital stay. Results Surgery was laparoscopic in 60 (33.9%), including 18 conversions (30.0%). By intention to treat analysis, 3 and 5 year OS were 72.1% and 51.8% after laparoscopic surgery compared to 62.8% and 36.2% after open surgery (p = 0.201). 3- and 5-year RFS were 29.1% and 19.4% after laparoscopic surgery and 28.7% and 19.1% after open surgery (p = 0.697). Severe (grade ≥ 3 ) complications (p = 0.032) and Comprehensive Complication Index (CCI; p = 0.027) were both significantly higher after laparoscopic surgery (p = 0.032), although length of hospital stay was significantly shorter after laparoscopic procedures both on intention-to-treat (median 6 vs. 8 days; p = 0.004) and per protocol analysis (median 6 vs. 8 days; p = 0.004). Conclusions Laparoscopic approach is feasible in patients with gallbladder cancer and may shorten the duration of hospital stay. Synopsis This retrospective cohort study suggests that laparoscopic liver resection is feasible in patients with gallbladder cancer and may shorten the duration of hospital stay. Minimally invasive procedures should be performed by surgeons experienced in laparoscopic liver surgery.

Background Recent research indicates a role of gut microbiota in development and progression of life-threatening diseases such as cancer. Carcinomas of the biliary ducts, the so-called cholangiocarcinomas, are known for their aggressive tumor biology, implying poor prognosis of affected patients. An impact of the gut microbiota on cholangiocarcinoma development and progression is plausible due to the enterohepatic circulation and is therefore the subject of scientific debate, however evidence is still lacking. This review aimed to discuss the suitability of complex cell culture models to investigate the role of gut microbiota in cholangiocarcinoma progression. Main body Clinical research in this area is challenging due to poor comparability of patients and feasibility reasons, which is why translational models are needed to understand the basis of tumor progression in cholangiocarcinoma. A promising approach to investigate the influence of gut microbiota could be an organoid model. Organoids are 3D cell models cultivated in a modifiable and controlled condition, which can be grown from tumor tissue. 3D cell models are able to imitate physiological and pathological processes in the human body and thus contribute to a better understanding of health and disease. Conclusion The use of complex cell cultures such as organoids and organoid co-cultures might be powerful and valuable tools to study not only the growth behavior and growth of cholangiocarcinoma cells, but also the interaction with the tumor microenvironment and with components of the gut microbiota.

Anatomical structures of the liver could be reconstructed three dimensionally from preoperative cross-sectional imaging for over 20 years. This three-dimensional (3D) representation not only optimizes the preoperative planning options but also the communication of specific operation-relevant structures can be improved using 3D models. In addition to a plastic and interactive visualization of 3D organ models, the disruptive technology of virtual reality (VR) can also provide a possibility for structured training and further education regarding surgical anatomy of the liver and operation planning. This makes examinations in virtual reality also seem tangible. The latest prototypes even enable patient-specific simulation of intraoperative sonography. This review article provides an overview of the current status of available technologies for training and further education using VR exemplified by liver surgery.

Esophageal cancer is an aggressive tumor entity, and oncologic esophagectomy with two-field lymphadenectomy after perioperative chemotherapy or chemoradiotherapy is the standard of care for curative treatment. Oncological esophagectomy is a complex procedure associated with a relevant surgical trauma. Complications, such as severe pulmonary infections and anastomotic leakage with mediastinitis lead to a high morbidity rate. To reduce the surgical trauma, the minimally invasive technique was introduced in esophageal surgery. Minimally invasive esophagectomy is associated with less postoperative pain and a reduced rate of pulmonary infections. Currently, there are two major different totally minimally invasive techniques, the conventional laparoscopic/thoracoscopic approach (MIE) and the robotic assisted approach (RAMIE). Both methods require teaching due to the flat learning curve associated with these complex procedures. However, both MIE and RAMIE are performed safely in specialized centers. They are associated with improved short-term outcome and similar oncological outcome compared to open esophagectomy. The robotic assisted approach has additional benefits that may be supported by the results of more randomized controlled trials in the future.

This preclinical feasibility study investigates the potential of utilizing the hinotori™ robot system for esophagectomy. In three human cadaver models, the esophagus was successfully mobilized and resected using the hinotori™ system, with a mean thoracic procedure time of 57 minutes. The system allowed for precise dissection and radical lymphadenectomy without arm collision, attributed to its versatile design and docking-free trocars. Standard robot-specific patient positioning, including a 35° left lateral inclination, and trocar placement in a posterior axillary line configuration were employed. Notably, trocars suitable for both laparoscopy and the hinotori™ robot were utilized, providing flexibility in trocar selection. Unique features, such as the ergonomic console and pointer-based pivot point identification system, contributed to procedural success. While these findings highlight the promising potential of the hinotori™ system in advancing esophageal surgery, further clinical studies are warranted to validate its reproducibility and clinical utility. Additionally, enhancements to the pivot point identification system and evaluation of the arm base's features may further optimize surgical outcomes.