Browsing by Author "Thapa, Prabin Bikram"
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Publication Determination of the Surgical Margin in Laparoscopic Liver Resections Using Infrared Indocyanine Green Fluorescence(Nepal Health Research Council, 2025) Maharjan, Dhiresh Kumar; Acharya, Bidur Prasad; Maharjan, Prabir; Limbu, Ugal; Ghimire, Oshan; Thapa, Prabin BikramBackground: The advent of minimally invasive techniques has revolutionized liver surgery, with improvement in postoperative outcomes while maintaining oncological efficacy. Achieving tumor-negative resection margins remains critical for optimal oncological outcomes. Considering the adversity of tactile feedback in minimally invasive surgery complicating margin assessment, this study evaluated the efficacy of near-infrared indocyanine green fluorescence imaging in real-time surgical margin delineation during the hepatic resection. Methods: This is a single-centered, prospective, descriptive study conducted between 15th March 2022 and 15th March 2024 as per the revised STROBE guidelines. Patients were enrolled by convenient sampling and received 0.5 mg/kg of indocyanine green one day before surgery intravenously. During surgery, near infrared-indocyanine green imaging was recorded and utilized to assess the surgical margins along with the white light as well. The findings were compared and confirmed with the final histopathology report. Results: A total number of 21 patients were included in this study who underwent laparoscopic liver resection. Majority of cases were of colorectal liver metastasis (90%), and most of them were located at segment 4 (80%). Participants had a normal preoperative liver status with a median tumor size of 28 mm and a median number of 1.2. Indocyanine green fluorescence successfully delineated resection margins in all cases, and final histopathological assessment confirmed R0 resection status. No adverse reactions to the indocyanine green were reported. Conclusions: Near infrared-indocyanine green provided significant benefit regarding R0 resection in all cases confirmed with histopathology results for the intra-operative identification and demarcation of margins during laparoscopic hepatic resection. Keywords: Colorectal liver metastasis; indocyanine green; laparoscopic liver resection.Publication Intraoperative Variations of the Gastrocolic Trunk of Henle noted in Gastrointestinal Surgeries(Nepal Health Research Council, 2024) Ghimire, Roshan; Thapa, Nishant; Acharya, Bidur Prasad; Sah, Bed Prakash; Limbu, Yugal; Regmee, Sujan; Maharjan, Dhiresh Kumar; Thapa, Prabin BikramBackground: The gastro-colic trunk of Henle is a venous trunk that comprises the veins draining the stomach and colon and is an important landmark for various gastro-intestinal surgeries. Understanding the anatomy of these vessels may enhance the surgical outcome. The aim of this study is, to assess the Intraoperative variations of the Gastrocolic Trunk of Henle noted in gastrointestinal surgeries in a tertiary care center. Methods: A descriptive cross-sectional study was conducted at Kathmandu Medical College Public Limited, a tertiary center in Nepal during the period of one year (1st January 2022, to 31st December 2022). All patients undergoing right hemicolectomy, gastrectomy, and pancreaticoduodenectomy were included in the study. Based on per-operative findings, the type of The gastro-colic trunk of Henle was noted during surgery. Results: A total of 49 patients underwent the above-mentioned surgeries during the study period. The gastro-colic trunk was found in 45 out of the 49 patients intraoperatively (91.84%), and the variations were distinguished. The most common configuration noted was the union of the right gastro-epiploic vein, the anterior superior pancreaticoduodenal vein, and the superior right colic vein (Type I), which was noticed in 46.67% of the patients. Conclusions: The intraoperative identification of the anatomy of The gastro-colic trunk of Henle is challenging because of its variable combinations of tributaries. Knowledge of variations in The gastro-colic trunk of Henle is important in preventing intraoperative bleeding, and during identification, the meticulousness of surgery is redefined. Keywords: Gastrocolic trunk of Henle; hemicolectomy; venous drainage.