Anterior approach for major right hepatic resection

Abstract

We review the history, indications, and latest modifications of the surgical technique of the anterior approach for right hepatectomy for massive tumors. The anterior approach provides a "no-touch" technique in resecting large right-lobe tumors, reduces bleeding volume, decreases the chance of iatrogenic rupture of tumors, and probably prolongs survival.

Beneficial use of the round ligament as a patch graft for vena cava reconstruction

“…The harvesting of other venous grafts, including femoral, iliac, or renal veins, results in their sacrifice, with unpleasant congestive complications being possible . Nevertheless, such medium‐sized venous grafts could be most useful as interposition grafts in the portal system 13. The use of a pericardial xenograft is not desirable because of possible foreign‐body reactions, which are difficult to manage 10.…”

“…Mobilization of the right‐side liver, including the posterior wall of the IVC, was completed, but the short hepatic veins on the right‐side IVC were not divided because of tumor invasion in the corresponding part. A long forceps was then placed on the anterior surface of the IVC, passing a tape for performing a hanging maneuver 13. After the application of a bipolar precoagulation system (Inline; Resect Medical, Fremont, CA, USA) on Cantlie's line, parenchymal resection was performed using cavitron ultrasonic surgical aspirator (CUSA) (Valleylab, Boulder, CO, USA), with intermittent inflow occlusion for 45 min in total.…”

Transdiaphragmatic approach facilitates resection of large (>12 cm) liver tumors

“…Fan and Liu resort to an anterior approach instead of the conventional approach for right hepatic resections of tumors more than 5 cm. To avoid handling of the tumor, these authors proceed to liver transection without prior mobilization of the organ.…”

“…Various transtho‐racic techniques have been proposed to overcome the problems posed by the size and location of large liver tumors. Despite their technical efficacy, such methods may be associated with increased morbidity and mortality …”

Giant mesenchymal hamartoma of the liver in an adult

“…1b). Based on these findings, as well as taking the patient's age and history into account, we diagnosed the tumor preoperatively as a biliary cystadenoma, and removed it successfully by a right hemihepatectomy, using the anterior approach introduced by Liu and coworkers2 and Liu and Fan3 (Fig. 2a), in order to prevent the tumor from rupturing due to inappropriate intraoperative manipulation.…”