Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy

Joechle, Katharina; Vega, Eduardo A.; Okuno, Masayuki; Simoneau, Ève; Ogiso, Satoshi; Newhook, Timothy E.; Ramirez, David Luis; Holmes, Allen A.; Soliz, José; Chun, Yun Shin; Tzeng, Ching Wei D.; Lee, Jeffrey E.; Vauthey, Jean Nicolas; Conrad, Claudius

doi:10.1245/s10434-018-7034-0

Cited by 4 publications

(1 citation statement)

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“…Precise parenchymal transection of the liver is necessary to locate the Glissonean branch of S8 because it is located in the deep parenchyma. Moreover, the main trunk of the MHV is a landmark in resection of liver S8 and the location of the MHV is relatively stable [ 15 , 16 ]. Therefore, we wondered whether the hepatic parenchymal transection-first approach guided by the MHV can be extended for laparoscopic resection of liver S8.…”

Section: Discussionmentioning

confidence: 99%

Laparoscopic liver resection of segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein

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2022

BMC Gastroenterol

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Background Pure laparoscopic liver resection (LLR) of segment 8 (S8) is still rarely performed due to the lack of an appropriate surgical approach. This article discusses the technical tips and operation methods for LLR of S8 via a hepatic parenchymal transection-first approach. Methods Clinical data of 22 patients who underwent LLR of S8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein (MHV) in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from May 2017 to February 2020 were retrospectively analyzed. Results The mean age was 51.1 ± 11.6 years; mean operation time, 186.6 ± 18.4 min; median blood loss, 170.0 ml (143.8–205.0 ml); and median length of hospital stay, 8.0 days (7.0–9.0 days). There was no case of open conversion. Pathologic findings revealed all cases of hepatocellular carcinoma (HCC). Pathology showed free surgical margins. Post-operative complications included liver section effusion, pleural effusion, pneumonia, intra-abdomen bleeding and bile leak. All the complications responded well to conservative treatment. No other abnormality was noted during outpatient follow-up examination. All patients survived tumor-free. Conclusions LLR of S8 is still quite challenging at present, and it is our goal to design a reasonable procedure with accurate efficacy and high safety. We use hepatic parenchymal transection-first approach guided by the MHV for LLR of S8. This technique overcomes the problem of high technical risk, greatly reduces the surgical difficulty and achieves technological breakthroughs, but there are still many problems worth further exploration.

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Section: Discussionmentioning

confidence: 99%