“Supraportal” Right Posterior Hepatic Artery: An Anatomic Trap in Hepatobiliary and Transplant Surgery

Abstract

Background A supraportal right posterior hepatic artery (RPHA), which runs cranially to the right portal vein and goes to the liver, has never been described. Methods The course of the RPHA to the right portal vein was evaluated, using (1) computed tomography (CT) arteriography and portography in 300 patients who underwent multidetector row CT (radiologic study) and (2) operative records in 203 patients who underwent left-sided hepatectomy for perihilar cholangiocarcinoma (surgical study). Results In the radiologic study, an infraportal type RPHA was observed in 239 (79.7%) patients, a supraportal type in 35 (11.7%), and a combined type in 26 (8.7%). In the surgical study, an infraportal type was observed in 179 (88.2%) patients, a supraportal type in 11 (5.4%), and a combined type in 13 (6.4%). In two patients with the combined type RPHA, the supraportal hepatic artery of the right posterior superior segment (A7) was injured during surgery. In another two patients with advanced carcinoma involving the supraportal PRHA, combined hepatic artery resection and reconstruction was necessary. Overall, in 4 (17.4%) of the 24 hepatectomized patients with supraportal or combined type RPHA, iatrogenic injury during surgery or cancer invasion of the hepatic artery occurred due to the course of the RPHA itself. In contrast, 179 hepatectomized patients with infraportal type RPHA did not have such course-dependent complications. ConclusionsThe supraportal RPHA runs just beneath the right hepatic duct, which may function as an anatomic trap during hepatobiliary and transplant surgery.

Surgical Strategy for Hilar Cholangiocarcinoma of the Left-Side Predominance

“…[30][31][32] However, LTS is generally considered to be a more complicated procedure, requiring greater skill. [33][34][35] Over the last 5 years, we have performed LTS more aggressively in patients with appropriate hepatic functional reserve, even if the tumor was possibly resectable by LH. As a result of this aggressive strategy, the proportion of LTS among left-sided hepatectomies increased from 10.3% (3/29) in period 1 to 46.9% (15/32) in period 2.…”

Current Technical Issues for Surgery of Primary Liver Cancer

“…For example, it is difficult to realize the branching patterns of the segmental hepatic artery through two-dimension computed tomography (CT) alone. A variation of the right posterior segmental artery sometimes becomes an issue in the surgery for perihilar tumors [8]. Virtual 3D-CT imaging clearly shows this kind of variation ( fig.…”

Use of a Right Lateral Sector Graft in Living Donor Liver Transplantation Is Feasible, but Special Caution Is Needed With Respect to Liver Anatomy

“…the right posterior hepatic artery running cranially over the right anterior portal vein) was initially encountered during extended left hepatectomy for cholangiocarcinoma (28).…”