The Anterior Approach: The Right Way for Right Massive Hepatectomy

Anterior approach for major right hepatic resection

“…Otherwise, ultrasonography has to be used repeatedly to determine whether the middle hepatic vein is in the remnant liver or on the specimen side. 8 On approach- ing the liver hilum, the right hepatic duct is encircled together with the surrounding hilar plate. The right hepatic duct is divided between a pair of vascular clamps and the stumps are sutured with 5-0 polydioxanone suture (PDS).…”

ANTERIOR APPROACH FOR A SYMPTOMATIC GIANT HEPATIC HAEMANGIOMA (>30 CENTIMETRE)

“…The anterior approach for a major right hepatectomy in which the right liver is not mobilized was first described by Ozawa as one of the ‘non‐conventional approaches’ to advanced liver cancer in an attempt to avoid prolonged rotation and displacement of the hepatic lobes 5 . In this study, 6–10 the anterior approach technique showed a favourable surgical outcome and long‐term survival outcome for patients who underwent a major right hepatic resection for large hepatocellular carcinomas compared with those using the conventional approach.…”

Modified hanging manoeuvre facilitates inferior vena cava resection and reconstruction during extended right hepatectomy: A technical case report

“…Ozawa (10) described the anterior transection technique in 1990. This technique was popularized over the next decade (11)(12)(13)(14)(15), driven by the perceived disadvantages of conventional right liver mobilization, namely impaired hepatic blood flow with rotational displacement of the liver (10), potential avulsion of hepatic veins (13), iatrogenic tumour rupture (13,16), and hematogenous dissemination of malignant cells when the hepatic veins remained patent (16)(17)(18)(19).…”