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Hepatic trisegmentectomy and other liver resections.

T E Starzl, R H Bell, R W Beart

    Surgery, Gynecology & Obstetrics
    |September 1, 1975
    PubMed
    Summary
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    Trisegmentectomy, an extended right hepatic lobectomy, involves precise dissection of liver segments. Understanding unique anatomy, like the switch-back blood supply, is crucial for safe liver resection and preventing complications.

    Area of Science:

    • Hepatobiliary Surgery
    • Surgical Anatomy
    • Liver Transplantation

    Background:

    • Trisegmentectomy, an extended right hepatic lobectomy, is a complex liver resection procedure.
    • Key anatomical features and surgical steps require precise description for safe execution.

    Purpose of the Study:

    • To detail critical, previously undescribed aspects of trisegmentectomy.
    • To provide guidelines for safe and effective performance of this extended liver resection.

    Main Methods:

    • Detailed anatomical dissection focusing on the umbilical fissure and portal triad structures.
    • Mobilization of left branches of portal triad and ligation of blood supply/duct drainage to the medial segment.
    • Consideration of caudate lobe excision and management of hepatic venous outflow.

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    Main Results:

    • Identified the critical "switch-back" arrangement of blood supply and duct drainage within the umbilical fissure.
    • Demonstrated safe techniques for mobilizing structures and ligating vessels, avoiding injury to the lateral segment.
    • Reported successful trisegmentectomy without mortality in 14 cases since 1963.

    Conclusions:

    • Safe trisegmentectomy relies on meticulous dissection and understanding of specific anatomical arrangements, particularly the vascular supply to the medial segment.
    • Adherence to principles of subtotal hepatic resection, including vascular control and adequate drainage, is essential.
    • The described techniques have proven effective in achieving zero mortality in a series of liver resections.