Preparatory hepatic resection with right hepatic vein reconstruction for paracaval liver tumor

A liver tumor in the paracaval portion was very difficult to resect because of its anatomical situation. We therefore employed a technique using right hepatic vein (RHV) resection and reconstruction following the resection of segments VII/VIII with the paracaval portion. The patient was a 70-year-old man who had a hepatocellular carcinoma in the paracaval portion, and the root of the RHV was compressed by the tumor. Computed tomography (CT) during arterioportography under temporary balloon occlusion of the RHV demonstrated hypoattenuation of the entire posterior segment, meaning that RHV reconstruction following the resection of segments VII/VIII with RHV resection would be necessary. We performed the above-mentioned operation without any trouble. On mobilizing segments VI/V to the caudal direction after dissecting the distal RHV, the paracaval Glissons were easily exposed and dissected anteriorly from the first order of the right Glissonean sheath. Our preliminary surgical technique, based on IVR-CT, could provide a better surgical field and result in decreased operating time and decreased blood loss in paracaval liver malignancy.