Retrograde portography of the right caudate lobe via the middle hepatic vein

Area of Science:

• Hepatobiliary surgery
• Surgical anatomy
• Vascular imaging

Background:

• Caudate lobectomy is used for bile duct carcinoma but lacks detailed anatomical understanding of the right caudate lobe's portal supply.
• Existing surgical techniques do not adequately visualize the portal branches of the right caudate lobe (P1r).

Purpose of the Study:

• To develop and evaluate a technique for visualizing the portal branches of the right caudate lobe (P1r).
• To assess the anatomical variations and drainage patterns of P1r relevant to hepatobiliary surgery.

Main Methods:

• Contrast medium injection into the dorso-caudal branches of the middle hepatic vein (MHV).
• Digital subtraction venography (DSV) to obtain images.
• Retrograde portography was performed to visualize P1r.

Main Results:

• Retrograde portography successfully visualized P1r in 84% (64/76) of cases.
• An average of 2.1 P1r branches were visualized per successful case.
• P1r coursed beyond the MHV trunk in 56% of visualized cases, with drainage into both right (59 branches) and left (20 branches) portal veins.

Conclusions:

• Retrograde portography of P1r provides valuable, previously unavailable anatomical information for surgeons.
• This technique enhances understanding of caudate lobe vascular anatomy, crucial for safe and effective hepatobiliary resections.