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Anatomic left hepatic trisegmentectomy.

Marcel Autran C Machado1, Paulo Herman, Fabio F Makdissi

  • 1Department of Surgery, University of São Paulo, São Paulo, Brazil. dr@drmarcel.com.br

American Journal of Surgery
|June 24, 2005
PubMed
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This study details a standardized left trisegmentectomy technique, enabling safe liver segment removal without warm ischemia. The method ensures precise control of blood flow to liver segments, crucial for complex liver surgeries.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Anatomy
  • Liver Transplantation

Background:

  • Left trisegmentectomy involves removing liver segments II, III, IV, V, and VIII.
  • Few detailed technical reports exist for this complex liver resection.
  • Understanding segmental liver anatomy is critical for this procedure.

Purpose of the Study:

  • To describe a standardized anatomical approach for left trisegmentectomy.
  • To detail the identification and isolation of glissonian sheaths and portal pedicles.
  • To present a method for inflow and outflow control without hilar clamping.

Main Methods:

  • Anatomical identification and isolation of glissonian sheaths for left liver segments (II-IV).
  • Dissection of portal pedicles supplying the right anterior sector (segments V, VIII).

Related Experiment Videos

  • Dissection of middle and left hepatic veins using Arantius ligament as a landmark.

    • Main Results:

    • The described technique allows precise inflow and outflow control of targeted liver segments.
    • Hilar dissection or clamping is avoided, enhancing surgical safety.
    • The procedure facilitates left extended hepatectomy with minimal warm ischemia to the remnant liver.

    Conclusions:

    • This standardized technique offers a safe and reproducible method for left trisegmentectomy.
    • It minimizes warm ischemia, improving outcomes for patients undergoing extended liver resection.
    • The approach enhances the safety profile of complex liver surgeries by avoiding hilar clamping.