[Hepatectomy with total vascular exclusion. Anatomical principles based on 64 dissections]

Area of Science:

• Surgical Anatomy
• Hepatobiliary Surgery
• Vascular Surgery

Background:

• Intra-operative hemorrhage is a significant risk in liver resections.
• Large or posterior liver tumors near the hepatocaval junction pose unique surgical challenges.
• Total hepatic vascular exclusion (HVE) is a technique used to manage bleeding during these complex procedures.

Purpose of the Study:

• To elucidate the anatomical aspects of total hepatic vascular exclusion (HVE).
• To provide detailed insights for safe and effective clamping of the inferior vena cava (IVC) during liver resections.

Main Methods:

• Study involved 64 subjects.
• Utilized segmental occlusive phlebographies of the IVC.
• Employed injection of corrosive substances into the hepatocaval network.
• Included biometry of the retrohepatic IVC and serial sections of injected livers.

Main Results:

• Total HVE requires exclusion of right suprarenal and phrenic veins.
• Suprahepatic IVC clamping depends on the left inferior phrenic vein termination.
• Subhepatic IVC clamping must be retrohepatic, with specific anatomical landmarks identified for safe placement.
• Optimal clamp placement avoids overlapping and ensures exclusion of the retrohepatic IVC and hepatocaval junction.

Conclusions:

• Detailed anatomical understanding of the retrohepatic IVC and its tributaries is critical for successful HVE.
• Precise identification of venous drainage patterns ensures safe and effective clamping strategies.
• This anatomical knowledge aids surgeons in minimizing risks associated with liver resections requiring HVE.