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Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience
09:51

Laparoscopic Anterior Right Hepatectomy: A Single-Center Experience

Published on: December 4, 2023

Upper transversal hepatectomy.

Guido Torzilli1, Fabio Procopio, Matteo Donadon

  • 1Liver Surgery Unit, Department of Surgery, University of Milan School of Medicine, IRCCS Istituto Clinico Humanitas, Humanitas Cancer Center, Rozzano, Milan, Italy. guido.torzilli@fastwebnet.it

Annals of Surgical Oncology
|September 15, 2012
PubMed
Summary

Detecting communicating veins (CVs) between hepatic veins (HVs) allows for conservative liver resections in complex hepato-caval confluence (HC) tumor cases. This approach preserves essential liver outflow and functional parenchyma, avoiding major hepatectomy.

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Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Vascular Anatomy

Background:

  • Tumors at the hepato-caval confluence (HC) involving hepatic veins (HVs) typically necessitate extensive liver resection or complex vascular reconstruction.
  • Identifying communicating veins (CVs) between adjacent HVs is crucial for enabling less invasive, conservative hepatectomy strategies.

Observation:

  • A patient with multiple colorectal liver metastases (CLM) presented with tumors adjacent to the middle HV (MHV) at the HC, involving segments 1, 7, 8, and 4-superior.
  • The larger tumor invaded the right HV (RHV), while the smaller tumor was near the left HV (LHV). Crucially, communicating veins (CVs) were identified between the inferior RHV (IRHV), MHV, and LHV.

Findings:

  • Intraoperative ultrasound (IOUS) confirmed the presence of CVs, guiding a conservative resection.
  • An upper-transverse hepatectomy was performed, preserving the IRHV and the identified CVs, while resecting the RHV and MHV. Adequate hepato-petal flow was maintained to the remaining liver segments.
  • The patient experienced no postoperative mortality or major morbidity and remained disease-free at 7 months.

Implications:

  • The detection of CVs between HVs opens possibilities for novel, conservative hepatectomy techniques for challenging HC tumors.
  • This IOUS-guided approach allows for adequate liver outflow and preservation of functional liver parenchyma, even when multiple HVs are involved and resected.
  • This strategy can potentially reduce the extent of liver resection required for HC tumors, improving patient outcomes.