Image-Guided Proper Liver Segmentectomy

Area of Science:

• Hepatobiliary surgery
• Surgical anatomy
• Medical imaging

Background:

• Advanced radiological tools like 3D computed tomography and magnetic resonance imaging offer precise visualization of liver anatomy.
• These techniques have led to the identification of a novel anatomical space within the liver parenchyma, termed the "hepatic core," which houses the hila of liver segments.

Purpose of the Study:

• To introduce and validate a new virtual dissection plane, the "hepato-portal" plane, for liver segmentectomy.
• To demonstrate the utility of integrating anatomical and radiological findings into surgical practice.

Main Methods:

• Identification of the "hepato-portal" plane based on anatomical and radiological observations.
• Application of the "hepato-portal" plane in conjunction with classical dissection planes during liver segmentectomy.
• Intra-operative transfer of simulated surgical procedures using ultrasound guidance.

Main Results:

• Ten liver segmentectomies were successfully performed using the described technique.
• Procedures involved preliminary dissection of hilar vessels and precise delineation of segment boundaries.
• The "hepato-portal" plane facilitated accurate surgical dissection.

Conclusions:

• The integration of anatomical knowledge and radiological imaging is crucial for simulated liver surgery.
• The "hepato-portal" dissection plane represents a valuable addition to surgical techniques for liver segmentectomy.
• This approach enhances precision and potentially improves outcomes in liver segmentectomies.