Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy

Area of Science:

• Hepatobiliary surgery
• Minimally invasive surgery
• Surgical anatomy

Background:

• Right hepatectomy requires precise parenchymal transection guided by the middle hepatic vein (MHV).
• Minimally invasive approaches present challenges in anticipating bleeding hotspots related to MHV anatomy.
• The MHV Roadmap offers a framework for navigating these complexities.

Observation:

• A patient with a large liver metastasis underwent laparoscopic right hepatectomy.
• Preoperative 3D reconstruction of MHV anatomy was performed.
• Surgical technique involved controlled hilar vessels and convex parenchymal transection along a demarcation line.

Findings:

• MHV guidance facilitated safe identification of V8 and other tributaries.
• The MHV Roadmap enabled anticipation of bleeding hotspots.
• The procedure was completed successfully with division of the anterior fissure and right hepatic vein.

Implications:

• Preoperative outlining of MHV anatomy improves surgical safety.
• MHV-guided transection minimizes risk of vascular injury and remnant liver ischemia.
• This approach enhances the safety and efficacy of minimally invasive right hepatectomy.