Right intersectional transection plane based on portal inflow in left trisectionectomy

Area of Science:

• Hepatobiliary Surgery
• Surgical Anatomy
• Medical Imaging

Background:

• Left trisectionectomy (LT) for perihilar cholangiocarcinoma (PHC) is complex and associated with high morbidity.
• Standard surgical practice involves orienting liver transection towards the right hepatic vein (RHV).
• Discrepancies between the theoretical RHV-oriented plane and the actual surgical plane are frequently observed.

Purpose of the Study:

• To investigate the three-dimensional right intersectional transection plane based on portal inflow.
• To compare this portal inflow-based plane with the theoretical RHV-oriented plane.
• To enhance the safety of anatomical LT for PHC.

Main Methods:

• Utilized multidetector-row computed tomography (MDCT) to analyze the right intersectional transection plane in 100 patients.
• Compared the portal inflow-oriented plane with the RHV-oriented plane.
• Assessed portal blood supply to different portions of the RHV and associated liver segments.

Main Results:

• The posterior RHV portion was supplied by segment VIII dorsal portal branches in 85% of cases.
• The anterior peripheral RHV was supplied by segment VI ventral portal branches in 26.7% of cases.
• In some cases, the RHV trunk anatomy varied, not reaching the caudal liver part.

Conclusions:

• The portal inflow-oriented transection plane frequently deviates from the RHV-oriented plane.
• The actual transection plane exhibits a hollow cranial part and a protruded caudal part relative to the RHV.
• Surgeons must understand this complex anatomical relationship to minimize postoperative complications during LT for PHC.