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Optimizing Growth of the Future Liver Remnant and Making In-Situ Liver Transsection Safe-A Standardized Approach to
Andrea Alexander1, Nadja Lehwald-Tywuschik1, Alexander Rehders1
1Departments of Surgery, Heinrich-Heine-University, University Hospital Duesseldorf, 40225 Duesseldorf, Germany.
Current Oncology (Toronto, Ont.)
|March 28, 2023
Summary
This study details a standardized in-situ liver splitting technique. The method enhances safety, prevents necrosis and bile leaks, and improves reproducibility for extended liver resections.
Area of Science:
- Hepatobiliary Surgery
- Surgical Techniques
- Liver Anatomy
Background:
- In-situ liver splitting is a complex procedure for extended liver resections.
- Current techniques lack standardization, leading to variable outcomes.
- A safe and reproducible method is needed to minimize complications.
Purpose of the Study:
- To describe a standardized, safe, and reproducible in-situ liver splitting technique.
- To minimize complications such as liver necrosis and bile leaks.
- To facilitate safer extended liver resections.
Main Methods:
- Dividing portal branches to segments I, IV to VIII while preserving arterial and bile duct structures.
- Encirculing vital structures for protection during dissection.
- Dividing parenchyma between segments II/III and IVa/b.
- Securing right and middle hepatic veins for the second surgical step.
Main Results:
- The described technique avoids necrosis and bile leaks in segments I and IV.
- It prevents the need for urgent completion operations.
- The procedure is easily reproducible and enhances safety.
- Securing hepatic veins simplifies the second stage of the resection.
Conclusions:
- A standardized in-situ liver splitting technique can be performed safely and reproducibly.
- This approach minimizes critical complications, improving patient outcomes.
- The technique facilitates safer and more predictable extended liver resections.
