Double cone-unit laparoscopic hepatic resection for tumors adjacent to the hepatic vein

In tumor adjacent to the hepatic vein, it is important to treat two tertiary Glissonean pedicles that straddle to the hepatic vein in order to remove the tumor with a negative margin. The anatomical resection of the smallest unit may be considered to be the resection of the double cone-unit (DCU) in small tumor adjacent to the vein.

127 patients who had undergone laparoscopic hepatectomy at the Jikei Medical University Hospital from 2020 through 2021. In 5 cases, Laparoscopic DCU resection was performed. If the CT image shows a hepatic vein near the tumor and the tumor is relatively small, less than 50 mm in size, DCU resection should be considered. After approaching the target Glissonean pedicles, the Bulldog Clamps were used to testing clamp it. After clamping it, the ICG was injected from peripheral veins. A few minutes later, the tumor-bearing portal territory could be identified as negative regions of fluorescence in the near infrared imaging system. The target hepatic vein, which runs between the two territories, was dissected where it transitions from the first to the second territory.

The median operative time in these 5 patients was 279 min, and the median volume of blood loss was 290 g. The average tumor size was 33 mm and the average surgical margin was 4.5 mm.

In small tumor adjacent to the hepatic vein, the anatomical hepatectomy of the smallest unit may be the Double Cone-Unit resection.