How-I-do-it: laparoscopic left medial sectionectomy utilizing a cranial approach to the middle hepatic vein and Laennec’s capsule

Abstract Background Laparoscopic anatomic liver resection is technically demanding, given the need to safely isolate the Glissonean pedicles and expose the hepatic veins (HVs) on the liver parenchyma cut surface. Laennec’s capsule is observed around the Glissonean pedicles and root of the HVs. However, its existence, particularly on the peripheral side of the HVs, remains controversial. Herein, we describe Laennec’s capsule-related histopathological findings around the HVs and a safe laparoscopic left medial sectionectomy utilizing Laennec’s capsule. Methods The extrahepatic Glissonean approach was performed by connecting Gates II and III, in accordance with Sugioka’s Gate theory. Liver parenchymal transection commenced along the demarcation line, which is between the medial and lateral sections, and the G4 was dissected during transection. Subsequently, via the outer-Laennec approach, the middle hepatic vein (MHV) was exposed from the root side in cranial view, while Laennec’s capsule was preserved. Parenchymal transection was completed while connecting the MHV with the demarcation line. We obtained the membrane surrounding the HVs and performed histopathological examinations. Results Six patients underwent laparoscopic left medial sectionectomy from February 2012 to November 2020. There were no cases involving complications (Clavien–Dindo classification; grade II or higher), open-surgery conversion, transfusion, or surgery-related death. The histopathological findings showed Laennec’s capsule surrounding both the trunk of the major HVs and the peripheral side of the HVs. Conclusions A cranial approach to the major HVs utilizing Laennec’s capsule is a feasible and advantageous procedure for laparoscopic left medial sectionectomy. We propose that Laennec’s capsule surrounds the entire length of the HVs.

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A RARE CASE OF COMPLICATED LIVER ABSCESS WITH MIDDLE HEPATIC VEIN THROMBOSIS: A CASE REPORT AND REVIEW OF LITERATURE

10.36106/gjra/4800158 ◽

2021 ◽

pp. 1-2

Author(s):

V.P.S. Punia ◽

Praveen Raman Mishra ◽

Shaavi Mittal ◽

Akash Bharti ◽

Prem Kumar ◽

...

Keyword(s):

Liver Abscess ◽

Hepatic Vein ◽

Middle Hepatic Vein ◽

Amoebic Liver Abscess ◽

Hepatic Veins ◽

Review Of Literature ◽

Extraintestinal Manifestation ◽

Vein Thrombosis ◽

Histolytica Infection ◽

Life Threatening

In developing countries Amoebic liver abscess is commonly encountered disease and it’s also the commonest extraintestinal manifestation of Entamoeba histolytica infection. Usual complication of Amoebic liver abscess arises due to collection of pus in various cavities, like in peritoneal cavity following perforation, in the pleural cavity which is known as empyema thoracis, and rarely it is complicated by life threatening conditions such as venous extension of the disease involving the hepatic veins and IVC, with only few cases reported. Here we describe a case of amoebic liver abscess extending across middle hepatic vein.

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FRACTAL PROPERTIES, SEGMENT ANATOMY, AND INTERDEPENDENCE OF THE HUMAN PORTAL VEIN AND THE HEPATIC VEIN IN 3D

Fractals ◽

10.1142/s0218348x03001422 ◽

2003 ◽

Vol 11 (01) ◽

pp. 53-62 ◽

Cited By ~ 11

Author(s):

HORST K. HAHN ◽

CARL J. G. EVERTSZ ◽

HEINZ-OTTO PEITGEN ◽

JEAN H. D. FASEL

Keyword(s):

Portal Vein ◽

Hepatic Vein ◽

Three Dimensional ◽

Branching Ratio ◽

Liver Parenchyma ◽

Hepatic Veins ◽

Scaling Properties ◽

Computed Tomography Images ◽

Fractal Properties ◽

Human Livers

The scaling properties of the portal vein and the hepatic vein are examined, based on three-dimensional computed tomography images of casts of human livers. In particular, a quantitative analysis of the branching ratio based on the Strahler ordering scheme as well as the diameter and length ratios are performed. To quantify the segment anatomy of the liver, the volume of supplied liver parenchyma is measured and related to the corresponding vessel radius. The implications of these findings for segment-oriented liver surgery are discussed. We also investigate the 3D interdependence of the intertwined portal and hepatic veins based on a concept of tree distance that will be introduced.

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Reconstruction of the middle hepatic vein using a vein graft from the resected portion of the liver

Surgical Case Reports ◽

10.1186/s40792-020-01057-8 ◽

2020 ◽

Vol 6 (1) ◽

Author(s):

ShiWei Yang ◽

DongDong Han ◽

Liang Wang ◽

Lei Gong ◽

CanHong Xiang

Keyword(s):

Portal Vein ◽

Hepatic Vein ◽

Intrahepatic Cholangiocarcinoma ◽

Vein Graft ◽

Critical Role ◽

Liver Volume ◽

Middle Hepatic Vein ◽

Postoperative Liver Failure ◽

Hepatic Veins ◽

Left Hepatectomy

Abstract Background The middle hepatic veins are often infiltrated by intrahepatic cholangiocarcinoma. Reconstruction of the hepatic vein plays a critical role in preserving more of the residual liver volume and reducing the risk of postoperative liver failure in extreme hepatectomy. We here report a novel way to reconstruct middle hepatic vein by using vessel grafts from wasted liver. Case presentation Case 1: A 64-year-old man was diagnosed with intrahepatic cholangiocarcinoma. The bifurcation and left branch of the portal vein were stenosed, and the root of the middle hepatic vein was infiltrated by the tumor. An extended left hepatectomy was performed, the portal vein was resected and reconstructed, and the middle hepatic vein was reconstructed by anastomosing the proximal left hepatic vein to the distal middle hepatic vein. Case 2: A 69-year-old woman was diagnosed with intrahepatic cholangiocarcinoma. The tumor was located in the left lobe of the liver and the left and middle hepatic veins were infiltrated by the tumor. An extended left hepatectomy was performed, and the left portal vein was used as a vein graft to reconstruct the middle hepatic vein. Both of the two patients’ postoperative ultrasound showed vessel graft patency. Conclusion Using a vein graft from the resected portion of the liver to reconstruct the middle hepatic vein was a useful technique and showed good result.

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Hepatic vein variations in 500 patients: surgical and radiological significance

British Journal of Radiology ◽

10.1259/bjr.20190487 ◽

2019 ◽

Vol 92 (1102) ◽

pp. 20190487

Author(s):

Binit Sureka ◽

Neelmani Sharma ◽

Pushpinder Singh Khera ◽

Pawan Kumar Garg ◽

Taruna Yadav

Keyword(s):

Hepatic Vein ◽

Inferior Vena ◽

Multidetector Ct ◽

Vena Cava ◽

Middle Hepatic Vein ◽

Hepatic Veins ◽

Common Trunk ◽

Biliary Anatomy ◽

Iatrogenic Complications ◽

Anatomy Knowledge

Objectives: The purpose of the study was to assess the incidence of hepatic vein variations on multidetector CT (MDCT) for abdominal examinations. Methods: A retrospective analysis of 534 MDCT scans was performed in patients sent for various abdominal pathologies between January 2017 and April 2019. After excluding 34 patients, finally total of 500 patients (N = 500) were included in the study. For simplification, we classified the hepatic vein variations as classified by Soyer et al, Fang et al and Cheng et al. Results: Single right hepatic vein was seen in 458 (91.6%) out of 500 patients in our study. Two right hepatic veins were seen in 36 patients out of which 27 had common trunk and nine had independent drainage into the inferior vena cava (IVC). Common trunk of middle hepatic vein (MHV) and left hepatic vein (LHV) was seen in 405 (81%) and independent drainage of MHV and LHV into the IVC was seen in 95 (19%) of patients in our study. Amongst the segmental hepatic vein variations, most common drainage of segment IV vein was into LHV (333,66.6%) followed by MHV (148,29.6%) and IVC (19,3.8%). Conclusion: Hepatic vein variations are commonly seen similar to variations in hepatic artery, portal vein and biliary anatomy. Knowledge of these variations is extremely important for transplant surgeons and intervention radiologists. Advances in knowledge: Awareness of the hepatic vein variations is essential for intervention radiologists and surgeons to reduce iatrogenic complications.

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Laparoscopic Anatomical Resection of Liver Segment 8 via a Hepatic Parenchymal Transection-first Approach Guided by the Middle Hepatic Vein

10.21203/rs.3.rs-953544/v1 ◽

2021 ◽

Author(s):

Nan You ◽

Ke Wu ◽

Jing Li ◽

Lu Zheng

Keyword(s):

Hepatic Vein ◽

Operation Time ◽

Middle Hepatic Vein ◽

Parenchymal Transection ◽

Anatomical Resection ◽

Liver Segment ◽

Technological Developments ◽

Surgical Difficulty ◽

Segment 8 ◽

Medical University

Abstract Background Although recent technological developments and improved endoscopic procedures have further extended the application of laparoscopic liver resection, pure laparoscopic anatomic resection of liver segment 8 (S8) is still rarely performed due to the lack of an appropriate surgical approach. This article discusses the technical tips and operation methods for laparoscopic anatomical resection of liver S8 via a hepatic parenchymal transection-first approach.Methods Clinical data of 14 patients who underwent laparoscopic anatomical resection of liver segment 8 via a hepatic parenchymal transection-first approach guided by the middle hepatic vein (MHV) in the Second Affiliated Hospital, Third Military Medical University (Army Medical University) from May 2017 to December 2019 were retrospectively analyzed. The operation time, intraoperative blood loss, postoperative complications, and hospitalization duration were observed.Results The operation was successful with no complications. No other abnormality was noted during outpatient follow-up examination.Conclusions Laparoscopic anatomical resection of liver S8 is still quite challenging at present, and it is our goal to design a reasonable procedure with accurate efficacy and high safety. We use hepatic parenchymal transection-first approach guided by the MHV for laparoscopic anatomical resection of liver S8. This technique overcomes the problem of high technical risk, greatly reduces the surgical difficulty and achieves technological breakthroughs, but there are still many problems worth further exploration.

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Selective Hepatic Vascular Exclusion versus Pringle Maneuver in Partial Hepatectomy for Liver Hemangioma Compressing or Involving the Major Hepatic Veins

The American Surgeon ◽

10.1177/000313481408000317 ◽

2014 ◽

Vol 80 (3) ◽

pp. 236-240 ◽

Cited By ~ 4

Author(s):

Yuan Yang ◽

Ling-Hao Zhao ◽

Si-Yuan Fu ◽

Wan Yee Lau ◽

Eric C. H. Lai ◽

...

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Hepatic Vein ◽

Pringle Maneuver ◽

Hepatic Veins ◽

Parenchymal Transection ◽

Liver Hemangioma ◽

Vascular Exclusion ◽

Significant Difference ◽

Hepatic Vascular Exclusion

Massive blood loss remains a problem during resection for giant liver hemangioma. This present study was designed to compare selective hepatic vascular exclusion (SHVE) versus Pringle maneuver in surgery for liver hemangioma compressing the major (right, middle, or left) hepatic veins. From January 2003 to December 2011, 589 consecutive patients with hemangioma underwent liver resection in our department, and 273 patients had their tumors compressing at least one of the three major hepatic veins (right, middle, or left). Either SHVE (n = 120 patients) or Pringle maneuver (n = 153 patients) was used to minimize blood loss during resection. Data regarding the intraoperative and postoperative courses of these patients were retrospectively analyzed. There was no significant difference between the two groups of patients regarding age, sex, tumor size, types of hepatectomy, and extent of tumor involvement of the major hepatic veins. Intraoperative blood loss, transfusion requirements, and transfusion volume were significantly less in the SHVE group ( P < 0.01). For the Pringle group, major hepatic veins were lacerated in 19 patients during hepatic parenchymal transection. For the SHVE group, a major hepatic vein was lacerated during extrahepatic dissection of the hepatic vein in two patients and during hepatic parenchymal transection in 14 patients. SHVE was more efficacious in minimizing intraoperative bleeding during liver resection for hemangiomas compressing the major hepatic veins. It prevented intraoperative major bleeding and air embolism and significantly decreased postoperative liver failure and in-hospital mortality.

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