Three-dimensional computed tomography analysis of venous collaterals between the middle hepatic vein tributaries and the right hepatic vein in the donor remnant right lobe: Report of a case

Abstract Background In hepatectomy, the preservation of portal perfusion and venous drainage in the remnant liver is important for securing postoperative hepatic function. Right hepatectomy is generally indicated when a hepatic tumor involves the right hepatic vein (RHV). However, if a sizable inferior RHV (IRHV) exists, hepatectomy with preservation of the IRHV territory may be another option. In this case, we verified the clinical feasibility of anatomical bisegmentectomy 7 and 8 with RHV ligation, averting the right hepatic parenchyma from venous congestion, utilizing the presence of the IRHV. Case presentation A 70-year-old man was presented with a large hepatic tumor infiltrating the RHV on computed tomography during a medical checkup. The patient was diagnosed with hepatocellular carcinoma (HCC), T2N0M0, stage III. Right hepatectomy was first considered, but multi-detector computed tomography (MDCT) also revealed a large IRHV draining almost all of segments 5 and 6, suggesting that IRHV-preserving liver resection may be another option. The calculated future remnant liver volumes were 382 mL (26.1% of the total volume) after right hepatectomy and 755 mL (51.7% of the total volume) after anatomical bisegmentectomy 7 and 8; therefore, we scheduled IRHV-preserving anatomical bisegmentectomy 7 and 8 considering the prevention of postoperative liver failure and increased chance of performing repeat resections in cases of recurrence. Preoperative three-dimensional simulation using MDCT clearly revealed the portal perfusion area and venous drainage territories by the RHV and IRHV. There was an issue with invisibility of the anatomical resection line of segments 7 and 8, which was completely dissolved by intraoperative ultrasonography using Sonazoid and the portal dye injection technique with counter staining. The postoperative course in the patient was uneventful, without recurrence of HCC, for 30 months after hepatectomy. Conclusions IRHV-preserving anatomical bisegmentectomy 7 and 8 is a safe and feasible procedure utilizing the three-dimensional simulation of the portal perfusion area and venous drainage territories and the portal dye injection technique.

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Total resection of the right hepatic vein drainage area with the aid of three-dimensional computed tomography

Surgery Today ◽

10.1007/s00595-011-0021-8 ◽

2011 ◽

Vol 42 (1) ◽

pp. 46-51 ◽

Cited By ~ 7

Author(s):

Akinobu Taketomi ◽

Kazuki Takeishi ◽

Yohei Mano ◽

Takeo Toshima ◽

Takashi Motomura ◽

...

Keyword(s):

Computed Tomography ◽

Hepatic Vein ◽

Three Dimensional ◽

Drainage Area ◽

Total Resection ◽

The Right ◽

Right Hepatic Vein

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Three-dimensional computed tomography analysis of variations in the middle hepatic vein tributaries: proposed new classification

Surgery Today ◽

10.1007/s00595-014-0836-1 ◽

2014 ◽

Vol 44 (11) ◽

pp. 2077-2085 ◽

Cited By ~ 2

Author(s):

Hiroto Kayashima ◽

Ken Shirabe ◽

Rumi Matono ◽

Shohei Yoshiya ◽

Kazutoyo Morita ◽

...

Keyword(s):

Computed Tomography ◽

Hepatic Vein ◽

Three Dimensional ◽

Middle Hepatic Vein ◽

New Classification ◽

Tomography Analysis

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Outflow Reconstruction in Adult Living Donor Liver Transplant; Taking the Right Lobe Graft without the Middle Hepatic Vein

Transplantation Journal ◽

10.1097/00007890-201211271-01127 ◽

2012 ◽

Vol 94 (10S) ◽

pp. 584

Author(s):

M. Ghazaly ◽

M. T. Badawy ◽

H. E.-D. Soliman ◽

M. El-Gendy ◽

T. Ibrahim ◽

...

Keyword(s):

Liver Transplant ◽

Hepatic Vein ◽

Living Donor ◽

Middle Hepatic Vein ◽

Donor Liver ◽

Living Donor Liver Transplant ◽

Right Lobe Graft ◽

Right Lobe ◽

Donor Liver Transplant ◽

The Right

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Middle Hepatic Vein Reconstruction in Living-Donor Liver Transplantation Using the Right Lobe

Current Issues in Liver and Small Bowel Transplantation ◽

10.1007/978-4-431-67889-2_7 ◽

2002 ◽

pp. 43-44

Author(s):

Sung Gyu Lee

Keyword(s):

Liver Transplantation ◽

Hepatic Vein ◽

Living Donor ◽

Living Donor Liver Transplantation ◽

Middle Hepatic Vein ◽

Donor Liver ◽

Donor Liver Transplantation ◽

Hepatic Vein Reconstruction ◽

Right Lobe ◽

The Right

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Three-dimensional Computed Tomography Scan Analysis of Anatomical Variations in the Hepatic Veins

International Surgery ◽

10.9738/intsurg-d-16-00077.1 ◽

2016 ◽

Author(s):

Wenli Xu ◽

Chonghui Li ◽

Weidong Duan ◽

Jiahong Dong

Keyword(s):

Hepatic Vein ◽

Malignant Tumors ◽

Liver Volume ◽

Three Dimensional ◽

Anatomical Variations ◽

Hepatic Veins ◽

Common Trunk ◽

Drainage Volume ◽

The Right ◽

Right Hepatic Vein

Abstract Objectives: Hepatic venous anatomy is a significant component of liver segmental anatomy, and its high variability is a challenge for hepatobiliary surgeons. Methods: This was a retrospective study of 98 consecutive patients with no cirrhosis or malignant tumors. IQQA-Liver software was used to display and analyze three-dimensional (3D) images of the hepatic veins and their branches and variations. Results: The average liver volume was 1272.65Â±322.04 ml;the left hepatic veins drained the smallest parts (21.13Â±5.41%) of the liver compared with the right (35.58Â±12.41%) and middle hepatic veins (34.64Â±8.76%). The most common pattern was that the left hepatic veins shared a common trunk with the middle hepatic veins in 51cases (52.0%). The visualization rate of the inferior right hepatic vein (IRHV) was 43.9%, and its drainage volume was 179.27Â±128.79 ml. In 11.2% of patients, the drainage volume for the IRHV was larger than for the right hepatic vein (RHV). The patterns of the left hepatic and middle hepatic veins were also observed and classified. Umbilical hepatic veins appeared in 75cases (76.5%), and anterior fissure hepatic veins appeared in 74 cases (75.5%).The rate of the presence of a separate segment 4 vein was 15.3%, and 77 patients had obvious superficial veins. There was a statistically significant correlation between the diameter of the IRHVs and the drainage volume of the IRHVs and RHVs. Conclusion: More detailed information about the anatomical features and variations of hepatic venous veins in Chinese people was provided using 3D reconstructions, and this will assist in more precise liver surgeries.

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Special considerations of living liver donor transplantation

Orvosi Hetilap ◽

10.1556/oh.2013.29698 ◽

2013 ◽

Vol 154 (36) ◽

pp. 1417-1425

Author(s):

Attila Szijártó ◽

Yasuhiro Fujimoto ◽

Kirino Izumi ◽

Uemoto Shinji

Keyword(s):

Hepatic Vein ◽

Middle Hepatic Vein ◽

Liver Donor ◽

Liver Lobe ◽

Left Liver Lobe ◽

Average Value ◽

Living Liver Donor ◽

The Right ◽

Disparity Index ◽

Right Hepatic Vein

Introduction: Due to the limited number of cadaver donors, adult living liver donor transplantation became an alternative for liver transplantation. During living liver donor transplantation, the safety and uncomplicated recovery of the donor are as important as the appropriate volume and weight of the donated graft. The middle hepatic vein causes a significant dilemma, due to the special anatomical position. The reconstruction of the middle hepatic vein branches supplying S5, S8 is suggested when the anatomically right liver lobe is transplanted. Aim: The aim of the present study was to investigate the requirements of the reconstruction of middle hepatic vein and to give an accurate description about the discrepancy between the portal vein in- and outflow. Method: The authors analyzed the liver anatomic characteristics of 130 donors undergoing living liver donor transplantation with the use of MeVis software. The so-called porto-hepatic disparity index (shift) was introduced. Results: The right hepatic vein was dominant in 64.6% of all cases, while the left hepatic vein was never observed to be dominant. The territories of V5 and V8 were responsible for the 33.2±8.9% of the right hepatic lobe area. The correlation between portal venous territory and vein dominancy were as follows: R2= 0.7811 in the left liver lobe; R² = 0.5463 in the area of middle hepatic vein and R² = 0.5843 in the case of the right hepatic vein. The average value of the shift was 28.2%. Conclusions: The differences among the pattern of portal in- and hepatic outflow is an important issue that should be taken into consideration when deciding the necessity for reconstruction of the middle hepatic vein. Orv. Hetil., 2013, 154, 1417–1425.

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