Pure Laparoscopic Anatomical Resection of the Ventral Area of the Right Anterior Section Using the Transfissural Glissonean Approach

2019 ◽  
Vol 23 (6) ◽  
pp. 1279-1282 ◽  
Author(s):  
Ji Hoon Kim
Keyword(s):  
Anatomical Resection ◽  
Anterior Section ◽  
Glissonean Approach ◽  
The Right ◽  
Ventral Area

scholarly journals Nonanatomical resection is comparable with anatomical resection in solitary hepatocellular carcinoma <5 cm in the right posterior section

Medicine ◽  
2016 ◽  
Vol 95 (51) ◽  
pp. e5382 ◽  
Author(s):  
Jong Man Kim ◽  
Choon Hyuck David Kwon ◽  
Jae-Won Joh ◽  
Byung-Gon Na ◽  
Kyo-Won Lee ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Anatomical Resection ◽  
Posterior Section ◽  
Solitary Hepatocellular Carcinoma ◽  
The Right

Handling of hilar vasculature in living donor right hepatectomy using extrahepatic Glissonean approach

2021 ◽  
Author(s):  
Naokazu Chiba ◽  
Motohide Shimazu ◽  
Shigeto Ochiai ◽  
Takahiro Gunji ◽  
Toshimichi Kobayashi ◽  
...  
Keyword(s):  
Bile Duct ◽  
Portal Vein ◽  
Hepatic Artery ◽  
Living Donor ◽  
Donor Hepatectomy ◽  
Central Direction ◽  
Tissue Removal ◽  
Glissonean Approach ◽  
The Right ◽  
Living Donor Hepatectomy

Donor hepatectomy is one of the most important procedures in LDLT because it affects the safety of donors and the outcome of the recipients. We standardized a method of securing the important vessels at the hepatic hilum while advancing the dissection toward the central direction. This research introduces our technique of handling hilar vasculature in living donor hepatectomy, using the extrahepatic Glissonean approach, and discusses its efficacy. At first, after the extrahepatic right Glissonean approach, the resected hepatic artery and portal vein are secured on the same line as with the secured the glisson. The resected hepatic artery and portal vein are followed in the central direction, and the surrounding area is dissected. The dissection is continued up to the main brunch of hepatic artery and portal vein. The bile duct can be secured by subtracting the hepatic artery and portal vein from the tape that secured the Glissonean pedicle. The bile duct, hepatic artery, and the portal vein are dissected in this order, before dissecting the right hepatic vein, completing the surgery. This method of dissection approaching the extrahepatic Glisson is carried out towards the central direction suggest to acquire minimal tissue removal and to shorten operative time. This could result in adequate perfusion to the remaining liver and donor safety, taken together effective results on recipient.

Parenchyma-preserving hepatectomy based on portal ramification and perfusion of the right anterior section: preserving the ventral or dorsal area

2016 ◽  
Vol 23 (3) ◽  
pp. 158-166 ◽  
Author(s):  
Ami Kurimoto ◽  
Junichi Yamanaka ◽  
Seikan Hai ◽  
Yuichi Kondo ◽  
Hideaki Sueoka ◽  
...  
Keyword(s):  
Anterior Section ◽  
Dorsal Area ◽  
The Right

Validity of hepatic cone-unit resection for hepatocellular carcinoma.

2019 ◽  
Vol 37 (4_suppl) ◽  
pp. 228-228
Author(s):  
Satoru Imura ◽  
Shinichiro Yamada ◽  
Yu Saito ◽  
Shuichi Iwahashi ◽  
Tetsuya Ikemoto ◽  
...  
Keyword(s):  
Hepatocellular Carcinoma ◽  
Anatomical Variation ◽  
Tumor Location ◽  
Tumor Diameter ◽  
Portal Branch ◽  
Dorsal Area ◽  
Anatomical Liver Resection ◽  
The Right ◽  
Ventral Area ◽  
Difficult Cases

228 Background: Anatomical liver resection (ALR) has been performed widely for hepatocellular carcinoma (HCC). However, there are difficult cases with typical ALR, due to tumor location or anatomical variation. The aim of this study is to review the cases of atypical ALR and to investigate the validity of small ALR for HCC. Methods: From 2007 to 2017, hepatic resection less than 2 segments was performed to 252 patients with HCC. (1) We reviewed cases with atypical ALR (eg. posterior segment + anterior dorsal area, S4 + S8 ventral area, etc.), and (2) Regarding the validity of cone-unite resection for single HCC, we compared the clinicopathological outcome with subsegmentectomy as a control. Results: (1) Atypical ALR was performed in 10% (17/169) of ALR less than 2 segments. There were 7 cases of extended anterior segmentectomy or extended S8 resection for patients having anterior or S8 portal branch that perfused to the right side of the right hepatic vein. Most of such atypical ALR tended to be indicated in right-side hepatectomy. (2) Liver function was well preserved in both groups, and it was better in subsegment group (ICGR15: 10.5 vs. 12.3%, ALB: 4.1 vs. 3.9g/dL). Regarding the tumor factor, the diameter was larger in the subsegment group than in the cone-unite group (2.8 vs. 2.1cm), and the proportion in which subsegmentectomy was performed in the case more than 3 cm was high (32 vs. 11%). There was no difference in OS and DFS between the two groups. Even when the tumor diameter was 3 cm or less, there was no difference in DFS between subsegment (n = 28) and cone-unite resection (n = 40). Conclusions: There are a number of cases that typical ALR is difficult, especially in the right-side hepatectomy. There was no difference in the prognosis depending on the range of resection, if HCC could be resected of subsegment or less. Therefore, depending on age and comorbidity, it is necessary to determine the type of hepatectomy without sticking to the subsegmentectomy.

Quantitative Assessment of the Accuracy of Real-Time Virtual Sonography for Liver Surgery

2019 ◽  
Vol 27 (1) ◽  
pp. 60-67 ◽  
Author(s):  
Akinori Miyata ◽  
Junichi Arita ◽  
Chikara Shirata ◽  
Satoru Abe ◽  
Nobuhisa Akamatsu ◽  
...  
Keyword(s):  
Real Time ◽  
Liver Surgery ◽  
Ct Images ◽  
Actual Measurement ◽  
Anterior Section ◽  
Left Liver ◽  
Computed Tomographic ◽  
Posterior Section ◽  
Adjustment Time ◽  
The Right

Background. Real-time virtual sonography (RVS) is a navigation system for liver surgery. In this study, the degree of misalignment of intraoperative RVS images with computed tomographic (CT) images was measured. Methods. Between December 2014 and July 2015, intraoperative RVS was performed in a total of 33 patients undergoing liver surgery. Reconstructed CT images, rendered like intraoperative ultrasonographic (IOUS) images, were adjusted with the IOUS images and visualized side by side. The degree of misalignment between the reconstructed CT images and IOUS images was measured at anterior section, posterior section, and left liver in each patient. Furthermore, the time required for the adjustment was measured as the “adjustment time.” Results. The degree of misalignment between the images could potentially be measured for a total of 96 points in the 33 patients. Of these, the actual measurement could not be conducted for 35 points due to poor visualization of the intrahepatic vasculature (n = 20) or to a large misalignment that hampered continuation of further adjustment (n = 15). The median degree of misalignment was 9.8 mm (range = 2.4-37.6 mm) in the right anterior section, 9.8 mm (range = 2.7-71.5 mm) in the right posterior section, and 9.5 mm (range = 0.9-37.6 mm) in the left liver. The median adjustment time was 105 seconds (range = 51-245 seconds). Conclusions. Although some misalignment occurred, it might be acceptable for selected situations. Further investigation is needed to reduce the frequency of adjustment failure.

scholarly journals Inferior Right Hepatic Vein: A Useful Anatomic Variation for Isolated Resection of Segment VIII

2013 ◽  
Vol 2013 ◽  
pp. 1-3 ◽  
Author(s):  
Klaus Steinbrück ◽  
Reinaldo Fernandes ◽  
Giuliano Bento ◽  
Rafael Vasconcelos ◽  
Gustavo Stoduto ◽  
...  
Keyword(s):  
Hepatic Vein ◽  
Anatomic Variation ◽  
Anatomical Variations ◽  
Surgical Results ◽  
Anatomical Resection ◽  
En Bloc ◽  
Main Trunk ◽  
Segment Viii ◽  
The Right ◽  
Right Hepatic Vein

Anatomical resection of segment VIII (SVIII) is one of the most difficult hepatectomies to perform. Although it is the best choice of surgical treatment for tumors located at SVIII, its feasibility can be compromised when the right hepatic vein (RHV) must be resected en bloc with SVIII. Herein we describe a case of a cirrhotic patient that was submitted to segmentectomy VIII in bloc with the main trunk of the RHV, due to hepatocellular carcinoma. The resection could only be performed because a well developed inferior right hepatic vein (IRHV) was present. Anatomical variations of the liver vascularization should be used by liver surgeons to improve surgical results.

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