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

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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Middle Hepatic Vein Branch-Guided Approach for Laparoscopic Resection of Liver Segment 8 Is Simple, Reliable, and Reproducible

Annals of Surgical Oncology ◽

10.1245/s10434-020-08652-x ◽

2020 ◽

Vol 27 (13) ◽

pp. 5195-5195 ◽

Cited By ~ 1

Author(s):

Satoshi Ogiso ◽

Satoru Seo ◽

Takamichi Ishii ◽

Takayuki Anazawa ◽

Kazuyuki Nagai ◽

...

Keyword(s):

Hepatic Vein ◽

Laparoscopic Resection ◽

Middle Hepatic Vein ◽

Liver Segment ◽

Segment 8

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Laparoscopic anatomical resection of segment 7 and segment 8 when right hepatic vein reconstruction was not necessary

HPB ◽

10.1016/j.hpb.2019.10.2061 ◽

2019 ◽

Vol 21 ◽

pp. S390

Author(s):

Ying-Chin Yang

Keyword(s):

Hepatic Vein ◽

Anatomical Resection ◽

Hepatic Vein Reconstruction ◽

Segment 8 ◽

Right Hepatic Vein

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ASO Author Reflections: Middle Hepatic Vein Anatomy for Safe Dissemination of Laparoscopic Segment 8 Resection

Annals of Surgical Oncology ◽

10.1245/s10434-020-08687-0 ◽

2020 ◽

Vol 27 (13) ◽

pp. 5196-5196

Author(s):

Satoshi Ogiso ◽

Satoru Seo

Keyword(s):

Hepatic Vein ◽

Middle Hepatic Vein ◽

Segment 8

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

Langenbeck s Archives of Surgery ◽

10.1007/s00423-021-02282-x ◽

2021 ◽

Author(s):

Shunya Hanzawa ◽

Kazuteru Monden ◽

Masayoshi Hioki ◽

Hiroshi Sadamori ◽

Satoshi Ohno ◽

...

Keyword(s):

Hepatic Vein ◽

Liver Parenchyma ◽

Middle Hepatic Vein ◽

Hepatic Veins ◽

Parenchymal Transection ◽

Demarcation Line ◽

Histopathological Findings ◽

Glissonean Approach ◽

Grade Ii ◽

Cranial Approach

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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3D Generated Model for Intraoperative Planning of Parenchymal Transection and Middle Hepatic Vein Reconstruction in Living Donor Liver Transplant

Journal of the American College of Surgeons ◽

10.1016/j.jamcollsurg.2021.08.517 ◽

2021 ◽

Vol 233 (5) ◽

pp. e192

Author(s):

Vivek Gupta ◽

Abhijit Chandra ◽

Divya Mehrotra ◽

Pratik Shah ◽

Anit Parihar ◽

...

Keyword(s):

Liver Transplant ◽

Hepatic Vein ◽

Living Donor ◽

Middle Hepatic Vein ◽

Parenchymal Transection ◽

Donor Liver ◽

Living Donor Liver Transplant ◽

Hepatic Vein Reconstruction ◽

Intraoperative Planning ◽

Donor Liver Transplant

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Effect of Age, Gender, Side and Impaction Types on Surgical Difficulty During Mandibular Third Molar Extraction.

Medical Journal of Shree Birendra Hospital ◽

10.3126/mjsbh.v17i2.18950 ◽

2018 ◽

Vol 17 (2) ◽

pp. 11

Author(s):

Krishna Gopal Bhuju ◽

Sujita Shrestha ◽

Riwaj Karki ◽

Sameer Aryal

Keyword(s):

Third Molar ◽

Objective Measure ◽

Operation Time ◽

Significance Level ◽

Third Molar Extraction ◽

Mandibular Third Molar ◽

Duration Of Surgery ◽

Surgical Difficulty ◽

Effect Of Age ◽

Molar Extraction

Aim: To study the effect of age, gender, side and impaction types on surgical difficulty during mandibular third molar extraction through the data collected over a period of one year by single maxillofacial surgeon. All the extractions were performed under the same environment and conditions.Methods: Descriptive clinical study of 401 patients was carried out between the ages of 16 to 45years. Age, gender, impaction side and impaction types (according to the winter classification) were recorded on proforma. Duration of surgery for each patient was recorded after starting incision to the completion of suture which was divided into less than 10 minutes (mild), 11 to 20 minutes (moderate) and above 21 minutes (severe). Pearson’s Chi-square test was used for data analysis and significance level was less than or equal to 0.05.Results: Among 401 participants, 225 (56.1%) were male and 176 (43.9%) were female. Mean age was 31.5 years and mean operation time was 17.59 minutes. After statistical analysis there was a significant correlation among gender and side of impaction where p value is 0.043 0.048 respectively.Conclusion: There is a statistically significant correlation between gender and side of impaction with duration of surgery which is considered as the objective measure of surgical difficulty whereas age and impaction types didn’t show any significant correlation.

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