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Operative Technique |

Hepatic Resections

David R. Holt, MD; David Van Thiel, MD; Steve Edelstein, MD; John J. Brems, MD
Arch Surg. 2000;135(11):1353-1358. doi:10.1001/archsurg.135.11.1353.
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Hepatic resection is the treatment of choice for many secondary and primary hepatic tumors. With improvement in surgical techniques and earlier recognition of hepatic tumors, there has been a renewed interest in performing hepatic resections. In this operative review, we will describe the techniques for performing right-sided and left-side hepatic resections. A major hepatic resection can be performed with less than 5% mortality and approximately a 5% to 15% morbidity. Special mention will be made of performing a hepatic resection without vascular inflow occlusion. This is necessary in performing a hepatic resection for use in live donor liver transplantation.

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Figures

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Figure 1.

Segmental anatomy of the liver.

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Figure 2.

The right hepatic vein has been encircled and is free from tumor, allowing for a right hepatic lobectomy.

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Figure 3.

The right portal vein, hepatic artery, and hepatic duct have been divided, with the liver demarcating between the right and left lobes.

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Figure 4.

A parenchymal dissection is performed, preserving the middle hepatic vein. The right hepatic vein was divided before the parenchymal dissection but can be divided from within the parenchyma of the liver.

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Figure 5.

Division of the tissue bridge between segments 3 and 4.

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Figure 6.

Lowering of the hilar plate to assist in exposure of left portal triad.

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Figure 7.

Division of the hepatic parenchyma.

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Figure 8.

Division of the vascular branches supplying segment 4.

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The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
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