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Operative Techniques |

A standardized technique for right segmental liver resections

Marcel autran c. Machado, MD; Paulo Herman, MD; Marcel c. c. Machado, MD
Arch Surg. 2003;138(8):918-920. doi:10.1001/archsurg.138.8.918.
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Published online

Hypothesis  The indications for segmental liver resections are increasing. this type of procedure can be performed by deep wedge transparenchymal transection or by the intrahepatic approach, reaching the portal pedicle through the hilar plate. we devised a systematized way to perform such an operation.

Design  Original surgical technique.

Patients and methods  Fourteen consecutive patients (8 men and 6 women; mean age, 55 years) underwent right segmental liver resections between july 1, 2001, and july 31, 2002. seven patients had liver metastasis, 3 had primary liver cancer, 3 had benign lesions, and 1 had gallbladder cancer. the surgery was performed by making 3 small incisions around the hilar plate. with a standardized method, the right posterior and anterior sheaths were reached by combining these incisions.

Results  Right segmental liver resection was feasible with the proposed technique in all patients. intraoperative blood loss was minimal in all cases, and 11 patients did not require blood transfusion. there was no postoperative death.

Conclusions  This operative procedure standardizes the intrahepatic approach to the right portal pedicle for right segmental resections. it may reduce bleeding at the site of hilar plate incisions and the need for main hepatic pedicle clamping and may facilitate the recognition of right posterior and anterior sheaths, with excellent immediate results.

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Figure 1.

Incisions for the intrahepatic approach of the glisson pedicle and the angles to isolate the sheaths. a, anterior incision in front of the hilum; b, a vertical incision is made perpendicular to the hepatic hilum in segment vii; c, a third incision is performed on the right edge of the gallbladder bed. when a clamp is passed from a to b, access to the right main sheath (containing arterial, portal, and bile duct branches of segments v to viii) is obtained. this maneuver is used for right hepatectomy. when a clamp is passed from a to c, access to the right anterior sheath (containing arterial, portal, and bile duct branches of segments v and viii) is obtained. this maneuver is used for en bloc resection of segments v and viii or resection of segment v or viii alone. when a clamp is passed from c to b, access to the right posterior sheath (containing arterial, portal, and bile duct branches of segments vi and vii) is obtained. this maneuver is used for en bloc resection of segments vi and vii or resection of segment vi or vii alone.

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Figure 2.

Schematic view of right anterior pedicle dissection (containing arterial, portal, and bile duct branches of segments v and viii).

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Figure 3.

Intraoperative view of right anterior pedicle delineation.

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Figure 4.

Intraoperative view of raw surface of the liver after right anterior hepatectomy.

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