Abstract
Left trisectionectomy [(LT) resection of segments 2, 3, 4, 5, 8, and 1] for perihilar cholangiocarcinoma is still a challenging procedure with high postoperative morbidity and mortality. To perform LT safely, the liver transection-first approach was developed. In this approach, liver transection is started without dividing the right anterior hepatic artery (RAHA) and right anterior portal vein (RAPV). After the completion of liver transection, the RAHA and RAPV, which run into the future resected liver, can be easily identified and divided under the wide surgical field at the hepatic hilus. The liver transection-first approach appears to be safer than the conventional LT, leading to less postoperative morbidity and mortality.
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10434_2020_8306_MOESM1_ESM.pptx
The three-dimensional positional relationship of the right anterior hepatic artery or the right posterior hepatic artery to the right portal vein (A), and the three-dimensional positional relationship of the right anterior sectional bile duct or the right posterior sectional bile duct to the right portal vein (B). RAHA, right anterior hepatic artery; RPHA, right posterior hepatic artery; A6, hepatic artery of segment 6; A7, hepatic artery of segment 7; PV, portal vein; BD, bile duct; RASBD, right anterior sectional bile duct; RPSBD, right posterior sectional bile duct; B6, bile duct of segment 6; B7, bile duct of segment 7 (PPTX 1315 kb)
Surgical video of the left trisectionectomy (resection of segments 2, 3, 4, 5, 8, and 1) with extrahepatic bile duct resection using the liver transection-first approach (MP4 142673 kb)
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Hosokawa, I., Shimizu, H., Ohtsuka, M. et al. Liver Transection-First Approach in Left Trisectionectomy for Perihilar Cholangiocarcinoma. Ann Surg Oncol 27, 2381–2386 (2020). https://doi.org/10.1245/s10434-020-08306-y
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DOI: https://doi.org/10.1245/s10434-020-08306-y