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Journal of Hepato-Biliary-Pancreatic Sciences

, Volume 19, Issue 1, pp 54–66 | Cite as

Sectionectomy of the liver

  • Junichi YamanakaEmail author
  • Jiro Fujimoto
Topics Highly advanced surgery in the hepatobiliary and pancreatic field (Liver Section)

Abstract

Anatomic resection of the liver, which refers to the systemic elimination of the main tumor with micrometastases, preserves liver function and is highly recommended. Tumors located centrally or in the vicinity of major portal pedicles or hepatic veins, however, tend to require extensive hepatectomy. Anatomic sectionectomy of the liver might represent an alternative to such extensive resection. Preoperative simulation, external landmarks, selective devascularization, and intraoperative ultrasound are useful to achieve anatomic sectionectomy. Anatomic resection requires division of the relevant portal vein, hepatic artery, and bile duct. This may be achieved by individual isolation of the three elements or by mass isolation of all three in their surrounding fibrous sheath (Glisson’s capsule). Both approaches are equally effective for extensive resections. When sectionectomy is performed, however, the isolation of individual vasculobiliary elements is sometimes difficult and dangerous compared with the isolation of the sectional portal pedicles. By identifying the portal pedicles to individual anatomic sections, it is possible to control the inflow to the section that is intended for resection. Anatomic sectionectomy is a safe alternative to extensive liver resection in selected patients, avoiding unnecessary sacrifice of functional liver parenchyma and increasing the opportunity to perform repeat resections in cases of recurrence.

Keywords

Anatomic hepatectomy Sectionectomy Curative resection 3D-CT Simulation 

Notes

Conflict of interest

The authors declare that they have no conflicts of interest.

Supplementary material

Supplementary material (MPG 41564 kb)

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Copyright information

© Japanese Society of Hepato-Biliary-Pancreatic Surgery and Springer 2011

Authors and Affiliations

  1. 1.Department of SurgeryHyogo College of MedicineNishinomiyaJapan
  2. 2.Yamanaka Medical CenterShisoJapan

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