Advertisement

Annals of Surgical Oncology

, Volume 26, Issue 1, pp 296–296 | Cite as

Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy

  • Katharina Joechle
  • Eduardo A. Vega
  • Masayuki Okuno
  • Eve Simoneau
  • Satoshi Ogiso
  • Timothy E. Newhook
  • David L. Ramirez
  • A. Alex Holmes
  • Jose M. Soliz
  • Yun Shin Chun
  • Ching-Wei D. Tzeng
  • Jeffrey E. Lee
  • Jean-Nicolas Vauthey
  • Claudius ConradEmail author
Hepatobiliary Tumors
  • 461 Downloads

Abstract

Background

When performing a right hepatectomy, the middle hepatic vein (MHV) should guide the parenchymal transection. MHV hotspots for bleeding can be anticipated when applying the previously developed MHV Roadmap to a minimally invasive approach.1 This video demonstrates application of the MHV Roadmap to perform a safe laparoscopic right hepatectomy.

Patient

A 44-year-old woman with a solitary and large breast cancer liver metastasis in the right liver was considered for a laparoscopic right hepatectomy following an excellent response to neoadjuvant chemotherapy. The MHV anatomy was reconstructed using automated vascular reconstruction software (Synapse, Fuji) ahead of surgery.

Technique

With the patient in the French position, the hilar vessels are exposed and the inflow is controlled. Parenchymal transection begins along the demarcation line.2,3 The constant relationship between the portal bifurcation and the V5 ventral and dorsal allows for easy intraparenchymal identification of the MHV. The parenchymal transection is performed in a convex fashion to optimize exposure of the MHV. Using MHV guidance, the parenchymal transection is continued and V8 is safely identified. The operation is completed with division of the anterior fissure and right hepatic vein.

Conclusion

Outlining the MHV anatomy according to the MHV Roadmap preoperatively helps to anticipate hotspots of bleeding. Guidance along the MHV through the parenchymal transection allows for early identification of tributaries, thereby preventing injury and remnant liver ischemia.

Notes

Acknowledgment

The University of Texas MD Anderson Cancer Center is supported in part by the NIH/NCI under Award Number P30CA016672.

Disclosures

The authors declare that they have no conflict of interest.

Supplementary material

Supplementary material 1 (MP4 336552 kb)

References

  1. 1.
    Ogiso S, Okuno M, Shindoh J, et al. Conceptual framework of middle hepatic vein anatomy as a roadmap for safe right hepatectomy. HPB (Oxford). Epub 25 Sep 2018.  https://doi.org/10.1016/j.hpb.2018.01.002.
  2. 2.
    Soubrane O, Schwarz L, Cauchy F, Perotto LO, Brustia R, Bernard D, et al. A conceptual technique for laparoscopic right hepatectomy based on facts and oncologic principles: the caudal Approach. Ann Surg. 2015;261(6):1226–31.CrossRefGoogle Scholar
  3. 3.
    Conrad C, Gayet B. Right hepatectomy. In: Conrad C, Gayet B, editors. Laparoscopic liver, pancreas, and biliary surgery. Chichester: Wiley; 2017. p. 410–5.Google Scholar

Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  • Katharina Joechle
    • 1
  • Eduardo A. Vega
    • 1
  • Masayuki Okuno
    • 1
  • Eve Simoneau
    • 1
  • Satoshi Ogiso
    • 2
  • Timothy E. Newhook
    • 1
  • David L. Ramirez
    • 3
  • A. Alex Holmes
    • 4
  • Jose M. Soliz
    • 4
  • Yun Shin Chun
    • 1
  • Ching-Wei D. Tzeng
    • 1
  • Jeffrey E. Lee
    • 1
  • Jean-Nicolas Vauthey
    • 1
  • Claudius Conrad
    • 1
    Email author
  1. 1.Department of Surgical Oncology, Hepato-Pancreato-Biliary SurgeryThe University of Texas MD Anderson Cancer CenterHoustonUSA
  2. 2.Department of SurgeryKyoto UniversityKyotoJapan
  3. 3.Department of Breast Medical OncologyThe University of Texas MD Anderson Cancer CenterHoustonUSA
  4. 4.Department of Anesthesiology and Perioperative MedicineThe University of Texas MD Anderson Cancer CenterHoustonUSA

Personalised recommendations