Abstract
Dissection or encirclement of the sectional pedicles for resection area demarcation is generally required for anatomical right posterior sectionectomy (RPS). These maneuvers are sometime unfeasible and potentially dangerous. A new technique for performing an RPS is herein described. Among the last 289 consecutive patients who underwent hepatic resection, 15 met the eligibility criteria for anatomical RPS by ultrasound-guided finger compression. This technique consists in demarcating the resection area by ultrasound-guided finger compression of the right posterior portal pedicle at the level closest to the tumor but oncologically suitable. Five patients had HCC; 11 had colorectal liver metastases. Median tumor number was 2 (range 1–46); median tumor size was 2.4 cm (range 0.4–13). Six patients had cirrhosis or chronic hepatitis, and ten had steatosis. Results show that the procedure resulted feasible in all eligible patients, and demarcation area was obtained in all patients within 1 min of bimanual IOUS guided compression. There was no mortality or major morbidity: only 2 (12%) patients experienced postoperative morbidity. Blood transfusions were not given. Ultrasound-guided finger compression of sectional portal pedicle feeding the right posterior section is a feasible, safe, and effective method, and introduces a new modality for performing RPS.
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References
Makuuchi M, Hasegawa H, Yamazaki S (1983) Intraoperative ultrasonic examination for hepatectomy. Ultrasound Med Biol S2:493–497
Bismuth H, Castaing D, Garden OJ (1987) The use of operative ultrasound in surgery of primary liver tumors. World J Surg 11:610–614
Torzilli G, Montorsi M, Donadon M et al (2005) “Radical but conservative” is the main goal for ultrasonography-guided liver resection: prospective validation of this approach. J Am Coll Surg 201:517–528
Torzilli G, Montorsi M, Del Fabbro D, Palmisano A, Donadon M, Makuuchi M (2006) Ultrasonographically guided surgical approach to liver tumours involving the hepatic veins close to the caval confluence. Br J Surg 93:1238–1246
Torzilli G, Donadon M, Marconi M et al (2008) Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Ann Surg 247:603–611
Torzilli G, Makuuchi M (2004) Ultrasound-guided finger compression in liver subsegmentectomy for hepatocellular carcinoma. Surg Endosc 18:136–139
Torzilli G, Procopio F, Cimino M et al (2010) Anatomical segmental and subsegmental resection of the liver for hepatocellular carcinoma: a new approach by means of ultrasound-guided vessel compression. Ann Surg 251:229–235
Terminology Committee of the IHPBA (2000) Terminology of liver anatomy and resections. HPB Surg 2:333–339
Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240(2):205–213
Torzilli G, Garancini M, Donadon M, Cimino M, Procopio F, Montorsi M (2010) Intraoperative ultrasonographic detection of communicating veins between adjacent hepatic veins during hepatectomy for tumours at the hepatocaval confluence. Br J Surg 97(12):1867–1873
Couinaud C (1989) The vasculo-biliary sheaths. In: Couinaud C (ed) Surgical anatomy of the liver revisited. Couinaud, Paris, pp 29–39
Makuuchi M, Hashikura Y, Kawasaki S, Tan D, Kosuge T, Takayama T (1993) Personal experience of right anterior segmentectomy (segments V and VIII) for hepatic malignancies. Surgery 114(1):52–58
Takasaki K, Kobayashi S, Tanaka S, Saito A, Yamamoto M, Hanyu F (1990) Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg 75(2):73–77
Launois B, Jamieson GG (1992) The posterior intrahepatic approach for hepatectomy or removal of segments of the liver. Surg Gynec Obstet 174:155–158
Launois B, Jamieson GG (1992) The importance of Glisson’s capsule and its sheaths in the intrahepatic approach to resection of the liver. Surg Gynecol Obstet 174:7–10
Batignani G (2000) Hilar plate detachment and extraglissonian extrahepatic anterior approach to the right portal pedicle for right liver resections. J Am Coll Surg 190:631–634
Strasberg S, Linehan DC, Hawkins WG (2008) Isolation of right main and right sectional portal pedicles for liver resection without hepatotomy or inflow occlusion. J Am Coll Surg 206(2):390–396
Torzilli G, Donadon M, Palmisano A et al (2007) Back-flow bleeding control during resection of right-sided liver tumors by means of ultrasound-guided finger compression of the right hepatic vein at its caval confluence. Hepatogastroenterol 54(77):1364–1367
Makuuchi M, Hasegawa H, Yamazaki S (1985) Ultrasonically guided subsegmentectomy. Surg Gynecol Obstet 161:346–350
Torzilli G, Procopio F, Botea F et al (2009) One-stage ultrasound-guided hepatectomy for multiple bilobar colorectal metastases: a feasible and effective alternative to two-stage hepatectomy. Surgery 146:60–71
Baba Y, Hokotate H, Nishi H, Inoue H, Nakajo M (2000) Intrahepatic portal venous variations: demonstration by helical CT during arterial portography. J Comput Assist Tomogr 24(5):802–808
Kusaka K, Harihara Y, Torzilli G, Kubota K, Takayama T, Makuuchi M, Mori M, Omata S (2000) Objective evaluation of liver consistency to estimate hepatic fibrosis and functional reserve for hepatectomy. J Am Coll Surg 191:47–53
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The authors thank Ms. Rosalind Roberts for her editorial assistance during manuscript preparation.
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Torzilli, G., Procopio, F., Donadon, M. et al. Anatomical right posterior sectionectomy: a further expansion of the ultrasound-guided compression technique. Updates Surg 63, 91–95 (2011). https://doi.org/10.1007/s13304-011-0068-5
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DOI: https://doi.org/10.1007/s13304-011-0068-5