Anatomy of the Middle Hepatic Vein Tributaries to Promote Safer Hepatic Vein-Guided Liver Resection.
Anatomy
Bleeding
Hepatectomy
Hepatic vein
Laparoscopy
Journal
Journal of gastrointestinal surgery : official journal of the Society for Surgery of the Alimentary Tract
ISSN: 1873-4626
Titre abrégé: J Gastrointest Surg
Pays: United States
ID NLM: 9706084
Informations de publication
Date de publication:
01 2022
01 2022
Historique:
received:
03
02
2021
accepted:
04
06
2021
pubmed:
31
7
2021
medline:
27
1
2022
entrez:
30
7
2021
Statut:
ppublish
Résumé
In laparoscopic anatomic liver resection, an increasingly common procedure, the hepatic vein-guided approach is widely used although the hepatic vein tributaries can be a major source of bleeding in the event of inadvertent injury. This report describes the anatomy of the middle hepatic vein (MHV) including its tributaries based on reconstructed three-dimensional computed tomography images and provides anatomic data to enable safe middle hepatic vein-guided liver resection. Following simulation modeling of the hepatic vasculatures, reconstructed MHV data was pooled from 35 healthy liver donors. Yields of the MHV tributaries were analyzed to enable MHV-guided liver resection. A total of 252 tributaries were identified in the 35 donors. The MHV yielded fewer tributaries from its anterior and posterior aspects than from its right-side and left-side aspects (40 [15.9%], 13 [5.2%], 93 [36.9%], and 106 [42.1%], respectively). The MHV tributaries from the anterior and posterior aspects were smaller in diameter than those from the right-side and left-side aspects (median, 3.0, 2.0, 4.8, and 4.0 mm, respectively). Our simulation revealed that MHV dissection from the anterior or posterior aspect poses a lower risk of injury to the MHV tributaries compared to dissection from either lateral aspect. In addition, MHV dissection from the anterior or posterior aspect allows for safer identification and isolation of the thick MHV tributaries originating from the lateral aspects. Ideally, the anterior or posterior aspect of the MHV should be accessed and exposed before the lateral aspects are dissected to minimize the risk of MHV tributary injury.
Sections du résumé
BACKGROUND
In laparoscopic anatomic liver resection, an increasingly common procedure, the hepatic vein-guided approach is widely used although the hepatic vein tributaries can be a major source of bleeding in the event of inadvertent injury. This report describes the anatomy of the middle hepatic vein (MHV) including its tributaries based on reconstructed three-dimensional computed tomography images and provides anatomic data to enable safe middle hepatic vein-guided liver resection.
METHODS
Following simulation modeling of the hepatic vasculatures, reconstructed MHV data was pooled from 35 healthy liver donors. Yields of the MHV tributaries were analyzed to enable MHV-guided liver resection.
RESULTS
A total of 252 tributaries were identified in the 35 donors. The MHV yielded fewer tributaries from its anterior and posterior aspects than from its right-side and left-side aspects (40 [15.9%], 13 [5.2%], 93 [36.9%], and 106 [42.1%], respectively). The MHV tributaries from the anterior and posterior aspects were smaller in diameter than those from the right-side and left-side aspects (median, 3.0, 2.0, 4.8, and 4.0 mm, respectively).
DISCUSSION
Our simulation revealed that MHV dissection from the anterior or posterior aspect poses a lower risk of injury to the MHV tributaries compared to dissection from either lateral aspect. In addition, MHV dissection from the anterior or posterior aspect allows for safer identification and isolation of the thick MHV tributaries originating from the lateral aspects. Ideally, the anterior or posterior aspect of the MHV should be accessed and exposed before the lateral aspects are dissected to minimize the risk of MHV tributary injury.
Identifiants
pubmed: 34327658
doi: 10.1007/s11605-021-05074-2
pii: 10.1007/s11605-021-05074-2
doi:
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
122-127Informations de copyright
© 2021. The Society for Surgery of the Alimentary Tract.
Références
Monden K, Alconchel F, Berardi G, et al. Landmarks and techniques to perform minimally invasive liver surgery: A systematic review with a focus on hepatic outflow. J Hepatobiliary Pancreat Sci 2021.
Okuda Y, Honda G, Kurata M, et al. Dorsal approach to the middle hepatic vein in laparoscopic left hemihepatectomy. J Am Coll Surg 2014; 219(2):e1-4.
doi: 10.1016/j.jamcollsurg.2014.01.068
Rotellar F, Martí-Cruchaga P, Zozaya G, et al. Caudal approach to the middle hepatic vein as a resection pathway in difficult major hepatectomies under laparoscopic approach. J Surg Oncol 2020; 122(7):1426-1427.
doi: 10.1002/jso.26150
Ogiso S, Okuno M, Shindoh J, et al. Conceptual framework of middle hepatic vein anatomy as a roadmap for safe right hepatectomy. HPB (Oxford) 2019; 21(1):43-50.
doi: 10.1016/j.hpb.2018.01.002
Kiguchi G, Sugioka A, Kato Y, et al. Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position. Surg Oncol 2019; 29:140-141.
doi: 10.1016/j.suronc.2019.05.001
Ogiso S, Seo S, Ishii T, et al. Middle hepatic vein branch-guided approach for laparoscopic resection of liver segment 8 is simple, reliable, and reproducible. Ann Surg Oncol 2020; 27(13):5195.
doi: 10.1245/s10434-020-08652-x
Ogiso S, Seo S, Ishii T, et al. Transfissural approach for laparoscopic resection of a deep segment 8 lesion in contact with the hepatocaval confluence. Ann Surg Oncol 2020; 15(1):229.
Monden K, Sadamori H, Hioki M, et al. Consideration of cranial approach to major hepatic veins in laparoscopic anatomic liver resection of segment 8. J Am Coll Surg 2020; 231(4):498-499.
doi: 10.1016/j.jamcollsurg.2020.06.011
Mise Y, Hasegawa K, Satou S, et al. How has virtual hepatectomy changed the practice of liver surgery?: Experience of 1194 virtual hepatectomy before liver resection and living donor liver transplantation. Ann Surg 2018; 268(1):127-133.
doi: 10.1097/SLA.0000000000002213
Araki K, Conrad C, Ogiso S, et al. Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 2014; 218(2):e37-41.
doi: 10.1016/j.jamcollsurg.2013.10.022
Monden K, Sadamori H, Hioki M, et al. Cranial approach to the left hepatic vein in laparoscopic anatomic liver resections of segment 2 and segment 3. Surg Oncol 2020; 35:298.
doi: 10.1016/j.suronc.2020.09.007
Ohshima S. Volume analyzer SYNAPSE VINCENT for liver analysis. J Hepatobiliary Pancreat Sci 2014; 21(4):235-8.
doi: 10.1002/jhbp.81
IHPBA TCot. Terminology of liver anatomy and resections. Vol. 2. HPB, 2000. pp. 333–339.
Aoki T, Koizumi T, Mansour DA, et al. Ultrasound-guided preoperative positive percutaneous indocyanine green fluorescence staining for laparoscopic anatomical liver resection. J Am Coll Surg 2020; 230(3):e7-e12.
doi: 10.1016/j.jamcollsurg.2019.11.004
Miyata A, Ishizawa T, Tani K, et al. Reappraisal of a dye-staining technique for anatomic hepatectomy by the concomitant use of indocyanine green fluorescence imaging. J Am Coll Surg 2015; 221(2):e27-36.
doi: 10.1016/j.jamcollsurg.2015.05.005
Nishino H, Hatano E, Seo S, et al. Real-time navigation for liver surgery using projection mapping with indocyanine green fluorescence: Development of the novel medical imaging projection system. Ann Surg 2018; 267(6):1134-1140.
doi: 10.1097/SLA.0000000000002172
Ogiso S, Seo S, Okumura S, et al. Laparoscopic left lateral sectionectomy using the extrahepatic Glissonean approach: A secure option for achieving a negative margin for lesions with ductal extension. Ann Surg Oncol 2019; 26(6):1858.
doi: 10.1245/s10434-019-07298-8
Berardi G, Igarashi K, Li CJ, et al. Parenchymal sparing anatomical liver resections with full laparoscopic approach: Description of technique and short-term results. Ann Surg 2019; 273(4):785-791.
doi: 10.1097/SLA.0000000000003575
Okuda Y, Honda G, Kobayashi S, et al. Intrahepatic Glissonean pedicle approach to segment 7 from the dorsal side during laparoscopic anatomic hepatectomy of the cranial part of the right liver. J Am Coll Surg 2018; 226(2):e1-e6.
doi: 10.1016/j.jamcollsurg.2017.10.018
Egger ME, Gottumukkala V, Wilks JA, et al. Anesthetic and operative considerations for laparoscopic liver resection. Surgery 2016; 161(5):1191-1202.
doi: 10.1016/j.surg.2016.07.011
Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg 2016; 263(6):1159-63.
doi: 10.1097/SLA.0000000000001482
Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 1997; 226(6):704-11; discussion 711-3.
doi: 10.1097/00000658-199712000-00007