title: Venous-drainage-guided selective hepatectomy: a novel approach to liver surgery.
abstract: Selective hepatectomy under the guidance of hepatic venous drainage has not yet been developed because hepatic venous occlusion alone produces no visible congested area. Now that this area can be identified by simultaneous occlusion of the hepatic vein and artery, venous-drainage-guided selective hepatectomy is considered feasible. Because the congested area becomes dysfunctional or atrophic due to the absence of portal blood supply, it can be regarded as a first candidate for preventive resection in livers that may bear latent tumors. We report here a novel approach to selective hepatectomy. Segment 4 hepatectomy and ventral hemisectorectomy of segments 5+8, with middle hepatic vein resection, was undertaken in a patient with hepatocellular carcinoma. After hepatic dissection between segments 2+3 and 4, the root of the middle hepatic vein was isolated. Test clamping of the middle hepatic vein and proper hepatic artery demonstrated a discolored area. Hepatic dissection was performed along the discolored border towards the hepatic hilum, exposing the right anterior portal pedicle with division of the ventral branches. The middle hepatic vein was finally divided. Selective hepatectomy was successfully performed without transfusion or complications. Venous-drainage-guided selective hepatectomy is feasible with acceptable perioperative results.
authors.affiliation: Department of Surgical Oncology, Hokkaido University Graduate School of Medicine, Sapporo, Japan. kondows@med.hokudai.ac.jp
authors.forename: Satoshi
authors.initials: S
authors.lastname: Kondo
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Katoh
authors.forename: Satoshi
authors.initials: S
authors.lastname: Hirano
authors.forename: Yoshiyasu
authors.initials: Y
authors.lastname: Ambo
authors.forename: Eiichi
authors.initials: E
authors.lastname: Tanaka
authors.forename: Katsunori
authors.initials: K
authors.lastname: Saito
authors.forename: Takehiro
authors.initials: T
authors.lastname: Noji
authors.forename: Shunichi
authors.initials: S
authors.lastname: Okushiba
authors.forename: Toshiaki
authors.initials: T
authors.lastname: Morikawa
authors.forename: Koji
authors.initials: K
authors.lastname: Taira
authors.forename: Hohei
authors.initials: H
authors.lastname: Hishiyama
mesh_terms: D000368:Aged; D006528:Carcinoma, Hepatocellular / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000000981:diagnostic imaging / Q000453:epidemiology / Q000601:surgery*; D008297:Male; D014057:Tomography, X-Ray Computed