Anatomical resection of left liver segments.
OBJECTIVE
Anatomical resection of the left liver segments are rarely mentioned in the literature. We describe an anatomical access to the left liver segments' pedicles without hilar dissection.


METHODS
Original surgical technique.


METHODS
This technique was used in 26 consecutive resections involving left liver segments between July 2001 and December 2003. There were 15 men and 11 women with mean age of 57.1 years. Eleven patients had liver metastasis, 8 had primary liver cancer, 6 had benign lesions, and 1 had gallbladder cancer. The technique consists of small liver incisions according to anatomical landmarks such as the Arantius and round ligaments. In a systematized way, it was possible to reach every glissonian sheath of segments II, III, and IV.


RESULTS
Liver resection was feasible using the proposed technique in every patient of this series, and the Pringle maneuver was not required in any patient. Intraoperative blood loss was minimal in all cases, and 23 patients did not require blood transfusion. There was no postoperative death.


CONCLUSIONS
This operative procedure allows easy, fast access for anatomical resection of the left liver segments. It is useful for performing controlled hepatectomies without clamping the main hepatic pedicle and may facilitate the recognition of all left liver segment sheaths, with excellent immediate results.
Machado
Marcel Autran C
MA
Department of Abdominal Surgery, Cancer Hospital, São Paulo, Brazil. dr@drmarcel.com.br
Herman
Paulo
P
Machado
Marcel C C
MC
D000328:Adult; D000368:Aged; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D008297:Male; D008875:Middle Aged