Right inferior phrenic vein indicating the right hepatic vein confluence into the inferior vena cava.
BACKGROUND
Limiting backflow bleeding from the hepatic veins is a priority when performing hepatectomy. However, hepatic vein encirclement is difficult, especially in re-resection. We verified the presence and trajectory of the right inferior phrenic vein (RIPV), which could be a useful anatomic landmark to guide surgeons in targeting the extrahepatic right hepatic vein (RHV) before dissection.


METHODS
Between May 2001 and January 2005, 100 consecutive patients with liver tumors were enrolled and underwent hepatectomy: 77 patients underwent surgery for tumors located in the right hemiliver.


RESULTS
RIPV was detected in all but 1 patient (99%), and its trajectory was always guided toward the extrahepatic RHV. The only patient in whom RIPV was not detected had undergone prior liver resection and interstitial therapies for colorectal cancer liver metastases.


CONCLUSIONS
Apart from exceptional conditions, detection of the RIPV is always feasible and allows safe surgical dissection while approaching the extrahepatic RHV before hepatic resection.
Torzilli
Guido
G
3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089 Rozzano, Milano, Italy. guido.torzilli@unimi.it
Montorsi
Marco
M
Palmisano
Angela
A
Del Fabbro
Daniele
D
Gambetti
Andrea
A
Donadon
Matteo
M
Olivari
Natale
N
Makuuchi
Masatoshi
M
D017115:Catheter Ablation; D016461:Chemoembolization, Therapeutic; D015179:Colorectal Neoplasms / Q000601:surgery; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000033:anatomy & histology* / Q000601:surgery; D006801:Humans; D008099:Liver / Q000098:blood supply; D008103:Liver Cirrhosis / Q000601:surgery; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D019106:Postoperative Hemorrhage / Q000517:prevention & control; D011446:Prospective Studies; D019233:Retreatment; D014680:Veins / Q000033:anatomy & histology / Q000601:surgery; D014682:Vena Cava, Inferior / Q000033:anatomy & histology* / Q000601:surgery