title: Superior approach for the exclusion of hepatic veins in major liver resection: a safe and easy technique.
abstract: We describe a technique for isolating and excluding the hepatic veins during liver resection. First, the bare area near the right and left wall of the suprahepatic inferior vena cava (IVC) is dissected, exposing the right, left, and superior walls of the right hepatic vein (RHV) and the left-middle hepatic vein (LMHV). Two Satinsky clamps are used to clamp the roots of the right and common trunk of the LMHV, parallel to the IVC. It is not necessary to dissect the posterior wall of the hepatic veins. We used this method during major liver resection in 65 patients. The mean dissecting time of each hepatic vein was 7.31 +/- 3.6 min. No hepatic vein was lacerated during dissection and exclusion. The postoperative complication rate was 31.2%. Thus, the superior approach is a safe and easy maneuver when the posterior wall of the hepatic vein is difficult to dissect due to tumor invasion.
authors.affiliation: Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital, 225 Changhai Street, 200438, Shanghai, China.
authors.forename: Aijun
authors.initials: A
authors.lastname: Li
authors.forename: Zeya
authors.initials: Z
authors.lastname: Pan
authors.forename: Weiping
authors.initials: W
authors.lastname: Zhou
authors.forename: Siyuan
authors.initials: S
authors.lastname: Fu
authors.forename: Yuan
authors.initials: Y
authors.lastname: Yang
authors.forename: Gang
authors.initials: G
authors.lastname: Huang
authors.forename: Lei
authors.initials: L
authors.lastname: Yin
authors.forename: Longjiu
authors.initials: L
authors.lastname: Cui
authors.forename: Bowen
authors.initials: B
authors.lastname: Wu
authors.forename: Mengchao
authors.initials: M
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D002648:Child; D002675:Child, Preschool; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D007223:Infant; D008099:Liver / Q000098:blood supply* / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000379:methods