title: Parenchyma-sparing anatomical liver resection based on Hjortsjo's concept: a venous-drainage-guided approach to identify the ventral segment fissure.
abstract: OBJECTIVE
  Anatomical liver resection is usually based on Couinaud's anatomical concept. In contrast, Hjortsjo's concept, which divides the right anterior section of the liver into ventral and dorsal segments by the vertical plane named the ventral segment fissure (VSF), has been rarely utilized for liver resection. Identification of the VSF is the most difficult step in liver resection based on Hjortsjo's concept. This study aimed to detail liver resection based on Hjortsjo's concept and report surgical outcomes of this procedure.
  
  
  METHODS
  We reviewed the records of 166 consecutive patients who underwent liver resection between September 2009 and June 2012 at Kyoto Medical Center and identified seven liver resections in which Hjortsjo's concept was utilized. These patients consisted of four men and three women aged 55-79 years. Four patients had hepatocellular carcinoma and cirrhosis and three patients had metachronous colorectal liver metastasis.
  
  
  RESULTS
  Liver resection along the VSF consisted of two extended left medial sectionectomies, three extended right posterior sectionectomies, and one Sg 7+8-dorsal resection by a venous-drainage-guided approach and one Sg 8-dorsal resection by a Glissonian approach. In all patients, the VSF was successfully identified as a congested or ischemic border on the liver surface. Mortality and major morbidity were nil. No patients underwent blood transfusion. After a median follow-up of 15 months, there were no deaths or local recurrence.
  
  
  CONCLUSIONS
  Anatomical liver resection based on Hjortsjo's concept is feasible and advantageous over conventional liver resection because it preserves more parenchyma. The venous-drainage-guided approach is an effective method for identifying the VSF.
authors: Department of Surgery, Kyoto Medical Center, Kyoto, Japan. oggy_so@ybb.ne.jp
authors: Satoshi
authors: S
authors: Ogiso
authors: Iwao
authors: I
authors: Ikai
authors: Masato
authors: M
authors: Narita
authors: Takahide
authors: T
authors: Murakami
authors: Hiroaki
authors: H
authors: Hata
authors: Takashi
authors: T
authors: Yamaguchi
authors: Tetsushi
authors: T
authors: Otani
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007902:Length of Stay / Q000706:statistics & numerical data; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D008111:Liver Function Tests; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications