Right intersectional transection plane based on portal inflow in left trisectionectomy.
Purpose: Left trisectionectomy (LT) extending to the segment I with bile duct resection for perihilar cholangiocarcinoma (PHC) is a technically demanding procedure with high morbidity. Liver transection during LT is generally conducted to expose the right hepatic vein (RHV) on the remnant side. In c...
| Published in: | Surgical & Radiologic Anatomy Vol. 41; no. 5; pp. 589 - 594 |
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| Main Authors: | , , , , , |
| Format: | Journal Article |
| Published: |
Springer Nature
May2019
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| Online Access: | View this record in EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=136115126&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 136115126 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 09301038 O1L jtl: Surgical & Radiologic Anatomy issn: 09301038 maglogo: N pubinfo: dt: May2019 vid: 41 iid: 5 pid: 237 pub: Springer Nature place: New York, New York artinfo: ui: 136115126 10.1007/s00276-018-2135-9 136115126 ppf: 589 ppct: 5 formats: fmt: – @attributes: type: T – @attributes: type: P tig: atl: Right intersectional transection plane based on portal inflow in left trisectionectomy. aug: au: Hosokawa, Isamu Ohtsuka, Masayuki Yoshitomi, Hideyuki Furukawa, Katsunori Miyazaki, Masaru Shimizu, Hiroaki affil: Department of Surgery, Teikyo University Chiba Medical Center, 3246-3, Anesaki, 299-0111, Ichihara, Chiba, Japan sug: ab: Purpose: Left trisectionectomy (LT) extending to the segment I with bile duct resection for perihilar cholangiocarcinoma (PHC) is a technically demanding procedure with high morbidity. Liver transection during LT is generally conducted to expose the right hepatic vein (RHV) on the remnant side. In clinical practice, we have often encountered a discrepancy between the theoretical RHV-oriented plane and the actual right intersectional plane. Methods: To enable anatomical LT safely, the three-dimensional right intersectional transection plane based on portal inflow was investigated using multidetector-row computed tomography, and it was compared to the theoretical RHV-oriented plane in 100 patients with hepatobiliary disease. Results: The posterior portion of RHV just below the diaphragm was supplied by the dorsal portal branches of segment VIII in 85 cases of 100 (85.0%). The median volume of this portion was 82 mL (25–169 mL). On the other hand, the anterior region of the peripheral RHV was supplied by a few small ventral portal branches of segment VI in 24 of 90 cases (26.7%). The median volume of this portion was 53 mL (20–104 mL). In ten cases with a large inferior RHV, the RHV trunk was relatively short and did not reach the caudal part of the liver. Conclusions: The portal inflow-oriented right intersectional plane does not coincide with the RHV-oriented plane in most cases. The cranial part of the actual transection plane becomes hollow, whereas the caudal part is protruded in relation to the RHV. Hepatobiliary surgeons should recognize this complicated transection plane to avoid postoperative complications when performing LT for PHC. pubtype: Academic Journal doctype: Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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