Exposure of the hepatic vein trunk via tracing of its branches: a useful surgical procedure for laparoscopic anatomical hepatectomy.

Abstract

Although there are various advantages of laparoscopic liver resection (LLR) over open liver resection, some problems have been reported, such as disorientation and lack of control of bleeding during liver parenchymal dissection. In this study, we discuss a strategy to overcome the disorientation experienced during liver parenchymal dissection, especially in anatomical LLR. This procedure involves hepatic parenchymal dissection from the hepatic vein branch along its trunk to reveal an important landmark in anatomical LLR. Knowing which region of the liver is perfused into each hepatic vein in preoperative 3D simulation allows the tracing of the hepatic vein branch that naturally leads to the hepatic vein trunk. After that, hepatic resection can be easily completed by dissecting the line connected to the other landmarks, the Glisson branch, the root of the hepatic vein, and the liver demarcation line. In conclusion, this surgical procedure that traces the branch of the hepatic vein exposes the trunk, which makes it a very useful tool for limited laparoscopic anatomical hepatectomy.