Extended left hepatectomy with temporary porto-caval shunt under total hepatic vascular exclusion and liver cooling

Abstract

Background: We report the case of a 79-year-old patient with voluminous cholangiocarcinoma that was located in the left liver extended to segment V. A left extended hepatectomy is planned, under temporary porto-caval shunt (TPCS) and Liver Cooling (LC) Methods: The patient was operated on 5 days before from left portal vein ligation. The first step is preparing for TPCS: the right suprahepatic and the trunk of the main and left suprahepatic veins are controlled and the liver is fully mobilized to expose and control the infra and suprahepatic inferior vena cava with a tape. The pedicle is prepared dissecting the portal vein independently from the artery and bile duct. Results: The second step is to realize porto-caval shunt: the graft is sutures between the inferior vena cava and the main trunk of the portal vein. The film reports step by step this operative procedure, until the cannulation of the portal vein. The third step starts with the extended left hepatectomy. The transaction is realized using conventional bipolar electrocautery and ultrasonic dissection. The mains segmental pedicles were controlled using ligation, in particular the pedicle of segment VIII that must be preserved. Conclusion: Liver is rewarmed, cannula is removed. The interest of this film is: i) the realisation of the venous shunt using a vascular graft and ii) the major hepatic resection, which can be managed safely, taking the time to attentively perform a meticulous haemostasis, thanks to the temporary portacaval shunt.