The APR triangle: A practical zone in the Glissonean approach to laparoscopic anatomical right hepatectomy

Abstract

An understanding of vascular anatomy is crucial for the safe performance of laparoscopic anatomical liver excision. We discovered a triangular zone during the laparoscopic right liver surgery and termed this zone the APR triangle. The purpose of this study was to determine the probability of the existence of the APR triangle and elucidate its various forms. Analyzed three-dimensional image reconstructions of 66 individuals who underwent liver surgery and calculated the statistics for various types of APR triangles under various grouping settings. The APR triangle was present in the majority of cases, with right hepatic vein trunk type in 68% and right hepatic vein branch type in 21%, respectively. The angle between the right anterior and right posterior hepatic pedicles (AP&PP) was at most between 45 and 90° (74%). There was a 35% chance that at least one of the AP&PP was longer than 2 cm, and a 39% chance that both were. The right posterior pedicle first branch would appear at the bifurcation of AP&PP in 13% only. The APR triangle is objectively present and may represent a practical zone for performing laparoscopic right hepatic anatomical resection more simply and safely.