"Zoom Resection": A Two-Step Wedge Liver Resection Technique to Resect Deep Tumors and Spare Parenchyma

Abstract

In certain cases, huge liver resections are required to deal with deep tumors located near vascular pedicles. However, this implies a higher risk of postoperative liver failure and mortality. Liver parenchyma sparing techniques play an essential role in decreasing these risks. In November 2018, our surgical team reported a new two-step wedge liver resection technique to resect deep tumors in an easy way. Although it was a case report, more patients have already been successfully operated with this approach since then. Regarding the technique itself, intraoperative ultrasound is a very important tool employed to plan and guide both steps of the procedure. Initially, we put stitches and resect a cylindrical piece of normal liver parenchyma above the deep tumor. This way, we can "superficialize" the tumor. After that, we place stitches on the future specimen and resect it in the same way it is done with superficial metastases. The main advantage of this procedure is the clear sight and vascular control that can be achieved in those cases in which the tumor is close to vascular pedicles. As a result, the bigger the chance of preserving vascular pedicles, the bigger the chance of sparing parenchyma as well. We have named this procedure “zoom resection” because its dynamics is similar to that of the photograph camera telescopic system.