Zoom Resection

Abstract

“Zoom resection” (ZR) was reported in 2018 by our surgical team. It is a two-step wedge liver resection technique to resect deep tumors near vascular pedicles. Small tumors are sometimes located in places where their resection entails a great sacrifice of normal liver parenchyma. As is known, this situation usually implies the implementation of strategies to increase the future liver remnant, such as “preoperative portal vein embolization”, “Two-staged hepatectomy” or “ALPPS”. Moreover, in multiple and bilateral metastatic disease, where normal parenchyma is scarce, this could be synonymous with irresectability. Consequently, if we are looking to increase the chances of one-staged hepatectomy or turn an irresectable disease into a resectable one, a parenchyma sparing strategy is essential. Regarding the ZR technique itself, it simply consists in resecting a cylindrical piece of normal liver parenchyma above a deep tumor prior to removing it. This way, we can "superficialize" the deep tumor. The main advantages of this procedure are the clear sight and vascular control that can be achieved in cases in which the tumor is lodged 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 employ IOUS to plan and guide both steps of the procedure.