Extended right hepatectomy
With in situ cold perfusion and reconstruction of the left hepatic vein
Case Description
- Patient was a 46 year old man, diagnosed with a large hepatocellular carcinoma predominantly in the right lobe.
- It enroached upon the right portal vein, right hepatic artery and the left and right hepatic ducts. In addition, it also enveloped the middle and right hepatic veins, and was involved the left hepatic vein.
Surgical Plan
- The liver would be transected with a plane that divides the intrahepatic left hepatic vein.
- Parenchymal transection would be performed until the intrahepatic left hepatic vein is reached.
- A standard IV tubing would be inserted into the main portal vein, and the hepatic artery and portal vein would be clamped.
- The vena cava would then be cross-clamped above and below the liver.
- While the left hepatic vein is divided, ice cold HTK solution would be perfused through the IV tubing. Sterile ice would also be placed around the liver remnant.
- The confluence of the middle/left hepatic vein would be divided at the cava, and then anastomosed to the divided left hepatic vein.
- A Roux-en-Y hepatico-jejunostomy will be performed to reconstruct the biliary circulation.
CT scans (arterial phase)
- Click and drag the slider on the left to transverse through the CT arterial series. Clicking on the grey button on the bottom will reveal clinical findings by the surgical team; click on the descriptions to bring the image up to the main window. Best viewed in Mozilla Firefox, Google Chrome or Safari.
①
Tumor shown here.
②
The tumor abuts the bifurcation of the hepatic arteries.
Click to turn annotations on/off
- Click and drag the slider on the left to transverse through the CT arterial series. Clicking on the grey button on the bottom will reveal clinical findings by the surgical team; click on the descriptions to bring the image up to the main window. Best viewed in Mozilla Firefox, Google Chrome or Safari.
CT scans (venous phase)
- Click and drag the slider on the left to transverse through the CT venous series. Clicking on the grey button on the bottom will reveal clinical findings by the surgical team; click on the descriptions to bring the image up to the main window. Best viewed in Mozilla Firefox, Google Chrome or Safari.
①
The tumor envelopes both the right and middle hepatic veins, and involves the left hepatic vein.
②
The tumor abuts the bifurcation of the portal veins.
Click to turn annotations on/off
- Click and drag the slider on the left to transverse through the CT venous series. Clicking on the grey button on the bottom will reveal clinical findings by the surgical team; click on the descriptions to bring the image up to the main window. Best viewed in Mozilla Firefox, Google Chrome or Safari.
