Laparoscopic right hepatectomy
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Case Scenario
- The patient was a 78 year old woman, diagnosed with a colorectal metastasis in segment VII, in close proximity to the right hepatic vein precluding wedge resection due to concerns about achieving a clear margin.
- A cholecystectomy will be performed, but the gall bladder will be left attached to the right lobe after dividing the cystic duct, to serve as a retractor for the laparoscopic exposure.
- Two branches of the right hepatic artery were divided to position the transection plane as far lateral as possible to spare parenchyma.
- The transection plane extends from the groove between the middle and right hepatic veins to the gall bladder fossa.
- The middle hepatic vein will be preserved. Crossing veins from segments V and VIII, draining into the MHV, will therefore be encountered and divided during transection.
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