Conceptual framework of middle hepatic vein anatomy as a roadmap for safe right hepatectomy. Issue 1 (January 2019)

• Record Type: Journal Article
• Authors: Ogiso, Satoshi; Okuno, Masayuki; Shindoh, Junichi; Sakamoto, Yoshihiro; Mizuno, Takashi; Araki, Kenichiro; Goumard, Claire; Nomi, Takeo; Ishii, Takamichi; Uemoto, Shinji; Chun, Yun Shin; Tzeng, Ching-Wei D.; Lee, Jeffrey E.; Vauthey, Jean-Nicolas; Conrad, Claudius
• Is Part Of: HPB. Volume 21:Issue 1(2019)
• Page Start: 43
• Page End: 50
• Publication Date: 2019-01
• Subjects: Liver -- Diseases -- Periodicals; Biliary tract -- Diseases -- Periodicals; Pancreas -- Diseases -- Periodicals; 616.362005
• DOI: 10.1016/j.hpb.2018.01.002
• Languages: English
• ISSNs: 1365-182X

Abstract

Abstract: Background: While the middle hepatic vein (MHV) guides parenchymal transection during right hepatectomy, its most proximal tributaries can be difficult to identify, and injury to its tributaries can be a source of major bleeding. Method: Following simulation modeling of right hepatectomy, reconstructed MHV data was pooled from 40 patients. MHV-tributaries and MHV-relationship to the portal pedicle were mapped out to facilitate their identification from the beginning of parenchymal transection. Results: Hotspots for injury were identified: A median of 1 (1–3) tributaries draining segment 5 (V5) were within 45–90mm from the MHV termination, and 16mm above and 22mm caudal to the portal trunk. Simulation demonstrated a constant anatomic relationship between portal pedicle and the proximal MHV. A median of 2 (0–4) tributaries draining segment 8 (V8) were located 9–35mm from the MHV termination. This information was compiled into an "MHV-road-map" demonstrating 86% of the MHV tributaries at risk for significant bleeding are within 15mm of the MHV, while only thin tributaries are located in the outer area. Conclusions: The MHV-road-map led to a peripheral-to-central parenchymal transection approach to minimize the risk of MHV-injury thereby reducing bleeding during open and minimally invasive right hepatectomy.