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Published in: Journal of Gastrointestinal Surgery 1/2022

01-01-2022 | Liver Resection | Original Article

Anatomy of the Middle Hepatic Vein Tributaries to Promote Safer Hepatic Vein-Guided Liver Resection

Authors: Satoshi Ogiso, Satoru Seo, Takamichi Ishii, Shinya Okumura, Tomoaki Yoh, Takahiro Nishio, Yukinori Koyama, Ken Fukumitsu, Kojiro Taura, Etsuro Hatano

Published in: Journal of Gastrointestinal Surgery | Issue 1/2022

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Abstract

Background

In laparoscopic anatomic liver resection, an increasingly common procedure, the hepatic vein-guided approach is widely used although the hepatic vein tributaries can be a major source of bleeding in the event of inadvertent injury. This report describes the anatomy of the middle hepatic vein (MHV) including its tributaries based on reconstructed three-dimensional computed tomography images and provides anatomic data to enable safe middle hepatic vein-guided liver resection.

Methods

Following simulation modeling of the hepatic vasculatures, reconstructed MHV data was pooled from 35 healthy liver donors. Yields of the MHV tributaries were analyzed to enable MHV-guided liver resection.

Results

A total of 252 tributaries were identified in the 35 donors. The MHV yielded fewer tributaries from its anterior and posterior aspects than from its right-side and left-side aspects (40 [15.9%], 13 [5.2%], 93 [36.9%], and 106 [42.1%], respectively). The MHV tributaries from the anterior and posterior aspects were smaller in diameter than those from the right-side and left-side aspects (median, 3.0, 2.0, 4.8, and 4.0 mm, respectively).

Discussion

Our simulation revealed that MHV dissection from the anterior or posterior aspect poses a lower risk of injury to the MHV tributaries compared to dissection from either lateral aspect. In addition, MHV dissection from the anterior or posterior aspect allows for safer identification and isolation of the thick MHV tributaries originating from the lateral aspects. Ideally, the anterior or posterior aspect of the MHV should be accessed and exposed before the lateral aspects are dissected to minimize the risk of MHV tributary injury.
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Literature
1.
go back to reference Monden K, Alconchel F, Berardi G, et al. Landmarks and techniques to perform minimally invasive liver surgery: A systematic review with a focus on hepatic outflow. J Hepatobiliary Pancreat Sci 2021. Monden K, Alconchel F, Berardi G, et al. Landmarks and techniques to perform minimally invasive liver surgery: A systematic review with a focus on hepatic outflow. J Hepatobiliary Pancreat Sci 2021.
2.
go back to reference Okuda Y, Honda G, Kurata M, et al. Dorsal approach to the middle hepatic vein in laparoscopic left hemihepatectomy. J Am Coll Surg 2014; 219(2):e1-4.CrossRef Okuda Y, Honda G, Kurata M, et al. Dorsal approach to the middle hepatic vein in laparoscopic left hemihepatectomy. J Am Coll Surg 2014; 219(2):e1-4.CrossRef
3.
go back to reference Rotellar F, Martí-Cruchaga P, Zozaya G, et al. Caudal approach to the middle hepatic vein as a resection pathway in difficult major hepatectomies under laparoscopic approach. J Surg Oncol 2020; 122(7):1426-1427.CrossRef Rotellar F, Martí-Cruchaga P, Zozaya G, et al. Caudal approach to the middle hepatic vein as a resection pathway in difficult major hepatectomies under laparoscopic approach. J Surg Oncol 2020; 122(7):1426-1427.CrossRef
4.
go back to reference Ogiso S, Okuno M, Shindoh J, et al. Conceptual framework of middle hepatic vein anatomy as a roadmap for safe right hepatectomy. HPB (Oxford) 2019; 21(1):43-50.CrossRef Ogiso S, Okuno M, Shindoh J, et al. Conceptual framework of middle hepatic vein anatomy as a roadmap for safe right hepatectomy. HPB (Oxford) 2019; 21(1):43-50.CrossRef
5.
go back to reference Kiguchi G, Sugioka A, Kato Y, et al. Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position. Surg Oncol 2019; 29:140-141.CrossRef Kiguchi G, Sugioka A, Kato Y, et al. Use of the inter-Laennec approach for laparoscopic anatomical right posterior sectionectomy in semi-prone position. Surg Oncol 2019; 29:140-141.CrossRef
6.
go back to reference Ogiso S, Seo S, Ishii T, et al. Middle hepatic vein branch-guided approach for laparoscopic resection of liver segment 8 is simple, reliable, and reproducible. Ann Surg Oncol 2020; 27(13):5195.CrossRef Ogiso S, Seo S, Ishii T, et al. Middle hepatic vein branch-guided approach for laparoscopic resection of liver segment 8 is simple, reliable, and reproducible. Ann Surg Oncol 2020; 27(13):5195.CrossRef
7.
go back to reference Ogiso S, Seo S, Ishii T, et al. Transfissural approach for laparoscopic resection of a deep segment 8 lesion in contact with the hepatocaval confluence. Ann Surg Oncol 2020; 15(1):229. Ogiso S, Seo S, Ishii T, et al. Transfissural approach for laparoscopic resection of a deep segment 8 lesion in contact with the hepatocaval confluence. Ann Surg Oncol 2020; 15(1):229.
8.
go back to reference Monden K, Sadamori H, Hioki M, et al. Consideration of cranial approach to major hepatic veins in laparoscopic anatomic liver resection of segment 8. J Am Coll Surg 2020; 231(4):498-499.CrossRef Monden K, Sadamori H, Hioki M, et al. Consideration of cranial approach to major hepatic veins in laparoscopic anatomic liver resection of segment 8. J Am Coll Surg 2020; 231(4):498-499.CrossRef
9.
go back to reference Mise Y, Hasegawa K, Satou S, et al. How has virtual hepatectomy changed the practice of liver surgery?: Experience of 1194 virtual hepatectomy before liver resection and living donor liver transplantation. Ann Surg 2018; 268(1):127-133.CrossRef Mise Y, Hasegawa K, Satou S, et al. How has virtual hepatectomy changed the practice of liver surgery?: Experience of 1194 virtual hepatectomy before liver resection and living donor liver transplantation. Ann Surg 2018; 268(1):127-133.CrossRef
10.
go back to reference Araki K, Conrad C, Ogiso S, et al. Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 2014; 218(2):e37-41.CrossRef Araki K, Conrad C, Ogiso S, et al. Intraoperative ultrasonography of laparoscopic hepatectomy: key technique for safe liver transection. J Am Coll Surg 2014; 218(2):e37-41.CrossRef
11.
go back to reference Monden K, Sadamori H, Hioki M, et al. Cranial approach to the left hepatic vein in laparoscopic anatomic liver resections of segment 2 and segment 3. Surg Oncol 2020; 35:298.CrossRef Monden K, Sadamori H, Hioki M, et al. Cranial approach to the left hepatic vein in laparoscopic anatomic liver resections of segment 2 and segment 3. Surg Oncol 2020; 35:298.CrossRef
12.
go back to reference Ohshima S. Volume analyzer SYNAPSE VINCENT for liver analysis. J Hepatobiliary Pancreat Sci 2014; 21(4):235-8.CrossRef Ohshima S. Volume analyzer SYNAPSE VINCENT for liver analysis. J Hepatobiliary Pancreat Sci 2014; 21(4):235-8.CrossRef
13.
go back to reference IHPBA TCot. Terminology of liver anatomy and resections. Vol. 2. HPB, 2000. pp. 333–339. IHPBA TCot. Terminology of liver anatomy and resections. Vol. 2. HPB, 2000. pp. 333–339.
14.
go back to reference Aoki T, Koizumi T, Mansour DA, et al. Ultrasound-guided preoperative positive percutaneous indocyanine green fluorescence staining for laparoscopic anatomical liver resection. J Am Coll Surg 2020; 230(3):e7-e12.CrossRef Aoki T, Koizumi T, Mansour DA, et al. Ultrasound-guided preoperative positive percutaneous indocyanine green fluorescence staining for laparoscopic anatomical liver resection. J Am Coll Surg 2020; 230(3):e7-e12.CrossRef
15.
go back to reference Miyata A, Ishizawa T, Tani K, et al. Reappraisal of a dye-staining technique for anatomic hepatectomy by the concomitant use of indocyanine green fluorescence imaging. J Am Coll Surg 2015; 221(2):e27-36.CrossRef Miyata A, Ishizawa T, Tani K, et al. Reappraisal of a dye-staining technique for anatomic hepatectomy by the concomitant use of indocyanine green fluorescence imaging. J Am Coll Surg 2015; 221(2):e27-36.CrossRef
16.
go back to reference Nishino H, Hatano E, Seo S, et al. Real-time navigation for liver surgery using projection mapping with indocyanine green fluorescence: Development of the novel medical imaging projection system. Ann Surg 2018; 267(6):1134-1140.CrossRef Nishino H, Hatano E, Seo S, et al. Real-time navigation for liver surgery using projection mapping with indocyanine green fluorescence: Development of the novel medical imaging projection system. Ann Surg 2018; 267(6):1134-1140.CrossRef
17.
go back to reference Ogiso S, Seo S, Okumura S, et al. Laparoscopic left lateral sectionectomy using the extrahepatic Glissonean approach: A secure option for achieving a negative margin for lesions with ductal extension. Ann Surg Oncol 2019; 26(6):1858.CrossRef Ogiso S, Seo S, Okumura S, et al. Laparoscopic left lateral sectionectomy using the extrahepatic Glissonean approach: A secure option for achieving a negative margin for lesions with ductal extension. Ann Surg Oncol 2019; 26(6):1858.CrossRef
18.
go back to reference Berardi G, Igarashi K, Li CJ, et al. Parenchymal sparing anatomical liver resections with full laparoscopic approach: Description of technique and short-term results. Ann Surg 2019; 273(4):785-791.CrossRef Berardi G, Igarashi K, Li CJ, et al. Parenchymal sparing anatomical liver resections with full laparoscopic approach: Description of technique and short-term results. Ann Surg 2019; 273(4):785-791.CrossRef
19.
go back to reference Okuda Y, Honda G, Kobayashi S, et al. Intrahepatic Glissonean pedicle approach to segment 7 from the dorsal side during laparoscopic anatomic hepatectomy of the cranial part of the right liver. J Am Coll Surg 2018; 226(2):e1-e6.CrossRef Okuda Y, Honda G, Kobayashi S, et al. Intrahepatic Glissonean pedicle approach to segment 7 from the dorsal side during laparoscopic anatomic hepatectomy of the cranial part of the right liver. J Am Coll Surg 2018; 226(2):e1-e6.CrossRef
20.
go back to reference Egger ME, Gottumukkala V, Wilks JA, et al. Anesthetic and operative considerations for laparoscopic liver resection. Surgery 2016; 161(5):1191-1202.CrossRef Egger ME, Gottumukkala V, Wilks JA, et al. Anesthetic and operative considerations for laparoscopic liver resection. Surgery 2016; 161(5):1191-1202.CrossRef
21.
go back to reference Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg 2016; 263(6):1159-63.CrossRef Kobayashi S, Honda G, Kurata M, et al. An experimental study on the relationship among airway pressure, pneumoperitoneum pressure, and central venous pressure in pure laparoscopic hepatectomy. Ann Surg 2016; 263(6):1159-63.CrossRef
22.
go back to reference Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 1997; 226(6):704-11; discussion 711-3.CrossRef Man K, Fan ST, Ng IO, et al. Prospective evaluation of Pringle maneuver in hepatectomy for liver tumors by a randomized study. Ann Surg 1997; 226(6):704-11; discussion 711-3.CrossRef
Metadata
Title
Anatomy of the Middle Hepatic Vein Tributaries to Promote Safer Hepatic Vein-Guided Liver Resection
Authors
Satoshi Ogiso
Satoru Seo
Takamichi Ishii
Shinya Okumura
Tomoaki Yoh
Takahiro Nishio
Yukinori Koyama
Ken Fukumitsu
Kojiro Taura
Etsuro Hatano
Publication date
01-01-2022
Publisher
Springer US
Published in
Journal of Gastrointestinal Surgery / Issue 1/2022
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI
https://doi.org/10.1007/s11605-021-05074-2

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