General Surgery-HPB Unit, Hospital Universitari de Girona Doctor Josep Trueta, Girona, Spain.
Biomedical Research Institute of Girona (IDIBGI), Girona, Spain.
Ann Surg Oncol. 2021 Jul;28(7):3697. doi: 10.1245/s10434-020-09462-x. Epub 2021 Jan 5.
Anatomical resection of segment 8 (s8) is a challenging procedure. S8 can be subdivided into two areas: ventral (s8v) and dorsal (s8d). In the last years, different approaches for performing laparoscopic resection of s8 or any of its subsegments have been described, i.e. the hilar extrafascial approach, transfissural approach for s8v, transparenchymal approach for s8d, and the intrahepatic Glissonean approach. We recently described the dorsal approach of the right hepatic vein (RHV) for anatomical segment 7 resection. This video report describes the approach to a dorsal s8 pedicle using the RHV dorsal approach.
A 50-year-old woman with a history of morbid obesity and sleep apnea was diagnosed after episodes of hematochezia sigmoid cancer and a 2-cm liver metastases in the s8d, according to vascular reconstruction (Cella Medical Solutions, Murcia, Spain). The surgical technique started with mobilization of the right liver until the root of the RHV was identified and exposed in a craniocaudal fashion and until the s8d Glissonean pedicle was identified and clamped. Indocyanine green counterstaining depicted an intersegmental plane between the s8d and segment 5 and s8v. Transection continued until the anterior fissural vein was exposed at its root, as a landmark of the medial plane.
Operative time lasted 265 min. Transection was carried out using the intermittent Pringle maneuver over a period of 81 min. Estimated blood loss was 252 cc. There were no postoperative complications and the patient was discharged on postoperative day 2.
In some cases, the RHV dorsal approach can be used as the landmark for the s8d Glissonean pedicle, allowing anatomical resection of this particular area.
解剖性切除 8 段（s8）是一项具有挑战性的手术。s8 可进一步分为两个区域：腹侧（s8v）和背侧（s8d）。近年来，已经描述了多种用于进行腹腔镜下 s8 或其任何亚段切除的方法，即肝门筋膜外入路、s8v 的经裂入路、s8d 的经肝实质入路，以及肝内 Glisson 入路。我们最近描述了右肝静脉（RHV）背侧入路用于解剖性 7 段切除。本视频报告描述了使用 RHV 背侧入路处理背侧 s8 蒂的方法。
一名 50 岁女性，有肥胖症和睡眠呼吸暂停病史，因便血被诊断为乙状结肠癌，以及 s8d 处有 2cm 大的肝转移灶，行血管重建（西班牙穆尔西亚的 Cella Medical Solutions）。手术技术始于右肝的游离，直到 RHV 的根部被识别并沿头侧尾侧方向暴露，直到 s8d 的 Glisson 蒂被识别并夹闭。吲哚菁绿对比染色显示了 s8d 和 5 段及 s8v 之间的节段间平面。切断继续进行，直到在其根部暴露前裂隙静脉，作为内侧平面的标志。
手术时间为 265 分钟。间歇性阻断血流 81 分钟进行肝段切除。估计失血量为 252cc。术后无并发症，患者术后第 2 天出院。
在某些情况下，RHV 背侧入路可作为 s8d Glisson 蒂的标志，允许对该特定区域进行解剖性切除。
