Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan.
Surg Oncol. 2021 Dec;39:101630. doi: 10.1016/j.suronc.2021.101630. Epub 2021 Jul 10.
Laparoscopic trisectionectomy is a technically challenging procedure with high rate of postoperative morbidity [1,2]. Arantius' ligament approach is useful to expose the root of middle hepatic vein, which is required in left trisectionectomy [3].
This video illustrates laparoscopic left trisectionectomy using Arantius' ligament approach. A 63-year-old man, with chronic kidney disease, had intrahepatic cholangiocarcinoma with a diameter of 8 cm, located in the segment 4 and anterior section of the liver. The tumor was close to the umbilical portion of the left portal vein and future liver remnant was 770 ml (49.5% of the whole liver) after left trisectionectomy.
After the pneumoperitoneum and the mobilization of the left lateral segment, the root of left and middle hepatic vein was exposed by division of Arantius' ligament and parenchymal transection of dorsal surface around the root of left hepatic vein. Next, the left Glissonian pedicle was controlled and divided. The Glissonean pedicle for the anterior section was then isolated and divided. Demarcation line was then observed using indocyanine green negative counterstaining. Parenchymal transection was completed followed by the division of the common trunk of the left and middle hepatic veins.
The operation time was 294 min, and the blood loss was 400 g. The patient was discharged on postoperative day 16 after conservative treatment for temporary kidney injury. Pathological examination revealed intrahepatic cholangiocarcinoma with negative surgical margin.
The Arantius' ligament approach could be a feasible procedure for left trisectionectomy.
腹腔镜三叶切除术是一种技术上具有挑战性的手术，术后发病率高[1,2]。Arantius 韧带入路有助于显露中叶肝静脉根部，这在左三叶切除术[3]中是必需的。
本视频演示了使用 Arantius 韧带入路的腹腔镜左三叶切除术。一名 63 岁男性，患有慢性肾脏病，肝内胆管癌直径 8cm，位于肝 4 段和前段。肿瘤靠近左门静脉脐部，左三叶切除术后剩余肝体积为 770ml（占全肝的 49.5%）。
在气腹和左外侧段游离后，通过切开 Arantius 韧带和肝左静脉根部背侧实质切开，显露左、中肝静脉根部。然后控制并分离左 Glisson 蒂。然后游离前叶的 Glissonean 蒂并将其切断。然后使用吲哚菁绿负染观察分界线。完成实质切开后，再行左、中肝静脉共干的分离。
手术时间 294 分钟，出血量 400g。患者因暂时性肾损伤行保守治疗后于术后第 16 天出院。病理检查显示肝内胆管癌切缘阴性。
Arantius 韧带入路可作为左三叶切除术的一种可行方法。
