Department of Hepatobiliary Surgery, The Central Hospital of Wuhan, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
Ann Surg Oncol. 2024 Nov;31(12):7900-7901. doi: 10.1245/s10434-024-16015-z. Epub 2024 Aug 11.
Laparoscopic segment 7 resection has been a technically challenging procedure (Li et al. in J Gastrointest Surg 23:1084-1085, 2019). We introduce a dorsal approach with in situ split for laparoscopic segment 7 resection.
The patient was a 26-year-old male diagnosed with hepatic focal nodular hyperplasia located in segment 7. The lesion, measuring approximately 6.7 cm × 5.7 cm, was close to the right caudate lobe. Firstly, the segment 7 pedicle was exposed through the Rouviere's groove combined with caudate lobe-first approach, followed by clipping to confirm demarcation. Peripheral parenchymal transection at the dorsal side started and the intersegmental vein between segments 6 and 7 was found. Dissection of this vein towards its root proceeded preferentially at the dorsal side. Then the segment 7 pedicle was cut off, followed by parenchymal transection toward the cranial side to find the trunk of the compressed right hepatic vein (RHV). It was further dissociated from the trunk to periphery, exposing and cutting off its branches draining segment 7. The remaining parenchyma at the cranioventral side was subsequently separated along the exposed RHV. Finally, the resection of segment 7 was accomplished by dividing the right perihepatic ligaments.
The operative time was 395 min with the estimated blood loss of 500 ml. The patient did not receive perioperative blood transfusion. The patient was discharged on tenth postoperative day following suture removal without experiencing any postoperative bleeding, hepatic failure, or other complications.
Dorsal approach combined with in situ split for laparoscopic segment 7 resection is feasible and has certain advantages (Cao et al. in Surg Endosc 35:174-181, 2021; Liu et al. in Surg Oncol 38:101575, 2021; Yang et al. in Surg Endosc 37:1334-1341, 2023). Further investigations are required due to some limitations.
腹腔镜下 7 段切除术一直是一项具有挑战性的技术操作（Li 等人，J Gastrointest Surg 23:1084-1085, 2019）。我们介绍了一种采用原位劈裂的背侧入路进行腹腔镜下 7 段切除术。
患者为 26 岁男性，诊断为位于 7 段的局灶性结节性增生。病变大小约为 6.7cm×5.7cm，靠近右尾状叶。首先，通过 Rouviere 沟联合尾状叶优先入路暴露 7 段肝蒂，然后夹闭确认分界。开始在背侧进行 7 段肝外周实质的离断，发现 6 段和 7 段之间的间段静脉。优先在背侧向根部解剖该静脉。然后切断 7 段肝蒂，再向头侧行肝实质离断，找到受压的右肝静脉（RHV）主干。进一步从主干向周边游离，显露并切断汇入 7 段的分支。然后沿着显露的 RHV 分离头侧和尾侧剩余的肝实质。最后，通过分离右肝周韧带完成 7 段切除术。
手术时间 395 分钟，估计出血量 500ml。患者未接受围手术期输血。患者术后第 10 天拆线出院，无术后出血、肝功能衰竭等并发症。
腹腔镜下 7 段切除术的背侧入路联合原位劈裂是可行的，具有一定的优势（Cao 等人，Surg Endosc 35:174-181, 2021；Liu 等人，Surg Oncol 38:101575, 2021；Yang 等人，Surg Endosc 37:1334-1341, 2023）。由于存在一些局限性，需要进一步研究。
