Extended left hepatectomy with caval resection
With in situ cold perfusion and extracellular matrix graft for right hepatic vein reconstruction
00:10 SURGICAL PLANNING
03:18 EXPOSURE & MOBILIZATION
08:48 CAVAL GRAFT PREPARATION
- The patient was a 73 year old female with cholangiocarcinoma - a large mass was found in the caudate lobe.
- A segment 8 portal vein branch arises from the main anterior right portal vein but a posterior segment 8 hepatic artery branch arises from the main posterior right hepatic artery.
- An extended left hepatectomy was planned with resections of segments 1-5 and 8, preserving segments 6 and 7.
- After parenchymal transection, the right hepatic vein and the retrohepatic cava will be divided with in situ cold perfusion running through the right lobe.
- The cava will be reconstructed with a cava graft made from a sheet of extracellular matrix. The right hepatic vein will also be reconstructed with a sheet of extracellular matrix.
- During the operation, the surgical plan was altered because it was possible to preserve more liver volume due to the anatomy.
CT Scans (Arterial phase)
CT Scans (Venous phase)