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

04:33  PORTAL DISSECTION & RE-EVALUATION OF SURGICAL PLAN

08:48  CAVAL GRAFT PREPARATION

09:10  TRANSECTION

13:11  RECONSTRUCTION

Case description
  • 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)

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CT Scans (Venous phase)

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RELATED CATEGORIES: HEPATO-PANCREATO-BILIARY | LIVER

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