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Download File: https://pie.med.utoronto.ca/tvasurg/TVASurg_content/assets/masterFolders/PL_segment24aResect/video/HD/video.mp4?_=1Segment II/IVa Resection
with 4B wedge, in situ cold perfusion of the liver and reconstruction of MHV
00:16 SURGICAL PLANNING
01:57 MOBILIZATION OF THE LIVER & IVC
04:29 RESECTION OF SEGMENT 2 & 4B wedge
07:18 IN SITU COLD PERFUSION SET UP & GRAFT CONSTRUCTION
08:54 RESECTION OF SEGMENT 4A
10:04 IN SITU COLD PERFUSION & RECONSTRUCTION OF MHV
CASE DESCRIPTION
- The patient is a 49-year-old male with colon cancer with metastases to the liver.
- He has undergone prior right hepatectomy with caudate, prior anterior resection of the colon, and ileostomy reversal
- MR scans revealed a tumour located in segment 2, which invaded segment 2 portal vein and close to the left hepatic vein. Scans also shows a lesion in the periphery of segment 4b. Another lesion is also visible in segment 4a, very close to the root of the middle hepatic vein.
- The surgical plan is to resect segment 2 with the Pringle maneuver. Intraoperative ultrasound will be used to confirm transection border.
- A wedge resection will be performed to remove the lesion in segment 4b.
- In situ cold perfusion will be set up and segment 4a will be removed along with a portion of the middle hepatic vein.
- A bovine pericardial patch will be use to construct the middle hepatic vein. It will then be used to reconnect the distal middle hepatic vein to the cava.
MRI SCANS
①
Lesion in segment 4A is in contact with the middle hepatic vein.
②
One of the lesions in segment 2 is close to the left hepatic vein.
③
Minor lesion found in the periphery of segment 4B.
④
One of the lesions in segment 2 is in contact with the segment 2 portal vein.
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