Segment II/IVa Resection
with 4B wedge, in situ cold perfusion of the liver and reconstruction of MHV
00:16 SURGICAL PLANNING
08:54 RESECTION OF SEGMENT 4A
- 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.