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Download File: https://pie.med.utoronto.ca/tvasurg/TVASurg_content/assets/masterFolders/PL_segment14Resect/video/SD/video.mp4?_=1Segment I/IV mesoheptectomy
Liver resection of segments I, IVa & IVb, with wedge resections of segments III, V & VI
00:07 Surgical Planning
02:49 Exposure & mobilization
04:16 Portal dissection
05:51 Hepatic vein dissection
06:35 First liver transection
08:26 Second liver transection
10:02 Wedge resection
10:38 Inspection and closure
Case description
- A 57 year old woman was diagnosed with lesions in segments I & IV. In addition, there were small lesions in segments III, V, and VI.
- Due to fatty liver, and a patient who has been subject to a large amount of chemotherapy, a segment I/IV resection was considered the best option.
- While a left hepatectomy with caudate resection could be considered, a mesohepatectomy with multiple wedge resections is more parenchymal preserving.
Surgical plan
- The relationship of the segment IV lesion will require resection of the MHV.
- Options for mobilizing caudate are exclusively from left, exclusively from right, or a combination of both. The best option is one which yields as much control as possible.
- The replaced left hepatic artery, and right hepatic artery will remain intact.
- All inflow to the caudate, a segment I artery and segment I portal vein branches, will be divided.
- Following dissection of the porto-umbilical fissure, segment IV arteries and portal vein branches will be divided.
- The segment IV pedicle will be divided at the end of transecting the porto-umbilical fissure plane.
- The segment I pedicle will be divided at the end of transecting the right hepatectomy plane.
- The MHV will be divided at the end of transection.
- A bridge of parenchyma will remain to protect the LPV and contents of the segment II/III pedicle.
CT scans
①
Segment IV lesion
②
Hepatic vein branches
③
LPV branches
④
RPV branches
⑤
Segment V & VI lesions
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MRI scans
①
Segment IV lesion
②
Caudate lesion
③
Bile ducts
④
Segment III lesion
⑤
Segment V & VI lesions
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