|
1
|
Cawich SO, Naraynsingh V, Pearce NW, Deshpande RR, Rampersad R, Gardner MT, Mohammed F, Dindial R, Barrow TA. Surgical relevance of anatomic variations of the right hepatic vein. World J Transplant 2021; 11:231-243. [PMID: 34164298 PMCID: PMC8218342 DOI: 10.5500/wjt.v11.i6.231] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/18/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Variations in the anatomy of hepatic veins are of interest to transplant surgeons, interventional radiologists, and other medical practitioners who treat liver diseases. The drainage patterns of the right hepatic veins (RHVs) are particularly relevant to transplantation services.
AIM The aim was to identify variations of the patterns of venous drainage from the right side of the liver. To the best of our knowledge, there have been no reports on RHV variations in in a Caribbean population.
METHODS Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral center. Venous outflow patterns were observed and RHV variants were described as: (1) Tributaries of the RHV; (2) Variations at the hepatocaval junction (HCJ); and (3) Accessory RHVs.
RESULTS A total of 118 scans met the inclusion criteria. Only 39% of the scans found conventional anatomy of the main hepatic veins. Accessory RHVs were present 49.2% and included a well-defined inferior RHV draining segment VI (45%) and a middle RHV (4%). At the HCJ, 83 of the 118 (70.3%) had a superior RHV that received no tributaries within 1 cm of the junction (Nakamura and Tsuzuki type I). In 35 individuals (29.7%) there was a short superior RHV with at least one variant tributary. According to the Nakamura and Tsuzuki classification, there were 24 type II variants (20.3%), six type III variants (5.1%) and, five type IV variants (4.2%).
CONCLUSION There was significant variation in RHV patterns in this population, each with important relevance to liver surgery. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.
Collapse
Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Neil W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Robbie Rampersad
- Department of Radiology, University of the West Indies, St. Augustine 000000, Trinidad and Tobago
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Michael T Gardner
- Section of Anatomy, Basic Medical Sciences, University of the West Indies, Kingston 000000, Jamaica
| | - Fawwaz Mohammed
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Roma Dindial
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Tanzilah Afzal Barrow
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
- Department of Radiology, University of the West Indies, St Augustine 000000, Trinidad and Tobago
| |
Collapse
|
|
2
|
Tranchart H, Gaillard M, Lainas P, Dagher I. Selective Control of the Left Hepatic Vein During Laparoscopic Liver Resection: Arentius' Ligament Approach. J Am Coll Surg 2015; 221:e75-9. [DOI: 10.1016/j.jamcollsurg.2015.07.009] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2015] [Revised: 07/03/2015] [Accepted: 07/13/2015] [Indexed: 01/28/2023]
|
|
3
|
Shilal P, Tuli A. Anatomical variations in the pattern of the right hepatic veins draining the posterior segment of the right lobe of the liver. J Clin Diagn Res 2015; 9:AC08-12. [PMID: 25954610 DOI: 10.7860/jcdr/2015/8736.5671] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2014] [Accepted: 05/06/2014] [Indexed: 01/03/2023]
Abstract
BACKGROUND The pattern of drainage in the right posterior lobe of liver varies considerably. The knowledge of this variation is very important while performing various surgeries on the right posterior lobe. AIM A study was conducted to see the variations in the pattern of drainage of posterior segment of the right lobe of liver. The aim was to see the variations of right hepatic vein and small accessory hepatic veins draining the posterior segment, the presence of which led to modifications in drainage of posterior segment. MATERIAL AND METHODS Sixty formalin fixed adult human liver specimens were dissected manually. RESULTS According to the pattern of drainage of tributaries of right hepatic vein, the right hepatic vein was classified into type I, type II, type III and type IV. According to presence of inferior right hepatic vein, three types of drainage of posterior lobe were seen: Type I, (76.36%) right hepatic vein was large, draining wide area of posterior segment. A small inferior right hepatic vein drained the small area of posterior segment. In Type II, (19.92%) both right hepatic and inferior right hepatic veins were medium sized draining the posteroinferior segment of the right lobe concomitantly. In Type III, (32%) accessory veins, the middle right hepatic vein drained the posterosuperior (VII) as well as the posteroinferior (VI) segment. In one specimen, there were numerous middle right hepatic veins draining the right posterior segment. The knowledge of anatomic relationship of veins draining right lobe, is important in performing right posterior segmentectomy. CONCLUSION For safe resection of the liver, the complex anatomy of the distribution of the tributaries of the right hepatic vein and the accessory veins have to be studied prior to any surgery done on liver.
Collapse
Affiliation(s)
- Poonam Shilal
- Assistant Professor, Department of Anatomy, Sikkim Manipal Institute of Medical Sciences , Shilal Building, Forest Colony Road, Gangtok, Sikkim, India
| | - Anita Tuli
- Professor and Head, Department of Anatomy, Lady Hardinge Medical College , Connaught Place, Delhi, India
| |
Collapse
|
|
4
|
Le Treut YP, Fara R, Barbier L, Delpero JR, Arellano N, Hardwigsen J. Transdiaphragmatic Extrapericardial Approach of the Inferior Vena Cava. J Am Coll Surg 2013; 217:e41-3. [DOI: 10.1016/j.jamcollsurg.2013.07.399] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2013] [Revised: 07/19/2013] [Accepted: 07/24/2013] [Indexed: 10/26/2022]
|
|
5
|
Ghosh SK, Paul S. Anatomy of the retrohepatic segment of the inferior vena cava and the ostia venae hepaticae with its clinical significance. Surg Radiol Anat 2011; 34:347-55. [PMID: 22146982 DOI: 10.1007/s00276-011-0915-6] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2011] [Accepted: 11/24/2011] [Indexed: 12/13/2022]
Abstract
PURPOSE The present study was undertaken to provide morphological data regarding the retrohepatic segment of the inferior vena cava (RHIVC) and ostia venae hepaticae with an emphasis on the clinical significance of the observations made. METHODS This was an observational study conducted on 160 apparently healthy, randomly selected, cadaveric adult human livers fixed in 10% formalin. The distribution of the hepatic venous openings was studied by dividing the interior of the RHIVC into 16 quadrants. These openings were classified as large, medium, small and very small openings based on their diameter and were also classified as single/double/triple/quadruple according to the number of veins opening into them. RESULTS The median length of RHIVC was 7.3 cm (6.2-8.4) and was directed obliquely with respect to the vertical axis of the liver in 92.5% of cases. A total of 1,376 ostia venae hepaticae were observed, and the median number of openings per liver was 7 (5-9). The right hepatic vein had a single opening in 156 (97.5%) and the left and middle hepatic veins had a common opening in 144 (90%) cases. A longitudinal area on the anterior wall of the RHIVC, to the right side of the midline, was relatively avascular with 10.1% of the venous openings, of which 70% were single openings of the right dorsal vein having a small diameter (0.1-0.5 cm). CONCLUSION During liver hanging maneuver, rightward direction of the dissecting forceps would avoid injury to the caudate vein and allow access to the safe avascular space in the RHIVC.
Collapse
Affiliation(s)
- Sanjib Kumar Ghosh
- Department of Anatomy, Lady Hardinge Medical College and Smt. Sucheta Kriplani Hospital, Shaheed Bhagat Singh Marg, New Delhi 110001, India.
| | | |
Collapse
|
|
6
|
Ozaki K, Matsui O, Kobayashi S, Sanada J, Koda W, Minami T, Kawai K, Gabata T. Selective Atrophy of the Middle Hepatic Venous Drainage Area in Hepatitis C–related Cirrhotic Liver: Morphometric Study by Using Multidetector CT. Radiology 2010; 257:705-14. [DOI: 10.1148/radiol.10100468] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
|
|
7
|
Can the left hepatic vein always be safely selectively clamped during hepatectomy? The contribution of anatomy. Surg Radiol Anat 2009; 31:657-63. [DOI: 10.1007/s00276-009-0495-x] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/13/2008] [Accepted: 03/11/2009] [Indexed: 12/21/2022]
|
|
8
|
|
|
9
|
Peschaud F, Benoist S, Penna C, Nordlinger B. Anatomical basis for clamping of the right hepatic vein outside the liver during right hepatectomy. Surg Radiol Anat 2006; 28:625-30. [PMID: 17061030 DOI: 10.1007/s00276-006-0152-6] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2005] [Accepted: 08/11/2006] [Indexed: 10/24/2022]
Abstract
The possibility and value of clamping the right hepatic vein (HV) outside the liver during right hepatectomy remain a matter of debate. We carried out an anatomical study on ten fresh cadaveric subjects with no abdominal scarring or hepatic lesions, to determine the biometry of the extraparenchymatous segment of the right HV. One or several accessory right HVs were found in 90% of cases on release of the right edge of the inferior vena cava (IVC). These accessory right HVs had a diameter greater than that of the superior right HV in 10% of cases. In 70% of cases, the extraparenchymatous segment of the vein was free of collateral branches, and in 30% of cases, it was joined by a branch close to its point of exit from the hepatic parenchyma. The length of the vein that can be clamped (length between the point of exit from the hepatic parenchyma and the point of entry of the right HV into the IVC) was 8.6 +/- 1.8 mm (6-12). The right HV entered the vena cava, at an acute angle, in 100% of cases. Clamping of the right HV was possible in all cases. Knowledge of these anatomical points makes it possible to isolate an extraparenchymatous segment of the right HV more safely. The right HV can be isolated and clamped outside the liver in more than 80% of cases, making it possible to carry out right hepatectomy on an exsanguinous liver.
Collapse
|
|
10
|
Rudloff U, Gonzalez V, Fernandez E, Holguin E, Rubio G, Lomelin J, Dittmar M, Barrera R. Biomechanic Study of the Human Liver During a Frontal Deceleration. ACTA ACUST UNITED AC 2006; 61:970-4. [PMID: 17033570 DOI: 10.1097/01.ta.0000196871.19566.92] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
Abstract
BACKGROUND Mechanisms of hepatic injury remain poorly understood. Surgical literature reports some speculative theories that have never been proved. The aim of this study was to examine the behavior of the liver during brutal frontal deceleration. METHODS Six trunks, removed from human cadavers, underwent free falls at 4, 6, and 8 meters per second (mps). Accelerometers were positioned in the two lobes of the liver, in front of the vertebra L2, and in the retro hepatic inferior vena cava. Relative motions of the lobes of the liver and of the two other anatomic marks were observed. In parallel, numerical simulations of this experiment have been performed using a finite element model. RESULTS In the direction of impact, the vertebra L2 had no considerable displacement with the inferior vena cava. There was a noteworthy displacement between the two hepatic lobes. The left hepatic lobe had a large relative displacement with the vertebra L2 and the inferior vena cava. The right hepatic lobe was more stable with the vertebra L2 and the inferior vena cava. Numerical simulation of the same protocol underlined a rotation effect of the liver to the left around the axis of the inferior vena cava. CONCLUSIONS These results support the surgical data. They highlight a crucial zone and explain how dramatic lacerations between the two lobes of the liver can occur.
Collapse
Affiliation(s)
- Udo Rudloff
- Department of Surgery, Hospital Angeles del Carmen, Guadalajara, Mexico.
| | | | | | | | | | | | | | | |
Collapse
|
|
11
|
Capussotti L, Ferrero A, Viganò L, Polastri R, Ribero D, Berrino E. Hepatic bisegmentectomy 7-8 for a colorectal metastasis. Eur J Surg Oncol 2006; 32:469-71. [PMID: 16522363 DOI: 10.1016/j.ejso.2006.01.004] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/06/2005] [Accepted: 01/13/2006] [Indexed: 12/13/2022] Open
Affiliation(s)
- L Capussotti
- Unit of Surgical Oncology, Institute for Cancer Research and Treatment, Strada Provinciale 142, km 3,95, 10060 Candiolo, Italy.
| | | | | | | | | | | |
Collapse
|
|
12
|
Dixon E, Vollmer CM, Bathe OF, Sutherland F. Vascular occlusion to decrease blood loss during hepatic resection. Am J Surg 2005; 190:75-86. [PMID: 15972177 DOI: 10.1016/j.amjsurg.2004.10.007] [Citation(s) in RCA: 71] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/11/2004] [Revised: 10/05/2004] [Accepted: 10/05/2004] [Indexed: 02/06/2023]
Abstract
BACKGROUND Historically, the primary hazard with liver surgery has been intraoperative blood loss. This led to the refinement of inflow and outflow occlusive techniques. The utility of the different methods of inflow and outflow techniques for hepatic surgery were reviewed. METHODS A search of the English literature (Medline, Embase, Cochrane library, Cochrane clinical trials registry, hand searches, and bibliographic reviews) using the terms "liver," "hepatic," "Pringle," "total vascular exclusion," "ischemia," "reperfusion," "inflow," and "outflow occlusion" was performed. RESULTS A multitude of techniques to minimize blood loss during hepatic resection have been studied. The evidence suggests that inflow occlusion techniques are generally well tolerated. These should be used with caution in patients with cirrhosis, fibrosis, steatosis, cholestasis, and recent chemotherapy, and for prolonged time intervals. CONCLUSIONS Harmful effects of intraoperative blood loss and transfusion occur during hepatic resection. Portal triad clamping (PTC) is associated with less blood loss compared with no clamping. In procedures with ischemic times <1 hour in length, PTC-C (continuous) is likely equal to PTC-I (intermittent). In patients with chronic liver disease or undergoing lengthy operations, PTC-I is likely superior to PTC-C. PTC is superior to total vascular exclusion except in patients with tumors that are large and deep seated, hypervascular, and/or abutting the hepatic veins or vena cava and in patients with increased right-sided heart pressures.
Collapse
Affiliation(s)
- Elijah Dixon
- Department of Surgery, Faculty of Medicine, University of Calgary, Calgary, Alberta, Canada.
| | | | | | | |
Collapse
|
|
13
|
Gallucci M, Borzomati D, Flammia G, Alcini A, Albino G, Caricato M, Esposito A, Vincenzi B, Rossi M, Coppola R, Berloco P. Liver Harvesting Surgical Technique for the Treatment of Retro-Hepatic Caval Thrombosis Concomitant to Renal Cell Carcinoma: Perioperative and Long-Term Results in 15 Patients without Mortality. Eur Urol 2004; 45:194-202. [PMID: 14734006 DOI: 10.1016/j.eururo.2003.09.004] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
Abstract
OBJECTIVE Radical surgical treatment improves the prognosis of patients affected by Inferior Vena Cava (IVC) thrombosis concomitant to renal carcinoma. However, thrombus extension above the infrahepatic IVC represents a major technical topic for surgeons because of the possible occurrence of uncontrollable haemorrhages and tumor fragmentation. We report the results of an innovative surgical approach to caval thrombosis including the isolation of the IVC from the liver as routinely performed during liver harvesting. In the presence of retro-hepatic IVC thrombosis, this technique improves vascular control and allows to perform a large cavotomy with an en-bloc removal of the thrombus and the tumor. METHODS From January 1995 through June 2003, 15 patients with renal cancer and caval thrombosis were treated at our Institution. Four, ten and one patients were respectively affected by an infrahepatic (Level I), retro-hepatic (Level II) and atrial (Level III) IVC thrombosis. RESULTS All patients underwent radical surgical treatment. In presence of Level II caval thrombosis, the patients underwent the above reported surgical technique. Perioperative mortality was absent; major morbidity occurred in one patient (6.7%). The thrombus was radically removed in all cases. After a mean follow-up of 53.9 months (5-100 months) all patients but one are still alive. One patient died 9 months after surgery with multiple bilateral pulmonary metastases. CONCLUSIONS Isolation of the retro-hepatic IVC is a safe and effective manoeuvre to significantly reduce perioperative mortality and morbidity in patients affected by Level II caval thrombosis concomitant to renal carcinoma.
Collapse
|
|
14
|
De Cecchis L, Hribernik M, Ravnik D, Gadzijev EM. Anatomical variations in the pattern of the right hepatic veins: possibilities for type classification. J Anat 2000; 197 Pt 3:487-93. [PMID: 11117632 PMCID: PMC1468147 DOI: 10.1046/j.1469-7580.2000.19730487.x] [Citation(s) in RCA: 40] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/22/2022] Open
Abstract
A morphological study of the right hepatic veins (RHVv) was conducted based on the shape and the confluence pattern of the superior right hepatic vein (SRHV) and the presence of accessory right hepatic veins. The study was performed in 110 undamaged, randomly selected, cadaveric human livers prepared using the corrosion cast methodology. The principles for classifying the RHVv into types were as follows: the length of the vein trunk, the confluence of 2 or 3 main tributaries that form a trunk, and the accessory right hepatic veins that modify the venous drainage of the right side of the liver. Four types of SRHV were identified. Type 1 (20 %), type 2 (40 %) and type 3 (25 %) were the most common, while type 4 (15 %) was linked to the accessory right hepatic veins in cases where they drain a surgically important part of the liver. Accessory right hepatic veins were found in a total of 31 casts (28 %). The hepatocaval confluence was studied and the tributary-free part of the SRHV trunk before it entered the inferior vena cava was measured. The tributary-free part of the SRHV was longer than 1 cm in 77 % of the casts. Anastomoses between the terminal tributaries of the veins involved in the drainage of the right side of the liver were also investigated.
Collapse
Affiliation(s)
- L De Cecchis
- Department of Surgery, University of Udine, Italy
| | | | | | | |
Collapse
|
|
15
|
Abstract
Modern hepatic surgery is based on precise anatomic foundations. The importance of this information applies to all levels of the diagnostic and therapeutic chain. Modern methods of imaging--CT scanning, MR imaging, and preoperative sonography--help physicians to detect variations and plan surgical excision.
Collapse
Affiliation(s)
- J F Delattre
- Department of Anatomy, University of Reims, France
| | | | | |
Collapse
|
|
16
|
Wind P, Douard R, Cugnenc PH, Chevallier JM. Anatomy of the common trunk of the middle and left hepatic veins: application to liver transplantation. Surg Radiol Anat 1999; 21:17-21. [PMID: 10370988 DOI: 10.1007/bf01635047] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
An anastomosis between the common trunk of the middle and left hepatic veins of the receiver and the cranial portion of the inferior vena cava of the donor is one of the techniques for restoration of hepato-caval continuity in orthotopic liver transplantation. This technique avoids dissection of the retrohepatic vena cava and total caval clamping. The aim of this study was to define the feasibility of this technique by a morphologic and biometric study of the common trunk of the middle and left hepatic veins on the basis of 64 injection-corrosion hepatic specimens and 21 fresh subjects. A common trunk for the middle and left hepatic veins was present in 54 of 64 cases (84%) with a length of 3 to 17 mm. The diameter of the new ostium constructed by section 0.5 cm proximal to the junction of the middle and left hepatic veins was 23.9 +/- 2.3 mm, which approximated to that of the vena cava where it traversed the diaphragm (24.4 +/- 2.0 mm). These findings confirmed that restoration of hepato-caval continuity by anastomosis between the common trunk of the middle and left hepatic veins of the receiver and the cranial portion of the vena cava of the graft is possible without incongruence. This study makes no assumptions about the hemodynamic effects associated with the smallest diameter of the true ostium of the common trunk at its opening into the inferior vena cava. In this study, the morphology of the common trunk was comparable to that observed by Nakamura. Further, we propose an anatomo-clinical classification allowing evaluation of the facility of vascular control of the common trunk in terms of the number and location of the collateral veins.
Collapse
Affiliation(s)
- P Wind
- Laboratoires d'Anatomie, Faculté Necker, Institut d'Anatomie de Paris, France
| | | | | | | |
Collapse
|
|
17
|
Kraus T, Weitz J, Mehrabi A, Bredt M, Golling M, Schönfuss T, Otto G, Gebhard MM, Herfarth C, Klar E. Monitoring of gastric PCO2 for evaluation of splanchnic mucosal microcirculatory impairment during mesenteric venous occlusion and reperfusion. Transplant Proc 1998; 30:833-5. [PMID: 9595118 DOI: 10.1016/s0041-1345(98)00068-2] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Affiliation(s)
- T Kraus
- Department of Surgery, University of Heidelberg, Germany
| | | | | | | | | | | | | | | | | | | |
Collapse
|
|
18
|
Berney T, Mentha G, Morel P. Total vascular exclusion of the liver for the resection of lesions in contact with the vena cava or the hepatic veins. Br J Surg 1998; 85:485-8. [PMID: 9607528 DOI: 10.1046/j.1365-2168.1998.00659.x] [Citation(s) in RCA: 58] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND This study reviews experience with total vascular exclusion of the liver (TVE), for the resection of tumours in contact with the hepatic veins or the vena cava. METHODS A retrospective study was carried out of 366 hepatic resections performed over 13 years. Forty-one patients (11 per cent) were operated under TVE. RESULTS Twenty-four patients were operated for malignancy and 17 for benign disease. Major hepatectomy was performed in 26 patients and minor hepatectomy in 15. The technique allowed vascular repair in eight patients. Median intraoperative blood transfusion was 2 (range 0-26) units; 14 patients required none. Median duration of TVE was 29 (range 5-58) min. No deaths occurred. Significant complications occurred in ten patients. Morbidity was related to the malignant nature of the lesion, duration of surgery and volume of blood transfusion, but not to duration of TVE. CONCLUSION TVE facilitates resection of critically located hepatic lesions with safety and minimal blood loss. Within the limits of 1 h, prolonged TVE does not increase morbidity.
Collapse
Affiliation(s)
- T Berney
- Clinic of Digestive Surgery, Geneva University Hospital, Switzerland
| | | | | |
Collapse
|
|
19
|
Abstract
Rather discouraging in the past, treatment of malignant tumors in children allows today a 75% cure rate for hepatoblastoma. Complete surgical resection remains the ongoing basis of the treatment, but the main advances are due to more efficient chemotherapy protocols using cisplatin, to an improvement in imaging procedures, to modern techniques of anesthaesia, to aggressive surgery and treatment of metastases, and finally to liver transplantation when the extension of the tumor precludes total resection in the absence of metastasis. The management of children with malignant tumors should be performed in selected centres participating in collaborative protocols, therefore providing the best oncological and surgical standards and the possibility of liver transplantation if necessary.
Collapse
Affiliation(s)
- J A Tovar
- Departamento de Cirugía Pediatrica, Hospital Infantil Universitario La Paz, Madrid, Espagne
| |
Collapse
|
|
20
|
Ohwada S, Satoh Y, Nakamura S, Tanahasi Y, Otani Y, Lino Y, Morishita Y, Kobayashi M, Yamanaka H. Left-sided approach to renal cell carcinoma tumor thrombus extending into suprahepatic inferior vena cava by resection of the left caudate lobe. Angiology 1997; 48:629-35. [PMID: 9242161 DOI: 10.1177/000331979704800710] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
A new operative approach to resecting tumor thrombus originating from a right renal cell carcinoma extending into the suprahepatic inferior vena cava (IVC) is reported. Complete local control of the IVC must be obtained above and below the tumor thrombus to remove it under direct vision. The caudate lobe of the liver was resected to expose the retrohepatic IVC and open the lesser omentum. The subhepatic IVC was encircled just below the confluence of the hepatic veins. Caval tumor thrombus was removed en bloc, including the right kidney, by use of the total hepatic vascular exclusion technique (THVE) and IVC exclusion. The retrohepatic IVC was clamped just below the confluence of the hepatic veins once the thrombus was removed, and the suprahepatic IVC clamp was then released and the THVE was terminated. The sequential clamping from the suprahepatic IVC to the retrohepatic IVC below the confluence of the hepatic veins shortened the THVE time.
Collapse
Affiliation(s)
- S Ohwada
- Second Department of Surgery, Gunma University School of Medicine, Japan
| | | | | | | | | | | | | | | | | |
Collapse
|
|
21
|
Abstract
Modern surgical techniques depend in part on knowledge of both the "normal" and the anomalous arterial blood supply. For instance, in liver transplantation, during surgery of the gallbladder, gastrectomy, and gastric lymphadenectomy, or when selective arterial chemotherapy is used for treatment of liver cancer, aberrant hepatic arteries can be a significant problem. A series of 138 cadavers with arterial latex injection were dissected and 10 corrosion casts were made to obtain an exact knowledge of the topography of the normal and anomalous arteries of the lesser omentum in humans. The so-called normal anatomy was found in only 9% (15 of 148 individuals), the remaining five-sixths presenting some variations from this, many of direct surgical importance. In these cases one or two aberrant hepatic arteries (37%), an artery in the free border of the hepatoduodenal ligament (19%), a right hepatic artery crossing the portal vein posteriorly (4%), the right hepatic artery entering the triangle of Calot anteriorly (29%) or not (7%), or an accessory left gastric artery branching off the left hepatic artery (2%) were found.
Collapse
Affiliation(s)
- A H Weiglein
- Anatomical Institute, Karl-Franzens-University Graz, Austria
| |
Collapse
|
|
22
|
Cavalcanti JS, Andrade LP, Moreira IE, Rietra PH, Oliveira ML. A morphological and functional study of the cavo-hepatic junction in the human. Surg Radiol Anat 1995; 17:311-4. [PMID: 8896149 DOI: 10.1007/bf01795188] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/02/2023]
Abstract
The authors studied the morphological and structural aspects of the junctions between the hepatic veins and the inferior vena cava. The study was carried out on 20 specimens obtained from adult cadavers of both sexes, fixed in 10% formaldehyde solution. The hepatic veins with their junctions on the inferior vena cava were isolated. Then a macroscopic analysis of the openings of the hepatic veins into the inferior vena cava was performed. Part of this material was embedded in paraffin, submitted to serial sectioning and stained with Azan's trichrome and resorcin-fuchsin. Three hepatic veins were observed in all cases: right, left and the middle. In 20% of the cases the middle hepatic vein opens directly into the inferior vena cava. The hepatic vein openings are supported by two pillars inferiorly united through a semilunar fold. The hepatic vein wall is greatly thickened at the level of its junction with the inferior vena cava, showing a large amount of muscular and collagenous fibers. These bundles constitute a sphincter-like formation which may play a physiological role in the control of the hepatic circulation.
Collapse
Affiliation(s)
- J S Cavalcanti
- Department of Anatomy, Federal University of Pernambuco, Recife, Brazil
| | | | | | | | | |
Collapse
|
|
23
|
Metzler H. Continuous measurement of hepatic vein oxygen saturation with a new catheter. Intensive Care Med 1992; 18:131. [PMID: 1613196 DOI: 10.1007/bf01705050] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022]
|
|
24
|
Abstract
This study gathers the anatomic implications for a good liver transplantation. During hepatic removal a left hepatic a.exists in 20% of cases; a right hepatic artery originating from the superior mesenteric a. (SMA) can be the only arterial supply in 9% of cases; the whole lesser omentum has to be removed and the SMA from 6 cm to its origin. The SMA must be freed from the celiac ganglia and its ostium removed with the celiac trunk in an aortic patch cut on the anterior side in order to avoid the renal ostia. During total hepatectomy, dissection of the portal triad is often difficult because of portal hypertension dilating accessory portal veins (parabiliary arcade) and pedicular lymphatics. Nerve plexuses are thick in front of the hepatic artery or behind the portal triad. Transection of triangular ligaments leads to the retrohepatic inferior vena cava (IVC) that must be freed from its posterior tributaries (right suprarenal vein and inferior phrenic veins flowing either into the IVC or into the hepatic veins). One big problem during hepatic replacement is the biliary anastomosis which must be well irrigated. In the recipient, dissection up to the hilum preserves hepatic and pancreatico-duodenal pedicles. The biliary tract of the graft must be cut low, behind the pancreas, and several centimeters of the gastroduodenal artery must be preserved to save hepatic and gastroduodenal pedicles.
Collapse
Affiliation(s)
- J M Chevallier
- Department of Anatomy, Faculté Necker-Enfants Malades, Paris, France
| | | |
Collapse
|