Simplified
Hilar Division in Controlled Right Hepatectomy
Takashi Matsumata, MD, Takashi Kanematsu, MD, Motoyuki Yamagata, MD, Tohru Utsunomiya, Katsuhiko Yanaga, MD, Keizo Sugimachi, MD, FACS, hkuoka, Japan
Right hepatectomy with preliminary vascular control at the hepatie h&s could be performed not by the method of dividing the structures in the hepatoduodenal ligament separately but instead by simultaneously employing both the hemihepatic vascular control method and the ultrasonic dissector. When applying the tape around the fbst portal pedicle, the anterior and posterior portal pedicles are easily exposed by using the ultrasonic dkector and, thereafter, ligated and cut; by utilizing this simplified hilar division, hemostasis of the right hepatic lobe can be achieved.
MD,
we have utilized an ultrasonic dissector for transection combined with the preresectional vascular control of vessels supplying the hemiliver containing the lesion [2]. By using this hemihepatic vascular occlusion technique [3] in a controlled right hepatectomy, a simplified hilar division can be done; that is, after the gallbladder is removed, tape is wrapped tightly around the first portal pedicle. A change in color on the liver’s surface can then be perceived. The anterior and posterior portal pedicles are exposed by using the ultrasonic dissector and, thereafter, easily ligated and cut (Fcgure 1). There is no difficulty in such dissection and no risk of injuring any vascular or biliary elements supplying the retained liver; in this way, hemostasis of the right side of the liver can be achieved. Demarcation line
hen a right hepatectomy is performed, carrying W out a successful dissection and interruption of the portal pedicle at the hihrs prior to the transection of the parenchyma is useful in achieving a nearly bloodless division of the liver. The modem era of hepatic resection dates from the 1952 report of Lortat-Jacob and Robert [I] in which both the blood vessels and bile duct to the right lobe were ligated within the hepatoduodenal ligament in addition to the ligation of the right hepatic vein extrahepatically before transection of the hepatic parenchyma, due to the resistance of the intrahepatic portal pedicles and hepatic veins when the liver parenchyma was disrupted. The structures in the hepatoduodenal ligament supplying the right lobe, which is composed of the right hepatic artery and the right branches of the portal vein and the bile duct, are usually ligated and cut individually; however, this is an extremely time-consuming method. To minimize blood 1~ during parenchymal transection,
From the Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuolca, Japan. Rapeats for reprints should be addmssed to Takashi Matsumata, MD, Second Department of Surgery, Kyushu University, Faculty of Medicine, 3-l-l Maidashi, Higasbi-ltu, Fukuoka 812, Japan. Manuscript submitted October 22,1990, and accented November 21,199o.
Tape around the right portal pedicle Ultrasonic dissector nsu,1.whenallpwlgthetapeaKnJndttlerlghtfirstpclrtal
pedkle,theanterkrandpoeterkrportalpedkIesareeasiIy exposedby usingthe ultrasonk disseotor.
1. Schwartz SI. What’s new in general surgery: hepatic resection. Ann Surg 1990, 211: l-8. 2. Matsumata T, Kanematsu T, Shirabe K, Sonoda T, Furuta T, Sugbnachi K. Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma. Br J Surg 1990, 77: 677-80. 3. Makuuchi M, Mori T, Gunven P, Yamazaki S, Hasegawa H. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obatet 1987; 164: 155-8.
THE AMERICAN JOURNAL OF SURGERY
VOLUME 163 MARCH 1992
339
Hilar Division in Controlled Right Hepatectomy
Takashi Matsumata, MD, Takashi Kanematsu, MD, Motoyuki Yamagata, MD, Tohru Utsunomiya, Katsuhiko Yanaga, MD, Keizo Sugimachi, MD, FACS, hkuoka, Japan
Right hepatectomy with preliminary vascular control at the hepatie h&s could be performed not by the method of dividing the structures in the hepatoduodenal ligament separately but instead by simultaneously employing both the hemihepatic vascular control method and the ultrasonic dissector. When applying the tape around the fbst portal pedicle, the anterior and posterior portal pedicles are easily exposed by using the ultrasonic dkector and, thereafter, ligated and cut; by utilizing this simplified hilar division, hemostasis of the right hepatic lobe can be achieved.
MD,
we have utilized an ultrasonic dissector for transection combined with the preresectional vascular control of vessels supplying the hemiliver containing the lesion [2]. By using this hemihepatic vascular occlusion technique [3] in a controlled right hepatectomy, a simplified hilar division can be done; that is, after the gallbladder is removed, tape is wrapped tightly around the first portal pedicle. A change in color on the liver’s surface can then be perceived. The anterior and posterior portal pedicles are exposed by using the ultrasonic dissector and, thereafter, easily ligated and cut (Fcgure 1). There is no difficulty in such dissection and no risk of injuring any vascular or biliary elements supplying the retained liver; in this way, hemostasis of the right side of the liver can be achieved. Demarcation line
hen a right hepatectomy is performed, carrying W out a successful dissection and interruption of the portal pedicle at the hihrs prior to the transection of the parenchyma is useful in achieving a nearly bloodless division of the liver. The modem era of hepatic resection dates from the 1952 report of Lortat-Jacob and Robert [I] in which both the blood vessels and bile duct to the right lobe were ligated within the hepatoduodenal ligament in addition to the ligation of the right hepatic vein extrahepatically before transection of the hepatic parenchyma, due to the resistance of the intrahepatic portal pedicles and hepatic veins when the liver parenchyma was disrupted. The structures in the hepatoduodenal ligament supplying the right lobe, which is composed of the right hepatic artery and the right branches of the portal vein and the bile duct, are usually ligated and cut individually; however, this is an extremely time-consuming method. To minimize blood 1~ during parenchymal transection,
From the Second Department of Surgery, Faculty of Medicine, Kyushu University, Fukuolca, Japan. Rapeats for reprints should be addmssed to Takashi Matsumata, MD, Second Department of Surgery, Kyushu University, Faculty of Medicine, 3-l-l Maidashi, Higasbi-ltu, Fukuoka 812, Japan. Manuscript submitted October 22,1990, and accented November 21,199o.
Tape around the right portal pedicle Ultrasonic dissector nsu,1.whenallpwlgthetapeaKnJndttlerlghtfirstpclrtal
pedkle,theanterkrandpoeterkrportalpedkIesareeasiIy exposedby usingthe ultrasonk disseotor.
1. Schwartz SI. What’s new in general surgery: hepatic resection. Ann Surg 1990, 211: l-8. 2. Matsumata T, Kanematsu T, Shirabe K, Sonoda T, Furuta T, Sugbnachi K. Decreased morbidity and mortality rates in surgical patients with hepatocellular carcinoma. Br J Surg 1990, 77: 677-80. 3. Makuuchi M, Mori T, Gunven P, Yamazaki S, Hasegawa H. Safety of hemihepatic vascular occlusion during resection of the liver. Surg Gynecol Obatet 1987; 164: 155-8.
THE AMERICAN JOURNAL OF SURGERY
VOLUME 163 MARCH 1992
339
