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RIGHT TRISEGMENTECTOMY - LAUNOIS APPROACH ( Synonyms:  right hepatectomy extended to segment IV,  right extended  hemihepa...
REH (RIGHT EXTENDED HEPATECTOMY) (Lortat-Jacob, Robert) REH   -to  segment IV (par t ial ly ) REH -to  segment  IV and  I ...
Right t risegmentectom y removal of   theoretical  func t ional  tissue   (about  70-85% ) decrease of the portal vascular...
REH to  segment IV (par t ial ly ) CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
REH to  segment IV  and  I REH to  segment I CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
INDICA TIONS : <ul><li>volumino u s primitive malign ant  tumor s  ( > 5cm) ,  postero-superior  situated ; </li></ul><ul>...
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH CT image
Therapeutic strategy : <ul><li>-emboli s a tion of   RP V (Makuuchi)  -ligat ion of   RP V </li></ul><ul><li>hepatic re s ...
R P V ligation CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
V   liver – 2325 mm ³ V   tumor – 573 mm³  V L L   – 706 mm³ (31%) CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS A...
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
BLUMGART  technique VCI CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Inferior right retro-hepatic veins and the ligament of  the...
( ) Ligament  of the   I VC (cadav e r ous dissection ) CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
Ligament  of the I VC   (intraoperat ive ) CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Right hepatic vein - clamped
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Middle hepatic vein - isolated
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
VIII V CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
Intra-operat ive CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
IVb III IVb III REX Hepatic tissue bridge between  IVb  and  III (50%  of  ca ses  –   Starzl) CHIRURGIE I SCUMC –  RIGHT ...
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Dorsal portal scissure
LH L  = 15-25% CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
6 MONTHS POST-OPERATIVE TOMOGRAPHY CHIRURGIE I SCUMC –  RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
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Right trisegmentectomy; Launois approach

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  1. 1. RIGHT TRISEGMENTECTOMY - LAUNOIS APPROACH ( Synonyms: right hepatectomy extended to segment IV, right extended hemihepatectom y , trisectorectom y , dextromedian hepatic resection, right lobectom y , right extended lobectom y) Authors: I. C î mpeanu, M. Bogdan, T. Artenie, R. Petrescu, I. Lucescu Clinical 1-st Department of Surgery– Clinical and Emergency Central Military Hospital “Dr. Carol Davila” - Bucharest April 2003
  2. 2. REH (RIGHT EXTENDED HEPATECTOMY) (Lortat-Jacob, Robert) REH -to segment IV (par t ial ly ) REH -to segment IV and I REH -to segment IV ( STARZL trisegmentectom y ) REH -to segment I CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  3. 3. Right t risegmentectom y removal of theoretical func t ional tissue (about 70-85% ) decrease of the portal vascular bed with 75% (Broelsch ´ 93) amount of the remaining “classical” left lobe (LL: S II + S III) = prognostic paramet er (Broelsch ´ 93) CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  4. 4. REH to segment IV (par t ial ly ) CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  5. 5. REH to segment IV and I REH to segment I CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  6. 6. INDICA TIONS : <ul><li>volumino u s primitive malign ant tumor s ( > 5cm) , postero-superior situated ; </li></ul><ul><li>malign ant tumor s juxtacav located ; </li></ul><ul><li>multiloculate hepatic metasta sis . </li></ul>“ clas s ic al ” L L (+S I) ec h ogra ph ic scan ned = “ clean ” monitori s a tion of the locoregional nodes (G -) control of the af f erent/ef f erent circula tion permeabilit y of the “clas s ic al ” LL (Doppler e c h o graphy ) INTRAOPERAT IVE : CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  7. 7. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH CT image
  8. 8. Therapeutic strategy : <ul><li>-emboli s a tion of RP V (Makuuchi) -ligat ion of RP V </li></ul><ul><li>hepatic re s ec t i on </li></ul>Right Extended Hepatectomy to segment IV (Starzl trisegmentectom y ) = prototype of extraglissonian re s ec tion (T.T. Tung, Launois) CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  9. 9. R P V ligation CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  10. 10. V liver – 2325 mm ³ V tumor – 573 mm³ V L L – 706 mm³ (31%) CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  11. 11. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  12. 12. BLUMGART technique VCI CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  13. 13. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Inferior right retro-hepatic veins and the ligament of the inferior vena cava
  14. 14. ( ) Ligament of the I VC (cadav e r ous dissection ) CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  15. 15. Ligament of the I VC (intraoperat ive ) CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  16. 16. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Right hepatic vein - clamped
  17. 17. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Middle hepatic vein - isolated
  18. 18. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  19. 19. VIII V CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  20. 20. Intra-operat ive CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  21. 21. IVb III IVb III REX Hepatic tissue bridge between IVb and III (50% of ca ses – Starzl) CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Transsected
  22. 22. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  23. 23. CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH Dorsal portal scissure
  24. 24. LH L = 15-25% CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH
  25. 25. 6 MONTHS POST-OPERATIVE TOMOGRAPHY CHIRURGIE I SCUMC – RIGHT TRISEGMENTECTOMY – LAUNOIS APPROACH

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