Various liver anatomical resection

1. ANATOMICAL LIVER RESECTION
Vietnam National Cancer Hospital
Department of HBP Surgery
Nguyễn Trường Giang

2. THREE LEVELS OF COMPLEXITY
Liver’s anatomy
Conventional
level
Surgical level
Academic level
COMMON CLINICAL LANGUAGE:
An idealised scheme with 8 segments
1st
2nd
3rd
Source: Pietro M., Gilles M., Christian T., et al. ,Anatomy of the liver: An outline with three
levels of complexity – A further step towards tailored territorial liver resections, Journal of
hepatology, Volume 60, Issue 3, Page 654-662

3. THREE LEVELS OF COMPLEXITY
Liver’s vascular
anatomy
Conventional
level
Surgical level
Academic level
1st
2nd
3rd
Source: Pietro M., Gilles M., Christian T., et al. ,Anatomy of the liver: An outline with three
levels of complexity – A further step towards tailored territorial liver resections, Journal of
hepatology, Volume 60, Issue 3, Page 654-662
FOR THE ANATOMIST:
A futher call for an unprejudiced
view on intrahepatic vessels

4. THREE LEVELS OF COMPLEXITY
Liver’s vascular
anatomy
Conventional
level
SURGICAL
LEVEL
Academic level
FOR THE LIVER SURGEON:
Beyond the 8-segments scheme, toward
tailored territorial liver resection
1st
2nd
3rd
Source: Pietro M., Gilles M., Christian T., et al. ,Anatomy of the liver: An outline with three
levels of complexity – A further step towards tailored territorial liver resections, Journal of
hepatology, Volume 60, Issue 3, Page 654-662

5. Oncologically
goal
Functional liver
remnant
DILEMMA
WHAT DO LIVER SURGEONS WANT?

6. The tumor
The
satellites
RESECT ALL THE CANCER
TISSUES
ONCOLOGICALLY GOAL
Anatomical
Resection
Intrahepatic
Metastasis

7. The tumor
The
satellites
RESECT ALL THE CANCER
TISSUES
ONCOLOGICALLY GOAL
High risk region of
local recurrence

8. The tumor
The
satellites
RESECT ALL THE CANCER
TISSUES
ONCOLOGICALLY GOAL

9. ONCOLOGICAL GOAL/ Anatomical Resection
BRISBANE 2000
Fist-order
division
Second-order
division
Third-order
division
1
2
3
Source: The Brisbane 2000 Terminology of Liver Anatomy and Resections, HPB 2000
Volume 2, Number 3 333-33
FIRST-ORDER BRANCH of Portal vein:
- Left PV
- Right PV

10. Operative image
Right hepatectomy (resection of Segment 5-6-7-8)

11. Operative image
Left hepatectomy (resection of Segment 2-3-4)

12. ONCOLOGICAL GOAL/ Anatomical Resection
BRISBANE 2000
Fist-order division
Second-order
division
Third-order
division
1
2
3
Source: The Brisbane 2000 Terminology of Liver Anatomy and Resections, HPB 2000
Volume 2, Number 3 333-33

13. Operative image
Right anterior sectionectomy (resection of Segment 5-8)

14. Operative image
Right posterior sectionectomy (resection of Segment 6-7)

15. ONCOLOGICAL GOAL/ Anatomical Resection
BRISBANE 2000
Fist-order division
Second-order
division
Third-order
division
1
2
3
Source: The Brisbane 2000 Terminology of Liver Anatomy and Resections, HPB 2000
Volume 2, Number 3 333-33
THIRD-ORDER BRANCH of Portal vein

16. Operative image
Segmentectomy 5

17. Operative image
Segmentectomy 8

18. Operative image
Caudate lobectomy (Segmentectomy 1)

19. PARENCHYMAL SAVING ANATOMICAL LIVER RESECTION
Beyond
BRISBANE 2000
Mesohepatectomy
IRHV
Ventral-Dorsal
segment
1
2
3
Resection of segment 4
Resection of segment 5-8
Resection of segment 4-5-8
- Altenative choice for left
trisectionectomy or right
trisectionectomy
- Parenchymal saving
- Same result

20. Operative image
Mesohepatectomy

21. PARENCHYMAL SAVING ANATOMICAL LIVER RESECTION
Beyond
BRISBANE 2000
Mesohepatectomy
IRHV
Ventral-Dorsal
segment
1
2
3
INFERIOR RIGHT HEPATIC VEIN
- Drainage of segment 6
- 20% cases
- Four new hepatectomy procedures
for resection of the right hepatic
vein and preservation of the Inferior
Right Hepatic Vein.

22. Operative image
Bisegmentectomy 7-8

23. PARENCHYMAL SAVING ANATOMICAL LIVER RESECTION
Beyond
BRISBANE 2000
Mesohepatectomy
IRHV
Ventral-Dorsal
segment
1
2
3

24. Preoperative images
Ventral segment sparing right hepatectomy
Ventro-dorsal type

25. Operative Images
Ventral segment sparing right hepatectomy
Hepatic hilar approach

26. Ventral segment sparing right hepatectomy
Postoperative images

27. Dorsal segment sparing mesohepatectomy
Preoperative images
Ventro-dorsal type

28. Dorsal segment sparing mesohepatectomy
Operative Images
Right anterior pedicle

29. Dorsal segment sparing mesohepatectomy
Postoperative images

30. Thank for your attention