TECHNICAL ASPECTS OF PERFORMING EXTENDED ANATOMICAL RESECTION OF SEGMENT 2 OF THE LIVER WITH RESECTION OF THE LEFT HEPATIC VEIN: CLINICAL CASE

Burlaka A.A.¹, Paliichuk A.V.², Chukanov O.M.², Shudrak A.A.¹, Iatsyna O.I.¹, Kolesnik O.O.¹

• ¹National Cancer Institute
• ²Medical Centre «Omega-Kyiv», Kyiv, Ukraine

Parenchyma-preserving technique in hepatic surgery have proven its effectiveness in prevention of acute liver failure, small-for-size syndrome, and at the same time, its oncologic safety. Purpose: demonstration of technical aspects of performing the alternative surgical approach — extended anatomical resection (segmentectomy) of Segment 2 of the li­ver with resection of the left hepatic vein (LHV) and preserving umbilical fissure vein. Objective and Me­thods: we are presenting our proper experience of performing not-standardized approach of liver resection in a patient with isolated metastatic involvement of Segment 2 of the liver with vessel invasion of the proximal segment of the LHV. Results: access included performance of upper-middle lapa­rotomy on the extent of 12 cm. Mobilization of the liver foreseed the dissection of left triangular, round and falciform ligaments. Parenchyma transection was performed under control of selective Pringle maneuver (restricted the blood inflow to the left liver lobe according to the principle: 20 min — warm perfusion, 5 min — reperfusion), total duration of the warm ischemia was about 35 min. By using the «clamp-crush» technique the first stage was performing the dissection and ligation of li­ver parenchyma structures on the border between Segment 2 and Segments 3 to the level of the Umbilical fissure. Under control of iUS navigation we completed the transsection by atypical mobilization of segment 3 within parenchyma of Segment 4 sup. with preserving umbilical fissure vein. We have finished the stage by ligating of the Segment 2 Glisson in the area of its orifice. The control of effectiveness of venous outflow from the Segment 3 was performed by using iUS. Conclusion: extended ana­tomical resection of Segment 2 with resection of LHV and preserving umbilical fissure vein is effective alternative parenchyma-sparing approach in li­ver resections.