A Standardized Technique for Right Segmental Liver Resections

Hypothesis: The indications for segmental liver resections are increasing. This type of procedure can be performed by deep wedge transparenchymal transection or by the intrahepatic approach, reaching the portal pedicle through the hilar plate. We devised a systematized way to perform such an operation.

Design: Original surgical technique.

Patients And Methods: Fourteen consecutive patients (8 men and 6 women; mean age, 55 years) underwent right segmental liver resections between July 1, 2001, and July 31, 2002. Seven patients had liver metastasis, 3 had primary liver cancer, 3 had benign lesions, and 1 had gallbladder cancer. The surgery was performed by making 3 small incisions around the hilar plate. With a standardized method, the right posterior and anterior sheaths were reached by combining these incisions.

Results: Right segmental liver resection was feasible with the proposed technique in all patients. Intraoperative blood loss was minimal in all cases, and 11 patients did not require blood transfusion. There was no postoperative death.

Conclusions: This operative procedure standardizes the intrahepatic approach to the right portal pedicle for right segmental resections. It may reduce bleeding at the site of hilar plate incisions and the need for main hepatic pedicle clamping and may facilitate the recognition of right posterior and anterior sheaths, with excellent immediate results.