Chapter 26

Left Liver Resections

Ailton Sepulveda, Fabiano Perdigão and Olivier Scatton

Abstract

• An extrahepatic approach to vascular structures, combined with an intra-parenchymal left bile duct division, is the preferred technique to perform leftliver resection. IOUS is an indispensable resource – not only to confirm selective vascular disconnection, but also to identify the appropriate transection planeduring parenchyma transection. </p><p> • The left hepatic vascular pedicle is perpendicular in relation to the right pedicle when the round ligament is held upward during left hepatectomy. </p><p> • The transection plane of a left hepatectomy is initially vertical until the hilar plate, and becomes horizontal following the Arantius plane after the bile ductsection. </p><p> • A hanging maneuver is also a useful technique for left resection extended to segment 1 or to the middle hepatic vein, since the transection plane is the same as that for a right hepatectomy. </p><p> • Total vascular exclusion should be performed in case of voluminous tumors that are in close proximity to hepatic veins. </p><p> • Vascular control of the left middle hepatic trunk is achieved from the left to the right in a strict horizontal plane. Lowering segment 1 and cutting the Arantius ligament are mandatory in order to safely perform this vascular control.

Total Pages: 438-444 (7)

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