Laparoscopic right hepatectomy
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Case Scenario
- The patient was a 78 year old woman, diagnosed with a colorectal metastasis in segment VII, in close proximity to the right hepatic vein precluding wedge resection due to concerns about achieving a clear margin.
- A cholecystectomy will be performed, but the gall bladder will be left attached to the right lobe after dividing the cystic duct, to serve as a retractor for the laparoscopic exposure.
- Two branches of the right hepatic artery were divided to position the transection plane as far lateral as possible to spare parenchyma.
- The transection plane extends from the groove between the middle and right hepatic veins to the gall bladder fossa.
- The middle hepatic vein will be preserved. Crossing veins from segments V and VIII, draining into the MHV, will therefore be encountered and divided during transection.
CT scans
- Click and drag the slider on the left to transverse through the CT series. Clicking on the grey button on the bottom will reveal clinical findings by the surgical team; click on the descriptions to bring the image up to the main window. Best viewed in Mozilla Firefox, Google Chrome or Safari.
①
Lesion and Right Hepatic Vein
②
Portal vein branches
Click to turn annotations on/off
- Click and drag the slider on the left to transverse through the CT series. Clicking on the grey button on the bottom will reveal clinical findings by the surgical team; click on the descriptions to bring the image up to the main window. Best viewed in Mozilla Firefox, Google Chrome or Safari.
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