Laparoscopic Extended Segmentectomy VII Guided by the Right Hepatic Vein: Precise Surgical Planning with a Three-Dimensional Liver Model.

Abstract

Background: Laparoscopic extended segmentectomy VII is a technically challenging procedure owing to a lack of clear anatomical landmarks and difficulty in determining the cutting plane (Wang in J Am Coll Surg 238:321-330, 2024; Liu in Surg Oncol 38:101575, 2021). On the basis of precise surgical planning, we present a laparoscopic extended segmentectomy VII guided by the right hepatic vein.

Patient and methods: A 65 year-old male patient presented with a right hepatic mass. The three-dimensional liver model showed that the tumor was mainly located in segment 7, invading part of segment 8 (Fig. 1A). The right hepatic vein (RHV) trunk was not invaded by the tumor, and the segment 6/7 intersegmental vein was present; these served as the surgical landmarks for determining the cutting plane (Fig. 1B) (Wang in Updates Surg 75:1941-1948, 2023). Firstly, the Glissonean pedicle of segment 7 (G7) was dissected from the dorsal side of the liver. The ischemic area was identified and marked by clamping G7. Then, the intraoperative ultrasound confirmed the RHV trunk projection to satisfy the requirements of oncologic treatment (Lin in J Gastrointest Surg 27:1494-1495, 2023). Liver parenchymal transection was performed peripherally, followed by the exposure of the segment 6/7 intersegmental vein and RHV trunk on the cutting plane. Further transection was then continued along the RHV trunk, up to its root. Fig. 1 Precise surgical planning; A the tumor location, B the cutting plane extending from the RHV trunk and S6/7 intersegmental vein. RHV right hepatic vein, IVC inferior vena cava, S6/7 intersegmental vein intersegmental vein between segment 6 and 7, S7 segment 7, S8 segment 8 RESULTS: The operative time was 260 min, with an intraoperative blood loss of 50 ml. The pathology confirmed moderately differentiated hepatocellular carcinoma with a negative surgical margin. The patient was discharged on postoperative day 9 without any complications.

Conclusions: On the basis of precise surgical planning with a three-dimensional liver model, the laparoscopic extended segmentectomy VII guided by the RHV is feasible and effective.