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Liver anatomy can be variable, and understanding of anatomic variations is crucial to performing hepatic resections, particularly parenchymal-sparing resections.
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Anatomic knowledge is a critical prerequisite for effective hepatic resection with minimal blood loss, parenchymal preservation, and optimal oncologic outcome.
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Each anatomic resection has pitfalls, about which the operating surgeon should be aware and comfortable managing intraoperatively.
Anatomy of Hepatic Resectional Surgery
Section snippets
Key points
Historical Definitions
Historically, the liver was described as having 2 anatomic lobes, the larger right lobe and the smaller left lobe. These lobes are separated on the anterior surface of the liver by the falciform ligament, and on the inferior surface by the ligamentum teres as it enters the umbilical fissure. The liver is invested by peritoneum except on its posterior surface, where the peritoneum reflects to create the right and left triangular ligaments. The area between the folds of peritoneum that create the
Parenchymal preservation without oncologic compromise
Historically, liver resection was associated with high morbidity and mortality related to blood loss and hepatic failure. With recent advancements in surgical technique and anesthesia, morbidity and mortality rates have dramatically decreased. A major part of the reason for this decrease is the increased use of parenchymal-preserving liver resection. In a recent single-institution analysis of 3876 patients undergoing 4152 liver resections for cancer from 1993 to 2012, the percentage of major
Right Hepatectomy
Descriptions of this operation are common, and there are numerous techniques to accomplish a safe and effective right hepatectomy. Most commonly, the right liver is mobilized completely off of the diaphragm and vena cava by dividing the often numerous retrohepatic venous branches. The right caval ligament, which runs laterally to the right hepatic vein and envelops the vena cava posteriorly circumferentially to join the left side of the caudate, must be encircled and divided to expose the right
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Cited by (15)
Post hepatectomy liver failure (PHLF) – Recent advances in prevention and clinical management
2021, European Journal of Surgical OncologyCitation Excerpt :Liver resection has become a safe and a well-accepted treatment for a variety of primary and secondary tumors with excellent outcomes and acceptable morbidity [1]. Mortality after a liver resection varies from about 2% for colorectal metastases to about 10% for biliary tumors and hepatocellular carcinomas although some older series have even reported much higher rates, up to 30% for major liver resections involving over 4 segments [2,3]. Non-lethal complications after liver resections are frequently encountered in up to 45%, and vary from less severe incidents to life-threatening complications, including infections or sepsis, bleeding, leakage, or cardiopulmonary events [4,5].
Error traps and culture of safety in pediatric surgical oncology
2019, Seminars in Pediatric SurgeryCitation Excerpt :In liver surgery, knowledge of the surgical anatomy is the basis for anatomical resections; this has been described by Couinaud since the 1950s, but it was more widespread after the classical paper by Bismuth.30 There is an excellent review of the topic by Lowe and D'Angelica,31 including the anatomical variants. The division of the liver in four sections according to the distribution of the branches of the portal vein and hepatic artery, and the drainage through the hepatic veins is the cornerstone for hepatic resections, and is the foundation for the PRETEXT staging for the disease distribution in the liver, that was originally devised in the 1990s by the SIOPEL, the International Childhood Liver Tumor Study Group.
The hepatic response to thermal injury
2018, Total Burn Care: Fifth EditionThe Hepatic Response to Thermal Injury
2017, Total Burn Care, Fifth EditionSurgical Anatomy of the Liver—Significance in Ovarian Cancer Surgery
2023, Diagnostics
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