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Arantius’ Ligament Approach to Middle Hepatic Vein in Laparoscopic Extended Medial Segmentectomy (with Video)

  • Hepatobiliary Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Under laparoscopy-specific caudal and lateral view, Aranitius’ ligament could be the landmark for the root of the venous trunks in the left hepatic lobe.1,2,3 We performed laparoscopic hepatic extended medial segmentectomy including the middle hepatic vein (MHV) using the Arantius’ approach.

Methods

An 86-year-old man was referred to our hospital for hepatocellular carcinoma, 4.5 cm in size, located in the medial hepatic segment (Video 1). After pneumoperitoneum and placement of four working ports, the Arantius’ ligament was exposed, isolated, and divided. The liver parenchyma underneath the Arantius’ ligament was opened to widely expose the root of the MHV, umbilical fissure vein (UFV), and left hepatic vein (LHV). After dividing the Glissonean branches for segment 4 (G4), the parenchymal tissue between MHV and LHV was divided. The trunk of the MHV was fully exposed and was divided using the endo-stapling device. Parenchymal resection was further proceeded along the dorsal side of the MHV, and the planned hepatectomy was completed.

Results

The operation time was 337 min, and the estimated blood loss was 400 g. His postoperative course was uneventful, and he was discharged on postoperative day 10.

Conclusions

The significance of Arantius’ ligament approach is short-cut exposure of the MHV as the anatomical landmark during the initial process of the surgery under laparoscopy-specific caudal and lateral view, and is a reasonable technique in extended medial segmentectomy including the MHV.

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References

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Acknowledgment

We thank Angela Morben, DVM, ELS, from Edanz Group (https://en-author-services.edanz.com/ac), for editing a draft of this manuscript. This work was supported by JSPS KAKENHI Grant No. 21K08718.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The Jikei University School of Medicine, Tokyo, Japan

    Toru Ikegami MD, Shinji Onda MD, Tomohiko Taniai MD, Masashi Tsunematsu MD, Kenei Furukawa MD, Jungo Yasuda MD & Koichiro Haruki MD

Authors
  1. Toru Ikegami MD
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  2. Shinji Onda MD
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  3. Tomohiko Taniai MD
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  4. Masashi Tsunematsu MD
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  5. Kenei Furukawa MD
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  6. Jungo Yasuda MD
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  7. Koichiro Haruki MD
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Contributions

All authors are in agreement with the content of the manuscript. Each author’s contribution is as follows; TI; study conception and design, acquisition of data, and drafting of manuscript. KH, KF, TT, and MT; acquisition of data. JY; study conception and design and critical revision of manuscript.

Corresponding author

Correspondence to Toru Ikegami MD.

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Ethical statements

The present study was approved by the Institutional Ethics Committee of The Jikei University School of Medicine (Registration No. 27-177) and conformed to the ethical guidelines of the Declaration of Helsinki.

Consent for publication

Written informed consent was obtained from the patient for publication of this report and any accompanying images.

Disclosures

The authors have no conflict of interest to report. The manuscript was not prepared or funded by a commercial organization.

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Supplementary Information

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Video file 1. Arantius’ ligament approach to middle hepatic vein in laparoscopic extended medial segmentectomy (MP4 61822 KB)

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Ikegami, T., Onda, S., Taniai, T. et al. Arantius’ Ligament Approach to Middle Hepatic Vein in Laparoscopic Extended Medial Segmentectomy (with Video). Ann Surg Oncol 28, 8242–8243 (2021). https://doi.org/10.1245/s10434-021-10415-1

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  • DOI: https://doi.org/10.1245/s10434-021-10415-1

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