Hepatic Resection

Surgical Techniques
Nathaniel V. Talibong
Group 8
 Nomenclature
• Due to the confusion in language with regard to anatomic descriptions of
hepatic resections, a common nomenclature was introduced at the
International Hepato-Pancreato- Biliary Association meeting in Brisbane,
Australia, in 2000 (Table 31-8). The goal was to provide universal
terminology for liver anatomy and hepatic resections, because there was
much overlap among the designations for hepatic lobes, sections, sectors, and
segments used by surgeons worldwide (Fig. 31-21).
 Steps Common to All
Open Major Hepatic Resections
• 1. Make the skin incision—right subcostal with or without a partial or complete left subcostal extension across the
midline, depending on the patient’s habitus and liver/tumor anatomy.
• 2. Open and explore the abdomen, and place a fixed table retractor (e.g., Thompson or Bookwalter).
• 3. Examine the liver with bimanual palpation. Perform liver ultrasound, and confirm the operation to be performed.
• 4. Take down the round and falciform ligaments, and expose the anterior surface of the hepatic veins.
• 5. For a left hepatectomy, divide the left triangular ligament; for a right hepatectomy, mobilize the right lobe from the
right coronary and triangular ligaments.
• 6. Open the gastrohepatic ligament, palpate the porta hepatis, and assess for accessory or replaced hepatic arteries.
• 7. Perform a cholecystectomy; leave the gallbladder with the cystic duct intact if the gallbladder is involved by the tumor.
 Right Hepatic Lobectomy
(Right Hepatectomy or Hemihepatectomy)
 Right Hepatic Lobectomy
(Right Hepatectomy or Hemihepatectomy)
 Left Hepatic Lobectomy
(Left Hepatectomy or Hemihepatectomy)
 Left Hepatic Lobectomy
(Left Hepatectomy or Hemihepatectomy)
Pringle and Ischemic Preconditioning
Preoperative Portal Vein Embolization
 Staged Hepatectomy and Repeat Hepatic
Resection for Recurrent Liver Cancer
• A two-stage hepatectomy is a sequential resection strategy to remove all
metastatic liver tumors when it is impossible to resect all disease in a
single operative procedure.