Surgical anatomy and anatomical surgery of the liver

Intraoperative ultrasonographic study of the liver. Methods and anatomic results

In this study, we have reported our experience with the use of intraoperative ultrasonography in the field of liver surgery. Using the method, the intrahepatic segmental pedicles can be precisely located and thus, segmentectomies can be performed in an anatomic way. The technique allows the most economic parenchymal resection in cirrhotic patients which may be important for prevention of postoperative liver insufficiency.

Surgical anatomy of liver segment IV

Classical studies of the anatomy of the liver have led to the wide practice of hepatic resection. The difficulties encountered in the course of either right hepatectomy enlarged to include segment IV or left hepatectomy are mainly related to the vascular relations of this liver segment. This paper presents a summary of data from the literature concerning segment IV of the liver, as well as the results of experimental study via an original technique of resin injection of the portal vasculature and biliary drainage of this segment. The relations of the portal pedicles of segment IV with the bile duct originating from the confluence of the ducts draining segments II and III and with the left paramedian branch of the portal vein are described. Knowledge of these anatomical relations is essential to the proper execution of major hepatectomy.

Right hepatic lobectomy

Hepatic lobectomy has evolved to the point of being a precise anatomic surgical resection. The sequence of incision, mobilization, hepatoduodenal dissection, and management of the hepatic veins and parenchyma have been individually described herein. The historical background and indications for the procedure have been outlined, and the perioperative management of the patient considered.

Reduced-sized orthotopic liver graft in hepatic transplantation in children

Because of the rarity of child donors, in cases of adult donors room requirement for the liver graft is a major technical obstacle to liver transplantation in children. To overcome this difficulty in a child, the authors performed an orthotopic transplantation with an adult liver that had been reduced to the left lobe. The absence of technically-related complications suggests that this procedure might facilitate the performance of liver transplantation in children.

Hepatic resection

In the four years between the beginning of 1979 and the end of 1982, 23 hepatic resections have been carried out for tumours, trauma, biliary access, cystic disease of the liver and spontaneous rupture. There have been four deaths amongst these 23 patients. The 23 resections were performed on 68 patients referred for possible surgery on their hepatic lesions. Right-sided hepatic resections and resections carried out under emergency circumstances were found to carry a significantly higher risk than all other resections. Of the various organ imaging methods available for assessment of hepatic tumours, CT scanning seems to be the most powerful. Liver surgery is probably best done in a limited number of units prepared to implement appropriate protocols of investigation and surgical management.