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Senne M, Sgourakis G, Molmenti EP, Schroeder T, Beckebaum S, Nadalin S, Malagó M, Radtke A. Portal and Hepatic Venous Territorial Mapping in Healthy Human Livers: Virtual Three-Dimensional Computed Tomography Size-Shape-Topography Study. EXP CLIN TRANSPLANT 2022; 20:826-834. [DOI: 10.6002/ect.2022.0053] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
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Borhani AA, Elsayes KM, Catania R, Kambadakone A, Furlan A, Kierans AS, Kamath A, Harmath C, Horvat N, Humar A, Kielar AZ. Imaging Evaluation of Living Liver Donor Candidates: Techniques, Protocols, and Anatomy. Radiographics 2021; 41:1572-1591. [PMID: 34597229 PMCID: PMC9478886 DOI: 10.1148/rg.2021210012] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2021] [Revised: 04/05/2021] [Accepted: 04/13/2021] [Indexed: 12/17/2022]
Abstract
The need for liver transplants is increasing because the prevalence of liver diseases and the indications for transplants are growing. In response to the shortage of grafts from deceased donors, more transplants are being performed worldwide with grafts from living donors. Radiologic evaluation is an integral component in the assessment of donor candidates to ensure their eligibility and to choose the most appropriate surgical approach. MRI is the preferred modality for evaluation of the liver parenchyma and biliary tree. In most centers, a combination of MRI and CT is used to take advantage of the higher spatial resolution of CT for evaluation of arteries. However, MRI-only assessment is feasible. In addition to assessment of the liver parenchyma for abnormalities such as steatosis, a detailed evaluation of the hepatic vascular and biliary system for pertinent anatomic variants is crucial, because these variants can affect surgical techniques and outcomes in both recipients and donors. In this pictorial article, after a brief review of the most common surgical techniques and postsurgical liver anatomy, the biliary and vascular anatomy are discussed, with specific attention paid to the variants that are pertinent to this surgical procedure. The roles of liver segmentation and volumetric assessment and current imaging techniques and protocols are also discussed. Online supplemental material is available for this article. ©RSNA, 2021.
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Affiliation(s)
- Amir A. Borhani
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Khaled M. Elsayes
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Roberta Catania
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Avinash Kambadakone
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Alessandro Furlan
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Andrea S. Kierans
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Amita Kamath
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Carla Harmath
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Natally Horvat
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Abhinav Humar
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
| | - Ania Z. Kielar
- From the Department of Radiology, Northwestern University Feinberg
School of Medicine, 676 N Saint Clair St, Arkes Family Pavilion, Suite 800,
Chicago, IL 60611 (A.A.B., R.C.); Departments of Radiology (A.A.B., A.F.) and
Surgery (A.H.), University of Pittsburgh School of Medicine, Pittsburgh, Pa;
Department of Diagnostic Radiology, The University of Texas MD Anderson Cancer
Center, Houston, Tex (K.M.E.); Department of Radiology, Massachusetts General
Hospital, Harvard Medical School, Boston, Mass (A. Kambadakone); Department of
Radiology, Weill Cornell Medical Center, New York, NY (A.S.K.); Department of
Radiology, Icahn School of Medicine at Mount Sinai, New York, NY (A. Kamath);
Department of Radiology, University of Chicago School of Medicine, Chicago, Ill
(C.H.); Department of Radiology, Memorial Sloan Kettering Cancer Center, New
York, NY, and Department of Radiology, University of São Paulo,
São Paulo, Brazil (N.H.); and Department of Radiology, University of
Toronto, Toronto, Ontario, Canada (A.Z.K.)
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Cawich SO, Naraynsingh V, Pearce NW, Deshpande RR, Rampersad R, Gardner MT, Mohammed F, Dindial R, Barrow TA. Surgical relevance of anatomic variations of the right hepatic vein. World J Transplant 2021; 11:231-243. [PMID: 34164298 PMCID: PMC8218342 DOI: 10.5500/wjt.v11.i6.231] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/09/2021] [Revised: 03/18/2021] [Accepted: 05/20/2021] [Indexed: 02/06/2023] Open
Abstract
BACKGROUND Variations in the anatomy of hepatic veins are of interest to transplant surgeons, interventional radiologists, and other medical practitioners who treat liver diseases. The drainage patterns of the right hepatic veins (RHVs) are particularly relevant to transplantation services.
AIM The aim was to identify variations of the patterns of venous drainage from the right side of the liver. To the best of our knowledge, there have been no reports on RHV variations in in a Caribbean population.
METHODS Two radiologists independently reviewed 230 contrast-enhanced computed tomography scans performed in 1 year at a hepatobiliary referral center. Venous outflow patterns were observed and RHV variants were described as: (1) Tributaries of the RHV; (2) Variations at the hepatocaval junction (HCJ); and (3) Accessory RHVs.
RESULTS A total of 118 scans met the inclusion criteria. Only 39% of the scans found conventional anatomy of the main hepatic veins. Accessory RHVs were present 49.2% and included a well-defined inferior RHV draining segment VI (45%) and a middle RHV (4%). At the HCJ, 83 of the 118 (70.3%) had a superior RHV that received no tributaries within 1 cm of the junction (Nakamura and Tsuzuki type I). In 35 individuals (29.7%) there was a short superior RHV with at least one variant tributary. According to the Nakamura and Tsuzuki classification, there were 24 type II variants (20.3%), six type III variants (5.1%) and, five type IV variants (4.2%).
CONCLUSION There was significant variation in RHV patterns in this population, each with important relevance to liver surgery. Interventional radiologists and hepatobiliary surgeons practicing in the Caribbean must be cognizant of these differences in order to minimize morbidity during invasive procedures.
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Affiliation(s)
- Shamir O Cawich
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Vijay Naraynsingh
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Neil W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton SO16 6YD, United Kingdom
| | - Rahul R Deshpande
- Department of Surgery, Manchester Royal Infirmary, Manchester M13 9WL, United Kingdom
| | - Robbie Rampersad
- Department of Radiology, University of the West Indies, St. Augustine 000000, Trinidad and Tobago
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Michael T Gardner
- Section of Anatomy, Basic Medical Sciences, University of the West Indies, Kingston 000000, Jamaica
| | - Fawwaz Mohammed
- Department of Surgery, University of the West Indies, St Augustine 000000, Trinidad and Tobago
- Department of Surgery, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Roma Dindial
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
| | - Tanzilah Afzal Barrow
- Department of Radiology, Port of Spain General Hospital, Port of Spain 000000, Trinidad and Tobago
- Department of Radiology, University of the West Indies, St Augustine 000000, Trinidad and Tobago
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Cawich SO, Johnson P, Gardner MT, Pearce NW, Sinanan A, Gosein M, Shah S. Venous drainage of the left liver: an evaluation of anatomical variants and their clinical relevance. Clin Radiol 2020; 75:964.e1-964.e6. [PMID: 32958222 DOI: 10.1016/j.crad.2020.07.039] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2020] [Accepted: 07/02/2020] [Indexed: 11/17/2022]
Abstract
AIM To evaluate the variations in venous drainage from the left liver. MATERIALS AND METHODS A retrospective evaluation was performed of all consecutive abdominal computed tomography (CT) examinations at a tertiary referral facility between 1 January and 30 June 2018. Osirix (Pixmeo SARL, Bernex, Switzerland) was used to examine the major hepatic veins and their tributaries in each scan. The classification of variants as proposed by Nakamura and Tsuzuki was used to describe the findings. The following information was collected: ramification pattern, number, length and diameter of middle (MHV) and left (LHV) hepatic vein tributaries. Two researchers collected data independently, and the average measurements were used as the final dimensions. RESULTS Of 102 examinations evaluated, only 27 demonstrated the conventional venous drainage patterns. The LHV and MHV combined to form a common trunk that emptied into the inferior vena cava (IVC) in 75 (73.5%) cases. The common trunk had a mean length of 8.89 mm and mean diameter of 20.18 mm. Other patterns included Nakamura and Tsuzuki type I (27.5%), type II (29.4%) and type III variants (16.7%). In addition, 4.9% of patients had absent superior middle veins and 80% had supernumerary short hepatic veins (4%). CONCLUSION Only 26.5% of patients in this population had conventional venous drainage from the left liver. Surgeons and radiologists in hepatobiliary practice should be aware of these variants in order to minimise morbidity when performing invasive procedures.
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Affiliation(s)
- S O Cawich
- Department of Surgery, General Hospital, Port of Spain, Trinidad and Tobago.
| | - P Johnson
- Department of Surgery, Radiology, Anaesthetics and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - M T Gardner
- Department of Basic Medical Sciences, University of the West Indies, Mona Campus, Kingston 7, Jamaica
| | - N W Pearce
- University Surgical Unit, Southampton General Hospital, Southampton, UK
| | | | - M Gosein
- Department of Surgery, General Hospital, Port of Spain, Trinidad and Tobago
| | - S Shah
- Department of Surgery, Radiology, Anaesthetics and Intensive Care, Faculty of Medical Sciences, University of the West Indies, Mona Campus, Kingston 7, Jamaica
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Ozbilgin M, Unek T, Egeli T, Agalar C, Ozkardeşler S, Altay C, Astarcioglu I. Comparison of Patients With and Without Anterior Sector Venous Drainage in Right Lobe Liver Transplantation From Live Donors in Terms of Complications, Rejections, and Graft Survival: Single-Center Experience. Transplant Proc 2019; 51:1127-1133. [PMID: 31101185 DOI: 10.1016/j.transproceed.2019.01.103] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/23/2018] [Accepted: 01/21/2019] [Indexed: 12/28/2022]
Abstract
AIM The issue of performing an anastomosis of the anterior sector veins to the vena cava in living donor liver transplantation is still controversial. We aimed to research whether there was any difference in terms of complications, rejections, and graft survival between patients with and without anterior sector venous drainage to the vena cava. PATIENTS AND METHODS Patients were retrospectively investigated for demographic data and ratio of graft needed to available graft weight. Donors had volumetric calculations and middle hepatic vein anterior sector drainage documented in detail. RESULTS Seventy-three donors with middle hepatic vein drainage were included. Thirty-five had anterior sector venous drainage performed and 38 patients did not have drainage procedures performed. The incidence of general complications was higher in the group without anterior sector drainage (78.3% and P = .002). Biloma linked to bile leaks were observed in 8 patients without drainage (72.8%) and 3 patients with drainage (27.2%). Late acute rejection occurring during follow up after transplantation was identified in 28 patients (11.6%). Of these, 1 (14.3%) had anterior sector drainage and 6 (85.7%) were in the patient group without drainage (P = .067). CONCLUSION As a result of this study, for patients with grafts at the volume limit (graft weight to receiver weight ratio <0.8) and with congestion observed in the anterior sector after liver implantation and for patients with outflow problems identified on Doppler ultrasonography, anterior sector veins >5 mm should definitely be drained into the vena cava. Hence, both complication and rejection rates will reduce, and we can lengthen the graft, and thus patient, survival.
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Affiliation(s)
- M Ozbilgin
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey.
| | - T Unek
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - T Egeli
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - C Agalar
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - S Ozkardeşler
- Department of Anesthesiology and Reanimation, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - C Altay
- Department of Radiology, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
| | - I Astarcioglu
- Department of General Surgery, Faculty of Medicine, Dokuz Eylül University, İzmir, Turkey
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Conceptual framework of middle hepatic vein anatomy as a roadmap for safe right hepatectomy. HPB (Oxford) 2019; 21:43-50. [PMID: 30266496 DOI: 10.1016/j.hpb.2018.01.002] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2017] [Revised: 12/21/2017] [Accepted: 01/03/2018] [Indexed: 12/12/2022]
Abstract
BACKGROUND While the middle hepatic vein (MHV) guides parenchymal transection during right hepatectomy, its most proximal tributaries can be difficult to identify, and injury to its tributaries can be a source of major bleeding. METHOD Following simulation modeling of right hepatectomy, reconstructed MHV data was pooled from 40 patients. MHV-tributaries and MHV-relationship to the portal pedicle were mapped out to facilitate their identification from the beginning of parenchymal transection. RESULTS Hotspots for injury were identified: A median of 1 (1-3) tributaries draining segment 5 (V5) were within 45-90mm from the MHV termination, and 16mm above and 22mm caudal to the portal trunk. Simulation demonstrated a constant anatomic relationship between portal pedicle and the proximal MHV. A median of 2 (0-4) tributaries draining segment 8 (V8) were located 9-35mm from the MHV termination. This information was compiled into an "MHV-road-map" demonstrating 86% of the MHV tributaries at risk for significant bleeding are within 15mm of the MHV, while only thin tributaries are located in the outer area. CONCLUSIONS The MHV-road-map led to a peripheral-to-central parenchymal transection approach to minimize the risk of MHV-injury thereby reducing bleeding during open and minimally invasive right hepatectomy.
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Cazauran JB, Pâris L, Rousset P, Mercier F, Kepenekian V, Viste A, Passot G. Anatomy of the Right Anterior Sector of the Liver and Its Clinical Implications in Surgery. J Gastrointest Surg 2018; 22:1819-1831. [PMID: 29916108 DOI: 10.1007/s11605-018-3831-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/10/2018] [Accepted: 05/29/2018] [Indexed: 01/31/2023]
Abstract
BACKGROUND Surgery remains the gold standard both for delimited hepatocellular carcinoma by selective anatomic liver segentectomy and for colorectal liver metastases by parenchymal sparing liver resection. Right anterior sector (RAS) (segments V-VIII; Couinaud) is the largest and most difficult sector to operate on. A better knowledge of its segmentation could prevent postoperative remnant liver ischemia and its impacts on patient's survival. METHODS A literature search was conducted in PubMed for papers on anatomy and surgery of the right anterior sector. RESULTS Segmentation of the RAS depended of the anatomic variations of the third-order portal branches. Cranio-caudal segmentation was the most commonly found (50-53%), followed by ventro-dorsal (23-26%), trifurcation (13-20%), and quadrifurcation types (5-11%). Ventral and dorsal partial or total subsegmentectomy seemed accessible in 47 to 50% of patients, including bifurcation, trifurcation, and quadrifurcation types, and could spare up to 22% of the total liver volume. The RAS hepatic vein was present in 85-100% of the patients and could be used as a landmark between RAS dorsal and ventral part in 63% of patients. Reported overall morbidity rate of RAS subsegmentectomy ranged from 33 to 59% among studies with a postoperative major complication rate (Clavien-Dindo ≥ III) ranging around 18% and a biliary leakage rate from 16 to 21%. In-hospital reported mortality rate was low (0-3%), and results were comparable to "classic" liver resections. RAS subsegmentectomy remains a complex procedure; median operating time ranged from 253 to 520 min and median intraoperative blood loss reached 1255 ml. CONCLUSION Better knowledge of RAS anatomy could allow for parenchymal preservation by using subsegmentectomy of the RAS, selective or as a part of a major hepatectomy.
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Affiliation(s)
- Jean-Baptiste Cazauran
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Lucas Pâris
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Pascal Rousset
- Hospices Civils de Lyon, Department of Radiology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France.,EMR 3738, Claude Bernard University, Lyon 1, Lyon, France
| | - Frédéric Mercier
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Vahan Kepenekian
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Anthony Viste
- Faculté de Médecine Lyon Sud-Charles Mérieux, Laboratoire d'Anatomie, Université de Lyon, Chemin du Petit Revoyet, 69600, Oullins, France.,Department of Orthopaedic Surgery, Hospices Civils de Lyon, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France
| | - Guillaume Passot
- Hospices Civils de Lyon, Department of Surgical Oncology, Centre Hospitalier Lyon Sud, 165 Chemin du Grand Revoyet, 69310, Pierre Benite, France. .,EMR 3738, Claude Bernard University, Lyon 1, Lyon, France.
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Goja S, Kumar Yadav S, Singh Soin A. Readdressing the Middle Hepatic Vein in Right Lobe Liver Donation: Triangle of Safety. Liver Transpl 2018; 24:1363-1376. [PMID: 30359489 DOI: 10.1002/lt.25289] [Citation(s) in RCA: 12] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/13/2018] [Revised: 04/30/2018] [Accepted: 05/16/2018] [Indexed: 02/07/2023]
Abstract
For equipoising donor safety and optimal recipient outcomes, we adopted an algorithmic "triangle of safety" approach to retrieve 3 types of right lobe liver grafts (RLGs), namely, the modified extended right lobe graft (MERLG), the partial right lobe graft (PRLG), and the modified right lobe graft (MRLG). Reconstruction to achieve a single wide anterior sector outflow was ensured in all patients. We present donor and recipient outcomes based on our approach in 665 right lobe (RL) living donor liver transplantations (LDLTs) performed from January 2013 to August 2015. There were 347 patients who received a MERLG, 117 who received a PRLG, and 201 who received a MRLG. A right lobe graft (RLG) with a middle hepatic vein was retrieved only in 3 out of 18 donors with steatosis >10%. Cold ischemia time was significantly more and remnant volume was less in the MRLG group. Of the donors, 29.3% had complications (26% Clavien-Dindo grade I, II) with no statistically significant difference among the groups. The Model for End-Stage Liver Disease score was higher in the MERLG group. There were 34 out of 39 with a graft-to-recipient weight ratio (GRWR) of <0.7% who received a MERLG with inflow modulation. Out of 4 patients who developed small-for-size syndrome in this group, 2 died. The 90-day patient survival rate was similar among different GRWRs and types of RLG. In conclusion, a selective and tailored approach for RL donor hepatectomy based on optimal functional volume and metabolic demands not only addresses the key issue of double equipoise in LDLT but also creates a safe path for extending the limits.
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Affiliation(s)
- Sanjay Goja
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Delhi, India
| | - Sanjay Kumar Yadav
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Delhi, India
| | - Arvinder Singh Soin
- Institute of Liver Transplantation and Regenerative Medicine, Medanta-The Medicity, Gurgaon, Delhi, India
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Goja S, Yadav SK, Roy R, Soin AS. A retrospective comparative study of venous vs nonringed expanded polytetrafluoroethylene extension grafts for anterior sector outflow reconstruction in right lobe living donor liver transplantation. Clin Transplant 2018; 32:e13344. [DOI: 10.1111/ctr.13344] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/25/2018] [Revised: 06/04/2018] [Accepted: 07/04/2018] [Indexed: 12/13/2022]
Affiliation(s)
- Sanjay Goja
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
| | - Sanjay K. Yadav
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
| | - Rahul Roy
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
| | - Arvinder S. Soin
- Institute of Liver Transplantation and Regenerative Medicine; Medanta - The Medicity; Gurgaon, Delhi (NCR) India
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Tani K, Shindoh J, Akamatsu N, Arita J, Kaneko J, Sakamoto Y, Hasegawa K, Kokudo N. Venous drainage map of the liver for complex hepatobiliary surgery and liver transplantation. HPB (Oxford) 2016; 18:1031-1038. [PMID: 27665239 PMCID: PMC5144551 DOI: 10.1016/j.hpb.2016.08.007] [Citation(s) in RCA: 32] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/18/2016] [Revised: 08/14/2016] [Accepted: 08/29/2016] [Indexed: 02/06/2023]
Abstract
BACKGROUND Inflow and outflow patency of the liver parenchyma is required to maximize the metabolic function of the liver. However, the definition and distribution of hepatic venous drainage regions has yet to be reported. The aim of this study was to define major hepatic venous tributaries and investigate the mean drainage volume of each territory. METHODS Three-dimensional (3D) simulations from the livers of 100 healthy donors were reviewed for living donor liver transplantation to determine the distribution of the significant hepatic venous tributaries and the drainage patterns of each segment. RESULTS The left hepatic vein (LHV), middle hepatic vein (MHV), and right hepatic vein (RHV) contributed a mean drainage of 20.7%, 32.7%, and 39.6% of the entire liver, respectively. Accessory hepatic veins accounted for remaining 7.0%. The middle right hepatic vein (MRHV) and inferior right hepatic vein (IRHV) accounted for a mean total drainage of 8.0% and 10.6%, respectively, when they present. In addition, major tributaries of hepatic veins were clearly detected, and their typical distributions were described. CONCLUSIONS Knowledge of hepatic venous territories is necessary for complex hepatobiliary surgery. This "venous drainage map" may provide useful information for complex liver surgery and transplantation.
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Affiliation(s)
- Keigo Tani
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Junichi Shindoh
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan; Hepatobiliary-Pancreatic Surgery Division, Department of Digestive Surgery, Toranomon Hospital, Japan.
| | - Nobuhisa Akamatsu
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Junichi Arita
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Junichi Kaneko
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Yoshihiro Sakamoto
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Kiyoshi Hasegawa
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan
| | - Norihiro Kokudo
- Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Japan.
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Neumann JO, Giese H, Nagel AM, Biller A, Unterberg A, Meinzer HP. MR Angiography at 7T to Visualize Cerebrovascular Territories. J Neuroimaging 2016; 26:519-24. [PMID: 27074967 DOI: 10.1111/jon.12348] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2016] [Accepted: 02/28/2016] [Indexed: 11/27/2022] Open
Abstract
BACKGROUND There is considerable amount of interindividual variability in the size and location of the vascular territories of the major brain arteries. More data are needed to assess the amount of variability and the possible implications for further research and patient care. Arterial spin labeling (ASL) magnetic resonance imaging has been applied in various forms to facilitate noninvasive imaging of cerebrovascular flow territories, but it requires the definition of the flow territory of interest prior to image acquisition. OBJECTIVE Assessing the vascular territories of the major brain territories by using ultra-high-field time-of-flight (TOF) magnetic resonance angiography. METHODS We have developed an alternative method to ASL by simulating cerebrovascular dye injections. Following bias field normalization and segmentation of the vessels from 7 Tesla TOF imaging, a virtual model of the arterial vessel tree was generated and a simulation of dye dispersion into the brain tissue was performed. RESULTS The results provided by our method are consistent with the data obtained by autoptic dye injection studies in 23 human beings by van der Zwan in 1993. CONCLUSION Further technical improvements in imaging and segmentation techniques will improve the accuracy of the method and will facilitate the delineation of flow territories after image acquisition on even smaller subtrees of the cerebral vasculature.
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Affiliation(s)
- Jan-Oliver Neumann
- Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Henrik Giese
- Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Armin M Nagel
- Department of Medical Physics in Radiology, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
| | - Armin Biller
- Department of Neuroradiology, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Andreas Unterberg
- Department of Neurosurgery, University Hospital Heidelberg, Im Neuenheimer Feld 400, 69120, Heidelberg, Germany
| | - Hans-Peter Meinzer
- Division Medical and Biological Informatics, German Cancer Research Center, Im Neuenheimer Feld 280, 69120, Heidelberg, Germany
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Mokry T, Bellemann N, Müller D, Lorenzo Bermejo J, Klauß M, Stampfl U, Radeleff B, Schemmer P, Kauczor HU, Sommer CM. Accuracy of estimation of graft size for living-related liver transplantation: first results of a semi-automated interactive software for CT-volumetry. PLoS One 2014; 9:e110201. [PMID: 25330198 PMCID: PMC4201494 DOI: 10.1371/journal.pone.0110201] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/04/2013] [Accepted: 09/17/2014] [Indexed: 12/14/2022] Open
Abstract
OBJECTIVES To evaluate accuracy of estimated graft size for living-related liver transplantation using a semi-automated interactive software for CT-volumetry. MATERIALS AND METHODS Sixteen donors for living-related liver transplantation (11 male; mean age: 38.2±9.6 years) underwent contrast-enhanced CT prior to graft removal. CT-volumetry was performed using a semi-automated interactive software (P), and compared with a manual commercial software (TR). For P, liver volumes were provided either with or without vessels. For TR, liver volumes were provided always with vessels. Intraoperative weight served as reference standard. Major study goals included analyses of volumes using absolute numbers, linear regression analyses and inter-observer agreements. Minor study goals included the description of the software workflow: degree of manual correction, speed for completion, and overall intuitiveness using five-point Likert scales: 1--markedly lower/faster/higher for P compared with TR, 2--slightly lower/faster/higher for P compared with TR, 3--identical for P and TR, 4--slightly lower/faster/higher for TR compared with P, and 5--markedly lower/faster/higher for TR compared with P. RESULTS Liver segments II/III, II-IV and V-VIII served in 6, 3, and 7 donors as transplanted liver segments. Volumes were 642.9±368.8 ml for TR with vessels, 623.8±349.1 ml for P with vessels, and 605.2±345.8 ml for P without vessels (P<0.01). Regression equations between intraoperative weights and volumes were y = 0.94x+30.1 (R2 = 0.92; P<0.001) for TR with vessels, y = 1.00x+12.0 (R2 = 0.92; P<0.001) for P with vessels, and y = 1.01x+28.0 (R2 = 0.92; P<0.001) for P without vessels. Inter-observer agreement showed a bias of 1.8 ml for TR with vessels, 5.4 ml for P with vessels, and 4.6 ml for P without vessels. For the degree of manual correction, speed for completion and overall intuitiveness, scale values were 2.6±0.8, 2.4±0.5 and 2. CONCLUSIONS CT-volumetry performed with P can predict accurately graft size for living-related liver transplantation while improving workflow compared with TR.
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Affiliation(s)
- Theresa Mokry
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Nadine Bellemann
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Dirk Müller
- Philips Healthcare Germany, Hamburg, Germany
| | - Justo Lorenzo Bermejo
- Department of Medical Biometry and Informatics, University Hospital Heidelberg, Heidelberg, Germany
| | - Miriam Klauß
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Ulrike Stampfl
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Boris Radeleff
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Peter Schemmer
- Department of General and Transplant Surgery, University Hospital Heidelberg, Heidelberg, Germany
| | - Hans-Ulrich Kauczor
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
| | - Christof-Matthias Sommer
- Department of Diagnostic and Interventional Radiology, University Hospital Heidelberg, Heidelberg, Germany
- * E-mail:
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Faitot F, Vibert E, Salloum C, Gorden DL, Coscas F, Adam R, Castaing D. Importance of conserving middle hepatic vein distal branches for homogeneous regeneration of the left liver after right hepatectomy. HPB (Oxford) 2012; 14:746-53. [PMID: 23043663 PMCID: PMC3482670 DOI: 10.1111/j.1477-2574.2012.00514.x] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
BACKGROUND Liver regeneration enables repeat surgical procedures to achieve a potential cure in liver cancer patients. However, data regarding segmental regeneration and liver anatomy after liver resection are scarce. This study examined left liver regeneration after right hepatectomy and the impact of hepatic venous drainage on the regeneration of the paramedian sector (Couinaud's segment IV). METHODS Twenty patients in whom right hepatectomy with conservation of the middle hepatic vein (MHV) on healthy liver had been performed were analysed for segmental volumes and vascular anatomy. Volumetric analysis of left liver segments and three-dimensional MHV reconstruction were conducted using pre- and postoperative computed tomography. The volumetric proportions represented by each segment within the left liver were compared and MHV anatomy was analysed to determine its potential role in the regeneration of left liver segments. RESULTS After right hepatectomy, the proportion represented by segment IV within the left liver decreases by 13%, whereas the proportion represented by segments II and III increases by 15%. This heterogeneous regeneration is particularly observed in patients in whom a venous branch for segment IVb is sacrificed, leading to an altered outflow similar to that observed in MHV deprivation. The risk for venous branch deprivation in IVb is correlated to the depth of the bifurcation of the MHV in liver parenchyma. CONCLUSIONS It is crucial to conserve the MHV in its distal part if homogeneous left liver regeneration after right hepatectomy that will allow potential repeat liver resection is to be achieved.
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Affiliation(s)
| | - Eric Vibert
- Hepatobiliary CentreVillejuif, France,Unit 785, INSERM, University of Paris SouthVillejuif, France
| | | | - David Lee Gorden
- Hepatobiliary CentreVillejuif, France,Department of Surgery, Vanderbilt University Medical CenterNashville, TN, USA
| | - Franck Coscas
- Department of Radiology, Paul Brousse HospitalVillejuif, France
| | - René Adam
- Hepatobiliary CentreVillejuif, France,Unit 785, INSERM, University of Paris SouthVillejuif, France
| | - Denis Castaing
- Hepatobiliary CentreVillejuif, France,Unit 785, INSERM, University of Paris SouthVillejuif, France
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Radtke A, Sotiropoulos GC, Sgourakis G, Molmenti EP, Schroeder T, Saner FH, Beckebaum S, Schenk A, Lang H, Broelsch CE, Malagó M. “Anatomical” versus “Territorial” Belonging of the Middle Hepatic Vein: Virtual Imaging and Clinical Repercussions. J Surg Res 2011; 166:146-55. [DOI: 10.1016/j.jss.2009.07.042] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/23/2009] [Revised: 06/09/2009] [Accepted: 07/02/2009] [Indexed: 11/26/2022]
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16
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Uchida K, Taniguchi M, Shimamura T, Suzuki T, Yamashita K, Ota M, Kamiyama T, Matsushita M, Furukawa H, Todo S. Three-dimensional computed tomography scan analysis of hepatic vasculatures in the donor liver for living donor liver transplantation. Liver Transpl 2010; 16:1062-8. [PMID: 20818744 DOI: 10.1002/lt.22109] [Citation(s) in RCA: 38] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
Because hepatic vasculatures exhibit variations, a preoperative evaluation of the vascular anatomy and an estimation of the volume of the liver graft are essential for successful adult living donor liver transplantation. Using 3-dimensional (3D) computed tomography (CT), we analyzed the volumetric and anatomical relationship of the hepatic vasculatures of liver grafts. The livers of 223 potential donors were analyzed by 3D CT. Volumetric analysis was performed for each hepatic vein and its tributaries. The anatomy of the portal vein and hepatic artery was assessed along with the biliary system via intraoperative cholangiography in 110 recipients. On the basis of the anatomical presentation of the inferior right hepatic vein (IRHV), the hepatic veins were classified as follows: in type I, the IRHV was absent; in type II, the IRHV was smaller than the right hepatic vein (RHV); and in type III, the IRHV was greater than or equal to the RHV in size. The drainage volume of the middle hepatic vein (MHV) and especially its tributaries in the right lobe increased with the size of the IRHV (P < 0.001). In type III hepatic veins with a large IRHV (17% of the donors), the MHV tributaries had the largest drainage volume in the right lobe (41.2% +/- 11.8%). Furthermore, type III hepatic veins typically exhibited biliary variations in 75% of the donors. No correlation was observed between variations in the hepatic artery and portal vein. In conclusion, a right lobe graft with a large IRHV is accompanied by a large drainage volume via the MHV and by bile duct variations in 17% of livers. Therefore, anatomical and volumetric analysis is important for preoperative evaluations.
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Affiliation(s)
- Koichiro Uchida
- Department of General Surgery, Graduate School of Medicine, Hokkaido University, Sapporo, Japan
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Hepatic venous drainage: how much can we learn from imaging studies? Anatomic-functional classification derived from three-dimensional computed tomography reconstructions. Transplantation 2010; 89:1518-25. [PMID: 20410853 DOI: 10.1097/tp.0b013e3181dd6bac] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/21/2022]
Abstract
BACKGROUND The knowledge of "venous dominance" is essential to prevent serious venous congestion in live donor liver transplantation and extended liver resections. AIMS The purpose of our study was to delineate our proposed anatomic-functional classification of hepatic venous drainage. METHODS One hundred forty consecutive live liver donor candidates underwent three-dimensional computed tomography reconstructions and three-dimensional virtual hepatectomies. Five different venous dominance types were defined on drainage volumes or territories. "Risky" configurations were identified and classified. RESULTS The right hepatic vein (RHV) was dominant for the entire liver and right hemiliver (RHH) in most (83.5%) cases irrespective of the presence of inferior (accessory) hepatic veins (IHVs). The middle hepatic vein (MHV) was dominant for the total liver (TL) in 15.5% of cases and for the RHH in 27% of cases. The left hepatic vein was almost always (92%) dominant for the left hemiliver. When associated with a large IHV drainage volume, a RHV/IHV complex dominant for the TL led to a RHH dominant MHV (mean 59.5%RHH) if the IHV was not reconstructed. CONCLUSIONS Our proposed anatomic-functional classification provides a valuable insight into hepatic vein dominance patterns. RHH venous drainage patterns at "high risk" for venous congestion include (1) a dominant MHV for the TL and (2) a dominant RHV/IHV complex with a large IHV drainage volume.
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18
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Radtke A, Sgourakis G, Sotiropoulos G, Beckebaum S, Molmenti E, Saner F, Schroeder T, Nadalin S, Schenk A, Lang H, Malagó M, Broelsch C. Donor/recipient algorithm for management of the middle hepatic vein in right graft live donor liver transplantation. Am J Surg 2010; 199:708-15. [DOI: 10.1016/j.amjsurg.2009.03.024] [Citation(s) in RCA: 12] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2009] [Revised: 03/06/2009] [Accepted: 03/06/2009] [Indexed: 10/19/2022]
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How many CT detector rows are necessary to perform adequate three dimensional visualization? Eur J Radiol 2009; 74:e144-8. [PMID: 19559549 DOI: 10.1016/j.ejrad.2009.05.033] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/22/2008] [Accepted: 05/18/2009] [Indexed: 11/23/2022]
Abstract
INTRODUCTION The technical development of computer tomography (CT) imaging has experienced great progress. As consequence, CT data to be used for 3D visualization is not only based on 4 row CTs and 16 row CTs but also on 64 row CTs, respectively. The main goal of this study was to examine whether the increased amount of CT detector rows is correlated with improved quality of the 3D images. MATERIAL AND METHODS All CTs were acquired during routinely performed preoperative evaluation. Overall, there were 12 data sets based on 4 detector row CT, 12 data sets based on 16 detector row CT, and 10 data sets based on 64 detector row CT. Imaging data sets were transferred to the DKFZ Heidelberg using the CHILI teleradiology system. For the analysis all CT scans were examined in a blinded fashion, i.e. both the name of the patient as well as the name of the CT brand were erased. For analysis, the time for segmentation of liver, both portal and hepatic veins as well as the branching depth of portal veins and hepatic veins was recorded automatically. In addition, all results were validated in a blinded fashion based on given quality index. RESULTS Segmentation of the liver was performed in significantly shorter time (p<0.01, Kruskal-Wallis test) in the 16 row CT (median 479 s) compared to 4 row CT (median 611 s), and 64 row CT (median 670 s), respectively. The branching depth of the portal vein did not differ significantly among the 3 different data sets (p=0.37, Kruskal-Wallis test). However, the branching depth of the hepatic veins was significantly better (p=0.028, Kruskal-Wallis test) in the 4 row CT and 16 row CT compared to 64 row CT. The grading of the quality index was not statistically different for portal veins and hepatic veins (p=0.80, Kruskal-Wallis test). Even though the total quality index was better for the vessel tree based on 64 row CT data sets (mean scale 2.6) compared to 4 CT row data (mean scale 3.25) and 16 row CT data (mean scale 3.0), these differences did not reach statistical difference (p=0.53, Kruskal-Wallis test). CONCLUSION Even though 3D visualization is useful in operation planning, the quality of the 3D images appears to be not dependent of the number of CT detector rows.
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Exact CT-based liver volume calculation including nonmetabolic liver tissue in three-dimensional liver reconstruction. J Surg Res 2009; 160:236-43. [PMID: 19765736 DOI: 10.1016/j.jss.2009.04.050] [Citation(s) in RCA: 13] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2008] [Revised: 04/22/2009] [Accepted: 04/30/2009] [Indexed: 12/24/2022]
Abstract
Exact preoperative determination of the liver volume is of great importance prior to hepatobiliary surgery, especially in living donated liver transplantation (LDLT) and extended hepatic resections. Modern surgery-planning systems estimate these volumes from segmented image data. In an experimental porcine study, our aim was (1) to analyze and compare three volume measurement algorithms to predict total liver volume, and (2) to determine vessel tree volumes equivalent to nonmetabolic liver tissue. Twelve porcine livers were examined using a standardized three-phase computed tomography (CT) scan and liver volume was calculated computer-assisted with the three different algorithms. After hepatectomy, livers were weighed and their vascular system plasticized followed by CT scan, CT reconstruction and re-evaluation of total liver and vessel volumes with the three different algorithms. Blood volume determined by the plasticized model was at least 1.89 times higher than calculated by multislice CT scans (9.7% versus 21.36%, P=0.028). Analysis of 3D-CT-volumetry showed good correlation between the actual and the calculated liver volume in all tested algorithms with a high significant difference in estimating the liver volume between Heymsfield versus Heidelberg (P=0.0005) and literature versus Heidelberg (P=0.0060). The Heidelberg algorithm reduced the measuring error with deviations of only 1.2%. The present results suggest a safe and highly predictable use of 3D-volumetry in liver surgery for evaluating liver volumes. With a precise algorithm, the volume of remaining liver or single segments can be evaluated exactly and potential operative risks can therefore be better calculated. To our knowledge, this study implies for the first time a blood pool, which corresponds to nonmetabolic liver tissue, of more than 20% of the whole liver volume.
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Radtke A, Sgourakis G, Sotiropoulos GC, Molmenti EP, Saner FH, Timm S, Malagó M, Lang H. Territorial belonging of the middle hepatic vein in living liver donor candidates evaluated by three-dimensional computed tomographic reconstruction and virtual liver resection. Br J Surg 2009; 96:206-13. [DOI: 10.1002/bjs.6444] [Citation(s) in RCA: 24] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/28/2023]
Abstract
Abstract
Background
Postoperative venous congestion can lead to graft and remnant liver failure in living donor liver transplantation. This study was designed to delineate ‘territorial belonging’ of the middle hepatic vein (MHV) and to identify hepatic venous anatomy at high risk of outflow congestion.
Methods
MHV belonging patterns for right (RHL) and left (LHL) hemilivers were evaluated by three-dimensional computed tomographic reconstruction and virtual hepatectomy in 138 consecutive living liver donor candidates.
Results
The right hepatic vein (RHV) was dominant in 84·1 per cent and an accessory inferior hepatic vein (IHV) was present in 47·1 per cent of livers. Three MHV belonging types were identified for the RHL. Strong and complex MHV types A and C were associated with large RHL venous congestion. The MHV belonged to the LHL in 65·9 per cent, draining 37 per cent of this hemiliver. In virtual liver resections, left MHV type D was a risk category for small left liver remnants.
Conclusion
MHV territorial belonging types A and C were identified as high risk for RHL venous congestion. Their presence should prompt consideration of either inclusion of the MHV with the right graft or reconstruction of its tributaries, and preservation of IHV territory.
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Affiliation(s)
- A Radtke
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
| | - G Sgourakis
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General Surgery, Red Cross Hospital, Athens, Greece
| | - G C Sotiropoulos
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
| | - E P Molmenti
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - F H Saner
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - S Timm
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
| | - M Malagó
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
| | - H Lang
- Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany
- Department of General and Abdominal Surgery, Johannes Gutenberg University Hospital, Mainz, Germany
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Fischer L, Schoebinger M, Neumann JO, Müller S, Meinzer HP, Büchler MW, Schmied BM. Does preoperative analysis of intrahepatic venous anastomoses improve the surgeon's intraoperative decision making? Pilot data from a case report. Patient Saf Surg 2008; 2:19. [PMID: 18718022 PMCID: PMC2542344 DOI: 10.1186/1754-9493-2-19] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/26/2008] [Accepted: 08/21/2008] [Indexed: 11/27/2022] Open
Abstract
Background Three-dimensional (3D) visualization is thought to improve the anatomical understanding of clinicians, thus improving patient safety. Case presentation A 58-year-old male was admitted to our hospital in April 2007 with a suspected metastasis of a sigmoid cancer in the Couinaud segment (CS) 7. The anatomical situation of this patient was analyzed using both a CT scan and 3D images. The initial CT scan revealed that the proximal part of the middle hepatic vein was completely missing and the metastasis in the CS 7 was closely attached to the right hepatic vein. After analyzing additional 3D images, it became clear that due to the close proximity of metastasis and right hepatic vein, the resection of the right hepatic vein was inevitable. Based on this 3D analysis, it was decided to perform a right-sided hemihepatectomy. In this case report, 3D visualization resulted in a faster and clearer understanding of the unique anatomical situation in a patient with complicated liver anatomy than transversal CT images. Conclusion The here presented data shows for the first time 3D visualization of intravenous anastomoses in the human liver. The information offered by 3D visualization is not redundant but rather serves as a true source of additional information, indicating the potential benefit of 3D visualization in surgical operation planning.
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Affiliation(s)
- Lars Fischer
- Department of Surgery, University of Heidelberg, INF 110, D-69120 Heidelberg, Germany.
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Hashimoto M, Beck Y, Hashimoto T, Kokudo N, Makuuchi M. Preservation of thick middle hepatic vein tributary during right paramedian sectoriectomy. Surgery 2007; 141:546-7. [PMID: 17383537 DOI: 10.1016/j.surg.2006.12.007] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2006] [Accepted: 12/20/2006] [Indexed: 10/23/2022]
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Fischer L, Hoffmann K, Neumann JO, Schöbinger M, Grenacher L, Radeleff B, Friess H, Meinzer HP, Büchler MW, Schmidt J, Schemmer P. The Impact of Virtual Operation Planning on Liver Surgery. ACTA ACUST UNITED AC 2007. [DOI: 10.1111/j.1617-0830.2007.00090.x] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
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