Laparoscopic Anatomical Resection of Segment 7 Extended to the Right Hepatic Vein

Daniel Cherqui, MD; Andrea Laurenzi, MD; Massimo Giacca, MD

Product Details
Product ID: ACS-5607
Year Produced: 2018
Length: 9 min.


We present the case of a 44 year-old man that discovered in May 2017 a right colon cancer with a synchronous liver metastasis in segment 7 next to right hepatic vein. He underwent right colectomy who found colon adenocarcinoma pT4N2 (6/26). After colonic surgery he received 6 cycles of Folfox-Bevacizumab. The revaluation showed a stable liver metastasis with a persistent contact with the right hepatic vein. The patient was scheduled for laparoscopic anatomical resection of segment 7 extended to the right hepatic vein. The patient was placed in a left lateral position. We used three 10-12 mm trocars and two 5 mm trocars. The operation was started with the mobilization of right liver until exposure of the anterior surface of vena cava. Hepatic pedicle and right hepatic vein were controlled for vascular clamping. Hepatectomy was conducted under 4 intermittent pedicle clamping (total duration 60 minutes) associated to 2 right hepatic vein clampings. Liver transection was conducted using an energy-based device, an ultrasound dissector and a bipolar forceps. Right hepatic vein was intraparenchymally controlled with clips and extraparenchymally with a vascular GIA. The glissonian pedicle was controlled with a vascular GIA. The specimen was extracted through one of the trocars' incision with an endo-bag. Operative time was 240 min, blood loss 300 cc with no intraoperative transfusions. Postoperative course was uneventful and patient was discharged on 5th post-operative day. Pathological report confirmed the colorectal liver metastasis with 90% necrosis and a R0 resection. Patient is alive with no recurrence 6 months after surgery.