The Knowledgement of Hepatic Pedicles For A Safety Hepatic Resection
Eleazar Chaib, MD,PhD,FACS; Francisco Collet e Silva, MD, PhD, FACS; Fabio Quintavalle, MD; Renato Pogetti, MD, PhD, FACS; William Saad, MD, PhD; Ivan Cecconello, MD, PhD
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Experience with liver resection has increased in recent years and so have the indications for segmental resections.Lanouis and Jamieson (1992) described the intrahepatic posterior approach to the structures of the portal triad for right hepatectomy or right-sided segmentectomies. We demonstrated the importance of the glissonians pedicles for a safety hepatectomy or segmentectomy with preservation of normal liver. A 39 year old man, 8 months ago had a resection of an adenocarcinoma of the colo, now with hepatic metastasis at segments VI and VII of the liver. This video help to undestanding the complexities of liver anatomy with identification of all liver segments by the intrahepatic approach of portal triad in a fresh cadaveric man. A segmental resection (segments VI and VII) of the liver was performed by a intrahepatic approach of the posterior segment of the liver in the case described above. The resection of the metastasis located at the posterior segments of the liver was regular and the patient was discharged at 4th postoperative day. The intrahepatic approach to the Glisson pedicle for segmental resections of the liver facilitates surgery and also it may reduce the bleeding at the site of the liver parenchyme incision.