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Ex Vivo Extended Left Hepatectomy with Reconstruction of the Right Hepatic Vein Using a Reversed Portal Vein Graft

Alan Hemming, MD, FACS

Product Details
Product ID: ACS-2530
Year Produced: 2006
Length: 12 min.
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Liver resections that require ex-vivo techniques occur rarely, but when done are generally performed on veno-veno bypass to maintain venous return and decompress the portal circulation during the anhepatic phase of the procedure. A patient with a large centrally placed colorectal liver metastases involving all 3 hepatic veins underwent preoperative chemotherapy. Subsequently an ex-vivo extended left hepatectomy was performed with preservation of the inferior vena cava and the use of a temporary porta caval shunt to eliminate the need for veno-veno bypass. Ex-vivo resection allowed reconstruction of right hepatic vein branches using the patient's reversed portal vein bifurcation as a graft to provide venous outflow. A cryopreserved cadaveric vein graft was also used to reconstruct a large segment 6 vein branch. The patient's peak bilirubin post op was 6 mg/dl. He was discharged home from hospital post operative day 12. The need for ex-vivo liver resection is rare. However, the application of reconstruction techniques developed for liver transplantation to hepatic resection for malignancy allows the liver surgeon to redefine indications for curative surgery and expand the group of patients that may be offered a chance.