Standardized technique for segmental right liver resections.
Machado, M.A.C.; Herman, P.; Machado, M.C.C.
Arch. Surg. 138:918-920, 2003.



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The indications for segmental liver resections are increasing. This type of procedure can be done by deep wedge transparenchymal transection or by the intrahepatic approach reaching the portal pedicle through hilar plate. The authors devised a systematized way to perform such operation. Design: Original surgical technique. Patients and Methods: The technique consists in perform three small incisions around hilar plate. In a standardized way, it is possible to reach the right posterior and anterior sheaths combining these incisions. This technique was used in 14 consecutive right segmental liver resections between July 2001 and July 2002. There were eight men and 6 women with mean age of 55 years. Seven patients presented liver metastasis, three primary liver cancer, three benign lesions and one gallbladder cancer. Results: Right segmental liver resection was feasible using the proposed technique in every patient of this series. Intraoperative blood loss was minimal in all cases and eleven patients did not require blood transfusion. There was no postoperative death. Conclusions: This operative procedure standardizes the intrahepatic approach to the right portal pedicle for right segmental resections. It may reduce the bleeding at the site of hilar plate incisions, the need for main hepatic pedicle clamping and may facilitate the recognition of right posterior and anterior sheaths, with excellent immediate results.