How I do it: bi-segmentectomy V-VIII as alternative to right hepatectomy: an intrahepatic approach.
Machado MA, Herman P, Meirelles RF Jr, Bacchella T, Machado MC
J Surg Oncol. 2005 Apr 1;90(1):43-5.



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Among several types of liver resection, bi-segmentectomy V-VIII is one of the most difficult to perform. The main drawback of this technique is a complex dissection of hilar plate including individual identification of arterial, portal and bile duct branches of right anterior segments (V and VIII). We have recently described a modification of the intrahepatic posterior technique with a standardized way to identify and isolate the glissonian sheaths. The intrahepatic approach to glissonian pedicles is a useful step to make easier and safer this formerly complex procedure and permits the complete anatomical delineation of all liver segments. This technique allows the removal of individual hepatic segments leaving enough functioning liver. The authors describe the intrahepatic technique for bi-segmentectomy V-VIII and their experience in 8 patients with small left liver, steathotic liver or bilateral lesions that otherwise would result in hazardous or extensive liver resection.