Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy
Background When performing a right hepatectomy, the middle hepatic vein (MHV) should guide the parenchymal transection. MHV hotspots for bleeding can be anticipated when applying the previously developed MHV Roadmap to a minimally invasive approach. 1 This video demonstrates application of the MHV R...
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| Veröffentlicht in: | Annals of surgical oncology 2019-01, Vol.26 (1), p.296-296 |
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| creator | Joechle, Katharina Vega, Eduardo A. Okuno, Masayuki Simoneau, Eve Ogiso, Satoshi Newhook, Timothy E. Ramirez, David L. Holmes, A. Alex Soliz, Jose M. Chun, Yun Shin Tzeng, Ching-Wei D. Lee, Jeffrey E. Vauthey, Jean-Nicolas Conrad, Claudius |
| description | Background
When performing a right hepatectomy, the middle hepatic vein (MHV) should guide the parenchymal transection. MHV hotspots for bleeding can be anticipated when applying the previously developed MHV Roadmap to a minimally invasive approach.
1
This video demonstrates application of the MHV Roadmap to perform a safe laparoscopic right hepatectomy.
Patient
A 44-year-old woman with a solitary and large breast cancer liver metastasis in the right liver was considered for a laparoscopic right hepatectomy following an excellent response to neoadjuvant chemotherapy. The MHV anatomy was reconstructed using automated vascular reconstruction software (Synapse, Fuji) ahead of surgery.
Technique
With the patient in the French position, the hilar vessels are exposed and the inflow is controlled. Parenchymal transection begins along the demarcation line.
2
,
3
The constant relationship between the portal bifurcation and the V5 ventral and dorsal allows for easy intraparenchymal identification of the MHV. The parenchymal transection is performed in a convex fashion to optimize exposure of the MHV. Using MHV guidance, the parenchymal transection is continued and V8 is safely identified. The operation is completed with division of the anterior fissure and right hepatic vein.
Conclusion
Outlining the MHV anatomy according to the MHV Roadmap preoperatively helps to anticipate hotspots of bleeding. Guidance along the MHV through the parenchymal transection allows for early identification of tributaries, thereby preventing injury and remnant liver ischemia. |
| doi_str_mv | 10.1245/s10434-018-7034-0 |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_cross</sourceid><recordid>TN_cdi_proquest_miscellaneous_2179229921</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2136320638</sourcerecordid><originalsourceid>FETCH-LOGICAL-c415t-ff63d5b80c242848fea46d7135ed47396db5d83b64079b2fe6b153e1426ca3563</originalsourceid><addsrcrecordid>eNp1kEtLAzEUhYMotlZ_gBsZcONmNO_JLEWqFSpCfWxDJo86ZV4mM4v-e1OmKgiuciDfOffeA8A5gtcIU3YTEKSEphCJNIM7cQCmiEVBuUCHUUMu0hxzNgEnIWwgRBmB7BhMCKScYUynYP5UGlPZZGE71Zc6ebdlk6xaZWrVJa71iUpelLPJUnXKt0G3XYRW5fqjHy1W9229PQVHTlXBnu3fGXi7n7_eLdLl88Pj3e0y1RSxPnWOE8MKATWmWFDhrKLcZIgwa2hGcm4KZgQpOIVZXmBneRHPsYhirhVhnMzA1Zjb-fZzsKGXdRm0rSrV2HYIEqMsxzjPMYro5R900w6-idtFinCCISciUmikdDwueOtk58ta-a1EUO46lmPHMnYsdx1LGD0X--ShqK35cXyXGgE8AiF-NWvrf0f_n_oF7dWEIQ</addsrcrecordid><sourcetype>Aggregation Database</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2136320638</pqid></control><display><type>article</type><title>Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Joechle, Katharina ; Vega, Eduardo A. ; Okuno, Masayuki ; Simoneau, Eve ; Ogiso, Satoshi ; Newhook, Timothy E. ; Ramirez, David L. ; Holmes, A. Alex ; Soliz, Jose M. ; Chun, Yun Shin ; Tzeng, Ching-Wei D. ; Lee, Jeffrey E. ; Vauthey, Jean-Nicolas ; Conrad, Claudius</creator><creatorcontrib>Joechle, Katharina ; Vega, Eduardo A. ; Okuno, Masayuki ; Simoneau, Eve ; Ogiso, Satoshi ; Newhook, Timothy E. ; Ramirez, David L. ; Holmes, A. Alex ; Soliz, Jose M. ; Chun, Yun Shin ; Tzeng, Ching-Wei D. ; Lee, Jeffrey E. ; Vauthey, Jean-Nicolas ; Conrad, Claudius</creatorcontrib><description>Background
When performing a right hepatectomy, the middle hepatic vein (MHV) should guide the parenchymal transection. MHV hotspots for bleeding can be anticipated when applying the previously developed MHV Roadmap to a minimally invasive approach.
1
This video demonstrates application of the MHV Roadmap to perform a safe laparoscopic right hepatectomy.
Patient
A 44-year-old woman with a solitary and large breast cancer liver metastasis in the right liver was considered for a laparoscopic right hepatectomy following an excellent response to neoadjuvant chemotherapy. The MHV anatomy was reconstructed using automated vascular reconstruction software (Synapse, Fuji) ahead of surgery.
Technique
With the patient in the French position, the hilar vessels are exposed and the inflow is controlled. Parenchymal transection begins along the demarcation line.
2
,
3
The constant relationship between the portal bifurcation and the V5 ventral and dorsal allows for easy intraparenchymal identification of the MHV. The parenchymal transection is performed in a convex fashion to optimize exposure of the MHV. Using MHV guidance, the parenchymal transection is continued and V8 is safely identified. The operation is completed with division of the anterior fissure and right hepatic vein.
Conclusion
Outlining the MHV anatomy according to the MHV Roadmap preoperatively helps to anticipate hotspots of bleeding. Guidance along the MHV through the parenchymal transection allows for early identification of tributaries, thereby preventing injury and remnant liver ischemia.</description><identifier>ISSN: 1068-9265</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-018-7034-0</identifier><identifier>PMID: 30465224</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adult ; Anatomy ; Bleeding ; Breast cancer ; Breast Neoplasms - pathology ; Breast Neoplasms - surgery ; Chemotherapy ; Female ; Hepatectomy ; Hepatectomy - methods ; Hepatic vein ; Hepatic Veins - pathology ; Hepatic Veins - surgery ; Hepatobiliary Tumors ; Humans ; Ischemia ; Laparoscopy ; Laparoscopy - methods ; Liver cancer ; Liver Neoplasms - secondary ; Liver Neoplasms - surgery ; Medicine ; Medicine & Public Health ; Metastases ; Oncology ; Prognosis ; Surgery ; Surgical Oncology ; Synapses ; Veins & arteries</subject><ispartof>Annals of surgical oncology, 2019-01, Vol.26 (1), p.296-296</ispartof><rights>Society of Surgical Oncology 2018</rights><rights>Annals of Surgical Oncology is a copyright of Springer, (2018). All Rights Reserved.</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c415t-ff63d5b80c242848fea46d7135ed47396db5d83b64079b2fe6b153e1426ca3563</citedby><cites>FETCH-LOGICAL-c415t-ff63d5b80c242848fea46d7135ed47396db5d83b64079b2fe6b153e1426ca3563</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-018-7034-0$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-018-7034-0$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>314,780,784,27923,27924,41487,42556,51318</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30465224$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Joechle, Katharina</creatorcontrib><creatorcontrib>Vega, Eduardo A.</creatorcontrib><creatorcontrib>Okuno, Masayuki</creatorcontrib><creatorcontrib>Simoneau, Eve</creatorcontrib><creatorcontrib>Ogiso, Satoshi</creatorcontrib><creatorcontrib>Newhook, Timothy E.</creatorcontrib><creatorcontrib>Ramirez, David L.</creatorcontrib><creatorcontrib>Holmes, A. Alex</creatorcontrib><creatorcontrib>Soliz, Jose M.</creatorcontrib><creatorcontrib>Chun, Yun Shin</creatorcontrib><creatorcontrib>Tzeng, Ching-Wei D.</creatorcontrib><creatorcontrib>Lee, Jeffrey E.</creatorcontrib><creatorcontrib>Vauthey, Jean-Nicolas</creatorcontrib><creatorcontrib>Conrad, Claudius</creatorcontrib><title>Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
When performing a right hepatectomy, the middle hepatic vein (MHV) should guide the parenchymal transection. MHV hotspots for bleeding can be anticipated when applying the previously developed MHV Roadmap to a minimally invasive approach.
1
This video demonstrates application of the MHV Roadmap to perform a safe laparoscopic right hepatectomy.
Patient
A 44-year-old woman with a solitary and large breast cancer liver metastasis in the right liver was considered for a laparoscopic right hepatectomy following an excellent response to neoadjuvant chemotherapy. The MHV anatomy was reconstructed using automated vascular reconstruction software (Synapse, Fuji) ahead of surgery.
Technique
With the patient in the French position, the hilar vessels are exposed and the inflow is controlled. Parenchymal transection begins along the demarcation line.
2
,
3
The constant relationship between the portal bifurcation and the V5 ventral and dorsal allows for easy intraparenchymal identification of the MHV. The parenchymal transection is performed in a convex fashion to optimize exposure of the MHV. Using MHV guidance, the parenchymal transection is continued and V8 is safely identified. The operation is completed with division of the anterior fissure and right hepatic vein.
Conclusion
Outlining the MHV anatomy according to the MHV Roadmap preoperatively helps to anticipate hotspots of bleeding. Guidance along the MHV through the parenchymal transection allows for early identification of tributaries, thereby preventing injury and remnant liver ischemia.</description><subject>Adult</subject><subject>Anatomy</subject><subject>Bleeding</subject><subject>Breast cancer</subject><subject>Breast Neoplasms - pathology</subject><subject>Breast Neoplasms - surgery</subject><subject>Chemotherapy</subject><subject>Female</subject><subject>Hepatectomy</subject><subject>Hepatectomy - methods</subject><subject>Hepatic vein</subject><subject>Hepatic Veins - pathology</subject><subject>Hepatic Veins - surgery</subject><subject>Hepatobiliary Tumors</subject><subject>Humans</subject><subject>Ischemia</subject><subject>Laparoscopy</subject><subject>Laparoscopy - methods</subject><subject>Liver cancer</subject><subject>Liver Neoplasms - secondary</subject><subject>Liver Neoplasms - surgery</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Metastases</subject><subject>Oncology</subject><subject>Prognosis</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Synapses</subject><subject>Veins & arteries</subject><issn>1068-9265</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp1kEtLAzEUhYMotlZ_gBsZcONmNO_JLEWqFSpCfWxDJo86ZV4mM4v-e1OmKgiuciDfOffeA8A5gtcIU3YTEKSEphCJNIM7cQCmiEVBuUCHUUMu0hxzNgEnIWwgRBmB7BhMCKScYUynYP5UGlPZZGE71Zc6ebdlk6xaZWrVJa71iUpelLPJUnXKt0G3XYRW5fqjHy1W9229PQVHTlXBnu3fGXi7n7_eLdLl88Pj3e0y1RSxPnWOE8MKATWmWFDhrKLcZIgwa2hGcm4KZgQpOIVZXmBneRHPsYhirhVhnMzA1Zjb-fZzsKGXdRm0rSrV2HYIEqMsxzjPMYro5R900w6-idtFinCCISciUmikdDwueOtk58ta-a1EUO46lmPHMnYsdx1LGD0X--ShqK35cXyXGgE8AiF-NWvrf0f_n_oF7dWEIQ</recordid><startdate>20190101</startdate><enddate>20190101</enddate><creator>Joechle, Katharina</creator><creator>Vega, Eduardo A.</creator><creator>Okuno, Masayuki</creator><creator>Simoneau, Eve</creator><creator>Ogiso, Satoshi</creator><creator>Newhook, Timothy E.</creator><creator>Ramirez, David L.</creator><creator>Holmes, A. Alex</creator><creator>Soliz, Jose M.</creator><creator>Chun, Yun Shin</creator><creator>Tzeng, Ching-Wei D.</creator><creator>Lee, Jeffrey E.</creator><creator>Vauthey, Jean-Nicolas</creator><creator>Conrad, Claudius</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>20190101</creationdate><title>Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy</title><author>Joechle, Katharina ; Vega, Eduardo A. ; Okuno, Masayuki ; Simoneau, Eve ; Ogiso, Satoshi ; Newhook, Timothy E. ; Ramirez, David L. ; Holmes, A. Alex ; Soliz, Jose M. ; Chun, Yun Shin ; Tzeng, Ching-Wei D. ; Lee, Jeffrey E. ; Vauthey, Jean-Nicolas ; Conrad, Claudius</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c415t-ff63d5b80c242848fea46d7135ed47396db5d83b64079b2fe6b153e1426ca3563</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Adult</topic><topic>Anatomy</topic><topic>Bleeding</topic><topic>Breast cancer</topic><topic>Breast Neoplasms - pathology</topic><topic>Breast Neoplasms - surgery</topic><topic>Chemotherapy</topic><topic>Female</topic><topic>Hepatectomy</topic><topic>Hepatectomy - methods</topic><topic>Hepatic vein</topic><topic>Hepatic Veins - pathology</topic><topic>Hepatic Veins - surgery</topic><topic>Hepatobiliary Tumors</topic><topic>Humans</topic><topic>Ischemia</topic><topic>Laparoscopy</topic><topic>Laparoscopy - methods</topic><topic>Liver cancer</topic><topic>Liver Neoplasms - secondary</topic><topic>Liver Neoplasms - surgery</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Metastases</topic><topic>Oncology</topic><topic>Prognosis</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Synapses</topic><topic>Veins & arteries</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Joechle, Katharina</creatorcontrib><creatorcontrib>Vega, Eduardo A.</creatorcontrib><creatorcontrib>Okuno, Masayuki</creatorcontrib><creatorcontrib>Simoneau, Eve</creatorcontrib><creatorcontrib>Ogiso, Satoshi</creatorcontrib><creatorcontrib>Newhook, Timothy E.</creatorcontrib><creatorcontrib>Ramirez, David L.</creatorcontrib><creatorcontrib>Holmes, A. Alex</creatorcontrib><creatorcontrib>Soliz, Jose M.</creatorcontrib><creatorcontrib>Chun, Yun Shin</creatorcontrib><creatorcontrib>Tzeng, Ching-Wei D.</creatorcontrib><creatorcontrib>Lee, Jeffrey E.</creatorcontrib><creatorcontrib>Vauthey, Jean-Nicolas</creatorcontrib><creatorcontrib>Conrad, Claudius</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Joechle, Katharina</au><au>Vega, Eduardo A.</au><au>Okuno, Masayuki</au><au>Simoneau, Eve</au><au>Ogiso, Satoshi</au><au>Newhook, Timothy E.</au><au>Ramirez, David L.</au><au>Holmes, A. Alex</au><au>Soliz, Jose M.</au><au>Chun, Yun Shin</au><au>Tzeng, Ching-Wei D.</au><au>Lee, Jeffrey E.</au><au>Vauthey, Jean-Nicolas</au><au>Conrad, Claudius</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2019-01-01</date><risdate>2019</risdate><volume>26</volume><issue>1</issue><spage>296</spage><epage>296</epage><pages>296-296</pages><issn>1068-9265</issn><eissn>1534-4681</eissn><abstract>Background
When performing a right hepatectomy, the middle hepatic vein (MHV) should guide the parenchymal transection. MHV hotspots for bleeding can be anticipated when applying the previously developed MHV Roadmap to a minimally invasive approach.
1
This video demonstrates application of the MHV Roadmap to perform a safe laparoscopic right hepatectomy.
Patient
A 44-year-old woman with a solitary and large breast cancer liver metastasis in the right liver was considered for a laparoscopic right hepatectomy following an excellent response to neoadjuvant chemotherapy. The MHV anatomy was reconstructed using automated vascular reconstruction software (Synapse, Fuji) ahead of surgery.
Technique
With the patient in the French position, the hilar vessels are exposed and the inflow is controlled. Parenchymal transection begins along the demarcation line.
2
,
3
The constant relationship between the portal bifurcation and the V5 ventral and dorsal allows for easy intraparenchymal identification of the MHV. The parenchymal transection is performed in a convex fashion to optimize exposure of the MHV. Using MHV guidance, the parenchymal transection is continued and V8 is safely identified. The operation is completed with division of the anterior fissure and right hepatic vein.
Conclusion
Outlining the MHV anatomy according to the MHV Roadmap preoperatively helps to anticipate hotspots of bleeding. Guidance along the MHV through the parenchymal transection allows for early identification of tributaries, thereby preventing injury and remnant liver ischemia.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>30465224</pmid><doi>10.1245/s10434-018-7034-0</doi><tpages>1</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | Adult Anatomy Bleeding Breast cancer Breast Neoplasms - pathology Breast Neoplasms - surgery Chemotherapy Female Hepatectomy Hepatectomy - methods Hepatic vein Hepatic Veins - pathology Hepatic Veins - surgery Hepatobiliary Tumors Humans Ischemia Laparoscopy Laparoscopy - methods Liver cancer Liver Neoplasms - secondary Liver Neoplasms - surgery Medicine Medicine & Public Health Metastases Oncology Prognosis Surgery Surgical Oncology Synapses Veins & arteries |
| title | Middle Hepatic Vein Roadmap for a Safe Laparoscopic Right Hepatectomy |
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