Ser Yee Lee1, Daniel Cherqui, Michael D Kluger. 1. Section of Hepatobiliary Surgery and Liver Transplantation, Department of Surgery, New York-Presbyterian Hospital/Weill Cornell Medical Center, New York, NY 10065, USA.
Abstract
INTRODUCTION: Variations in portal vein anatomy occur in 20-35 % of individuals. A non-bifurcating portal vein (PV) was suspected on preoperative imaging in a patient with a large right lobe hepatocellular carcinoma. The single PV curved within the liver parenchyma from right to left supplying second-order branches along its course. CASE REPORT: Utilizing the hanging maneuver, an extended right hemihepatectomy was safely performed. This approach allowed for preservation of the main PV and its left-sided branches while easily identifying the second-order right branches for ligation. CONCLUSION: Knowledge of portal vein variations and identification preoperatively by cross-sectional imaging are critical. The hanging maneuver aids in the preservation of the main portal vein and its left-sided branches during right hemihepatectomy in the presence of portal vein anomalies, and this technique can be used to improve safety in hepatobiliary surgery.
INTRODUCTION: Variations in portal vein anatomy occur in 20-35 % of individuals. A non-bifurcating portal vein (PV) was suspected on preoperative imaging in a patient with a large right lobe hepatocellular carcinoma. The single PV curved within the liver parenchyma from right to left supplying second-order branches along its course. CASE REPORT: Utilizing the hanging maneuver, an extended right hemihepatectomy was safely performed. This approach allowed for preservation of the main PV and its left-sided branches while easily identifying the second-order right branches for ligation. CONCLUSION: Knowledge of portal vein variations and identification preoperatively by cross-sectional imaging are critical. The hanging maneuver aids in the preservation of the main portal vein and its left-sided branches during right hemihepatectomy in the presence of portal vein anomalies, and this technique can be used to improve safety in hepatobiliary surgery.
Authors: Wai-Kit Lee; Silvia D Chang; Vinay A Duddalwar; Jules M Comin; Warren Perera; Wing-Fai E Lau; Elhamy K Bekhit; Oliver F Hennessy Journal: Radiographics Date: 2011 Jul-Aug Impact factor: 5.333
Authors: Sébastien Gaujoux; Richard Douard; Giuseppe Maria Ettorre; Vincent Delmas; Jean-Marc Chevallier; Paul-Henri Cugnenc Journal: Am J Surg Date: 2007-04 Impact factor: 2.565