The detachment of the hilar plate from the liver parenchyma for the isolation of portal pedicles and liver resection was described by Couinaud in 19571 but it has not been used widely in clinical practice even though it was originally described as easy, safe, and bloodless. In 1989 Galperin and Karagiulian2 reported their technique for the isolation of portal pedicles through an extraglissonian approach and in 1992 Launois and Jamieson3 reported the posterior intrahepatic approach to the portal pedicles, renewing interest in the en masse portal triad isolation. Both of these techniques entail an intraparenchymal dissection to encircle the portal pedicles. For this reason a hilar clamping (Pringle maneuver) is advised before entering the hepatic parenchyma. When one uses the posterior intrahepatic approach the small accessory hepatic veins that drain the caudate lobe first should be tied to avoid back bleeding if torn, and cirrhotic liver is considered as a relative contraindication.4 The present technique is characterized by a different approach to encircle the right portal pedicle from the anterior aspect of the hepato-duodenal ligament to the posterior one, accomplished totally extraglissonianly and extraparenchymally, detaching the hilar plate from the liver parenchyma. This can be achieved without hilar clamping or accessory vein ligation. The technique can be used to perform right hepatectomies, sectoriectomies, or segmentectomies in cirrhotic or normal livers when the tumor is located far enough from portal bifurcation. -------------------------------------------------------------------
Hilar plate detachment and extraglissonian anterior approach to the right portal pedicle for right liver resections / G. BATIGNANI. - In: JOURNAL OF THE AMERICAN COLLEGE OF SURGEONS. - ISSN 1072-7515. - STAMPA. - 190:(2000), pp. 631-634.
Hilar plate detachment and extraglissonian anterior approach to the right portal pedicle for right liver resections.
BATIGNANI, GIACOMO
2000
Abstract
The detachment of the hilar plate from the liver parenchyma for the isolation of portal pedicles and liver resection was described by Couinaud in 19571 but it has not been used widely in clinical practice even though it was originally described as easy, safe, and bloodless. In 1989 Galperin and Karagiulian2 reported their technique for the isolation of portal pedicles through an extraglissonian approach and in 1992 Launois and Jamieson3 reported the posterior intrahepatic approach to the portal pedicles, renewing interest in the en masse portal triad isolation. Both of these techniques entail an intraparenchymal dissection to encircle the portal pedicles. For this reason a hilar clamping (Pringle maneuver) is advised before entering the hepatic parenchyma. When one uses the posterior intrahepatic approach the small accessory hepatic veins that drain the caudate lobe first should be tied to avoid back bleeding if torn, and cirrhotic liver is considered as a relative contraindication.4 The present technique is characterized by a different approach to encircle the right portal pedicle from the anterior aspect of the hepato-duodenal ligament to the posterior one, accomplished totally extraglissonianly and extraparenchymally, detaching the hilar plate from the liver parenchyma. This can be achieved without hilar clamping or accessory vein ligation. The technique can be used to perform right hepatectomies, sectoriectomies, or segmentectomies in cirrhotic or normal livers when the tumor is located far enough from portal bifurcation. -------------------------------------------------------------------File | Dimensione | Formato | |
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