Segment 7 Laparoscopic Liver Resection: Is It Possible to Resect
When Metastatic Lesions Border Suprahepatic Veins?
Marc A. Ward
Received: 15 March 2018 /Accepted: 15 May 2018
2018 The Society for Surgery of the Alimentary Tract
Introduction After nearly 25 years of experience, laparoscopic liver resection (LLR) is now recognized as being feasible and
However, laparoscopic resections of the posterosuperior segments are more technically demanding. They are associated
with higher conversions rates, more intraoperative bleeding, and increased operating time.
Appropriate training is required to
approach these resections safely.
This video demonstrates the technical maneuvers to laparoscopically approach a segment 7
tumor in contact with the right supra hepatic vein.
Method The pertinent aspect to perform a segment 7 metastasis resection using minimally invasive techniques is shown. The
main steps of this operation include (1) complete release of the right liver from the coronary and triangular ligament, (2)
dissection of the retrohepatic vena cava and transection of the hepatocaval ligament, (3) the use of intercostal trocars for direct
vision of the inferior vena cava and the right suprahepatic vein,
(4) the use of intraoperative ultrasound to evaluate the position
and limits of vascular structures compared to the lesion, (5) careful transection of the hepatic parenchyma, and (6) dissection of
the right hepatic vein to separate it from the lesion.
Results The surgery was performed in a 68-year-old male patient. The patient developed synchronous metastases to the liver
from a sigmoid colon tumor. Two lesions were identified; a 15 mm subcapsular lesion located in segment 5 and a 45 mm lesion
located in segment 7 in contact with the right hepatic vein and inferior vena cava confluence. Previously, laparoscopic
sigmoidectomy was performed without complications (TNM classification of the specimen: T3N0, with 31 resected lymph
nodes, KRAS gene mutated). Following chemotherapy with FOLFOX + bevacizumab, a good response to the liver lesion
was noted on imaging. Subsequently, a laparoscopic resection of the metastases in segment 7 and 5 was performed. The surgery
lasted 210 min, intraoperative blood loss was 200 cm
, no Pringle maneuver was required, and the postoperative period was
uneventful with the patient being discharged on postoperative day number four. Pathology of the liver specimens confirmed
metastases from colon adenocarcinoma with free surgical margins.
Discussion Some important points achieving easier and safer approach of the posterior segments of the liver by laparoscopic
route should be discussed. First, the patient’s semi-lateral position showed in the video allows placing the ports and the optic in a
Electronic supplementary material The online version of this article
(https://doi.org/10.1007/s11605-018-3824-8) contains supplementary
material, which is available to authorized users.
* David Fuks
Department of Digestive, Oncologic and Metabolic Surgery, Institut
Mutualiste Montsouris, 42 Boulevard Jourdan, 75014 Paris, France
Department of Surgery, Faculty of Medicine, Universidad de
Concepción, Concepción, Chile
Surgery Service, Hospital Guillermo Grant Benavente, Concepción
Health Service, Concepción, Chile
Université Paris Descartes, Paris, France
Department of Surgery, Baylor University Medical Center,
Dallas, TX, USA
Journal of Gastrointestinal Surgery