Anatomical Right Posterior Sectionectomy of the Liver by IOUS-Guided Finger Compression

A Novel Simple Technique for Performing Anatomical Right Posterior Sectionectomy of the Liver: the Ultrasound-Guided Finger Compression

The use of intraoperative ultrasound (IOUS) allows us to perform new conservative hepatectomies. The investigators previously reported the systematic subsegmentectomy by IOUS-guided finger compression for segments 2-3, which is currently applied for patients with hepatocellular carcinoma (HCC)on cirrhosis. The investigators herein describe a novel technique, which consists in the systematic right posterior sectionectomy by IOUS-guided finger compression.

A novel technique for the demarcation of the resection area by means of IOUS-guided finger compression to accomplish a right posterior sectionectomy is described. Dissection or encirclement of the sectional pedicles for resection area demarcation is thus avoided. Ten patients underwent this technique successfully without mortality or major morbidity. IOUS-guided finger compression of sectional portal pedicle feeding the right posterior section is a feasible, safe, and effective method.

Inclusion Criteria:

• Patients with tumors at least at 1 cm distally to the bifurcation of the right portal vein (bifurcation of P5-8 and P6-7) eligible for right posterior sectionectomy, namely the anatomical removal of segment 6 and 7, were considered potential candidates to this procedure. Precisely, these criteria were adopted:

  • Patients with hepatocellular carcinoma (HCC) with infiltrative growing pattern in contact with P6-7;
  • Patients with any type of HCC in contact with P6-7 with distal bile duct dilation;
  • Patients with colorectal liver metastasis (CLM) in contact with P6-7.

Exclusion Criteria:

• Exclusion criteria for carrying out the herein described procedure was considered the presence of tumoral thrombosis in P6-7.