Each of the 8 hepatic segments can be resected separately or associated with adjacent segments. The segmentectomies are designated according to the number of segments they remove and the number of segments (uni-, bi-, tri-segmentectomy, etc.). Note that the isolated segmentectomy of I is rare. Isolated segmentectomy of II or III offers little advantage over left lobectomy unless preservation of the functional parenchyma is critical. The resection is said to be minor or limited when it removes a maximum of 2 segments.Take a look here for William Nye Rhinoplasty Las Vegas if you are looking for a nose surgery.
For example, a sub-segmentectomy, a segmentectomy or a bi-segmentectomy. A hepatectomy is called major when it concerns at least 3 segments. Hepatectomy can be extended to segment I, to certain contralateral segments, to the main bile duct. A hepatectomy is said to be typical when it respects the anatomical or atypical criteria when it leaves in place the parenchyma partially devascularized or devoid of bile drainage.
A typical hepatectomy reduces the risk of post-operative biliary fistula and per-operative hemorrhage. This is why atypical hepatectomies are usually small, coarsely wedge-resection. hepatectomie_gauche_ – Right hepatectomy removes segments V, VI, VII, VIII or about 65% of the total liver volume. It can be extended to I or IV. – Right lobectomy removes segments IV to VIII, ie approximately 80% of total liver volume (= right hepatectomy + IV). – The left hepatectomy removes II, III and IV or 35% of the total liver volume.
It may be extended to include I. (See photo: left hepatectomy for multifocal hepatocellular carcinoma, the nodular lesions are visualized, the falciform ligament separating the left lobe of segment IV). – The left lobectomy removes II and III is about 20% of the total liver volume. The left lobectomy is the easiest of the typical hepatectomies to perform. For hepatic resection to be functionally acceptable, it should remain after resection, at least 30% of the initial liver volume for a healthy liver, 40% after chemotherapy and at least 50% on cirrhotic liver.
Example of pre-surgical hepatic volumetry Understanding surgical technique (4, 5) tranche_section_hepatique Mobilization of the liver It requires the section of the ligamentous ligaments (sickle ligament, round ligament, right and left triangular) and sometimes a complete release of the inferior vena cava under and hepatic. Vascular clamping: It is done intermittently. It helps to limit blood loss. Vascular and biliary ligation: Each identified biliary, arterial and biliary pedicle can be ligated to the wire or clipped. Hepatic Transsection This hepatic transection (cf photo) is performed centimeter by centimeter. It can be done by crushing with the clamp or destroying by ultrasound. The biliary, arterial and glandular pedicles are thus identified and can be linked to the thread or clipped. More recently, a new technique of hepatic transection by tissue coagulation by radiofrequency has been developed which allows a burn of the section slice which can be seen in imaging.
Cholecystectomy associated with right or left hepatectomy. Normal postoperative aspect (3, 6) The sectional section is visible by the presence of surgical clips, hyperdenses to the scanner, left in place on the sectioned vascular and biliary pedicles. But sometimes the sectional section is devoid of clips, when the surgeon chooses to ligate each vascular pedicle, each bile duct manually. In contact with the cross-sectional margin, a hypodense band linked to an accumulation of bile and blood, a fibrous infiltration or a fatty transformation secondary to the local trauma or to a band can occur transiently in 30 to 50% of the cases Of devascularized parenchyma. This band will gradually disappear spontaneously with time In the case of a section made by radiofrequency, one or more centimetric hypodense band interposes between the sectional section and the remaining hepatic parenchyma. It may be more or less nodular. This band decreases with time (on average within 4 months) but does not disappear.