Anterior approach during hepatectomy

Abstract

The anterior-approach right hepatectomy was introduced by Kazue Ozawa in 1992. It is particularly suitable for treating large right-liver tumors. With this technique, prolonged rotation of the right liver could be avoided, thereby precluding interruption of the inflow and outflow of the liver and preserving the liver function. In the technique, after division of the right portal vein and the hepatic artery, the liver is transected by CUSA from the anterior surface of the liver down to the liver hilum and caudate lobe, thereby exposing the inferior vena cava. Short hepatic veins and right hepatic vein are then dissected from the front and individually ligated. After dividing the triangular ligament, the right liver could be removed. In a prospective randomized trial on patients with hepatocellular carcinoma, we demonstrated that the anterior-approach right hepatectomy resulted in less major bleeding, less dissemination of cancer cells into the systemic circulation and longer overall survival when compared with the conventional technique. The anterior approach is also applicable to left hepatectomy. Moreover, it is a favorable approach when the bile duct in the right liver is infected and obstructed or when abscess is present in the right liver, as without forceful rotation of the right liver, infected material would not be squeezed into the systemic circulation.