Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):412-415. 10.14701/ahbps.2018.22.4.412.

New two-step wedge liver resection technique: “zoom resection”: A case report

• Pfaffen G
• Ortiz N
• Sotelo J
• Azzi RM
• Serafini V

• KMID: 2427374
• DOI: http://doi.org/10.14701/ahbps.2018.22.4.412

Abstract

Different surgical procedures have been described for the treatment of colorectal liver metastases. The appropriate surgical approach depends, among many other factors, on the relationship between liver metastases and suprahepatic veins. If possible, the detachment of colorectal liver metastasis from suprahepatic veins is a good alternative liver parenchyma sparing technique. In this study, we describe a new two-step wedge liver resection technique for colorectal liver metastases located between suprahepatic veins. Prior to resection, intraoperative ultrasound is employed in order to plan and guide both steps. Initially, we place stitches and resect a cylindrical piece of normal liver parenchyma above the tumor and suprahepatic veins. Next, we place stitches on the future specimen located between suprahepatic veins, then resect it. The main advantages of this procedure are the good visualization and vascular control that may be achieved during the detachment of the tumor from suprahepatic veins. We call this procedure "zoom resection" because its dynamics are similar to the workings of a photograph camera's telescopic system. We present the case of a 55-year-old patient diagnosed with multiple colorectal liver metastases, one of which was resected through this technique.

Keyword

Metastasis; Liver; Wedge resection

MeSH Terms

Humans
Liver*
Middle Aged
Neoplasm Metastasis
Ultrasonography
Veins

Figure

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  Fig. 1 Intraoperative ultrasonography shows the anatomical relationship between the IVa colorectal liver metastases (white arrow) and suprahepatic veins (SHVs) (black arrows).

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  Fig. 2 Illustration of procedure: a. Distance between liver surface and SHVs upper edge. b. Distance between SHVs outer edges. c. 5 millimeter margin. d. First step parenchyma resection (more dark area).

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  Fig. 3 Illustration of first-step parenchyma resection.

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  Fig. 4 Illustration of stitches prior to tumor resection.

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  Fig. 5 Illustration of tumor resection.

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  Fig. 6 Intraoperative photograph of “Zoom resection” site.

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