Bi‐segmentectomy V‐VIII as alternative to right hepatectomy: An intrahepatic approach

The knowledge of segmental liver anatomy has provided the fundamental basis for segmental liver resections. Formerly described by Couinaud [1] as right paramedian sectorectomy, right anterior liver resection or bi-segmentectomy V-VIII is defined as the removal of segments V and VIII of the liver. Among several types of liver resection, bi-segmentectomy V-VIII is one of the most difficult to perform. Makuuchi et al. [2] were the first authors to present detailed operative technique and clinical data regarding this procedure. The main drawback of this technique is a complex hilar plate dissection including individual identification of arterial, portal, and bile duct branches of right anterior liver segments (V and VIII). We have recently described a modification of the intrahepatic posterior technique with a standardized way to identify and isolate the right glissonian sheaths [3]. The intrahepatic approach to glissonian pedicles is a useful step to make easier and safer this formerly complex procedure and permits the complete anatomical delineation of all liver segments [3–6]. This technique allows the removal of individual hepatic segments sparing functioning parenchyma. The authors describe the intrahepatic technique for bi-segmentectomy V-VIII and their experience in eight patients with a small left liver, steathotic liver, or bilateral lesions that otherwise would result in hazardous or extensive liver resection.