Laparoscopic Left Lateral Sectionectomy: Guided by the Ligamentum Teres Hepatis and the Umbilical Fissure Vein
September 27th, 2024
Laparoscopic left lateral sectionectomy guided by the ligamentum teres hepatis and umbilical fissure vein effectively controls intraoperative bleeding even without controlled low central venous pressure and prevents loss of direction during parenchymal dissection.
My research focuses on minimally invasive surgical treatments for hepatobiliary and pancreatic tumors. Guided by ligamentum teres hepatis and the umbilical fissure vein, this laparoscopic left lateral sectionectomy procedure effectively controlled intraoperative bleeding, even in the absence of controlled low central venous pressure. These attributes offer the potential benefit for patients with cardiovascular or cerebrovascular conditions.
Advanced imaging modalities, such as indocyanine green fluorescence imaging, can provide real-time visualization of liver anatomy, aiding in surgical planning and decision making. The advantage of our technique is that it avoids hepatic hilar dissection. Second, during liver parenchymal dissection, we utilize the intrahepatic anatomic landmark of the umbilical fissure vein as a guide to prevent loss of direction.
To begin the left liver lobe mobilization, use an ultrasonic scalpel to dissect the hepatic round ligament and falciform ligament of the anesthetized patient. Then, completely divide the triangular ligament and coronary ligament to reveal the root of the left hepatic vein. Next, employ a grasper posterior to the hepatic pedicle via the foramen of Winslow to facilitate the placement of a cotton tape.
Extract the ends of the cotton tape through a five millimeter port trocar under the guidance of the grasper. After removing the five millimeter trocar, thread one end of the cotton tape through a suction tube and advance it into the abdominal cavity up to the hepatic pedicle. Maintain the external end of the cotton tape outside the patient's body.
Next, using an ultrasonic scalpel, dissect the superficial peritoneum along the left side of the ligamentum teres hepatis. Dissect the Glissonean pedicles for segments two and three from the ventral to the dorsal side, and excise them using clips or a stapler. Then, dissect the hepatic parenchyma along the umbilical fissure vein within the hepatic parenchyma to identify the root of the left hepatic vein.
Divide the small vessels with the ultrasonic scalpel. After dividing the large vessels, transect the left hepatic vein with a stapler. Finally, utilize bipolar electrocoagulation forceps to coagulate the hemorrhagic points.
The CT scan on postoperative day five showed no blood or fluid accumulation in the liver section. Histological examination revealed intrahepatic bile duct stones, inflammatory cell infiltration, and small bile duct proliferation in the porta hepatis region. The postoperative incision healed satisfactorily without infection.
Overview
This article discusses a laparoscopic left lateral sectionectomy technique that utilizes the ligamentum teres hepatis and umbilical fissure vein as anatomical guides. This approach effectively controls intraoperative bleeding and maintains direction during liver parenchymal dissection.
Key Study Components
Area of Science
- Minimally invasive surgery
- Hepatobiliary surgery
- Oncology
Background
- Minimally invasive techniques are essential for reducing patient recovery time.
- Intraoperative bleeding control is critical in liver surgeries.
- Advanced imaging aids in surgical precision.
- Understanding liver anatomy is vital for successful surgical outcomes.
Purpose of Study
- To demonstrate a technique that minimizes bleeding during liver surgery.
- To utilize anatomical landmarks for better surgical navigation.
- To assess the benefits for patients with cardiovascular or cerebrovascular conditions.
Methods Used
- Laparoscopic left lateral sectionectomy procedure.
- Guidance by ligamentum teres hepatis and umbilical fissure vein.
- Indocyanine green fluorescence imaging for real-time visualization.
- Avoidance of hepatic hilar dissection.
Main Results
- Effective control of intraoperative bleeding without low central venous pressure.
- Improved surgical navigation using intrahepatic landmarks.
- Potential benefits for patients with specific cardiovascular conditions.
- Enhanced surgical planning through advanced imaging techniques.
Conclusions
- The technique offers a reliable method for liver surgeries.
- Utilizing anatomical landmarks can prevent disorientation during procedures.
- Further research may explore broader applications for various patient populations.
Frequently Asked Questions
Executive Industry Relevance
Precise anatomical guidance in laparoscopic left lateral sectionectomy (LLLS) addresses a critical challenge in minimizing intraoperative bleeding, especially when controlled low central venous pressure is contraindicated. Leveraging the ligamentum teres hepatis and umbilical fissure vein as landmarks enhances surgical accuracy and safety, supporting broader applicability across patient populations. This approach strengthens procedural predictability and operational confidence at key inflection points in surgical innovation pipelines.
Strategic Applications in Biopharma R&D
Early Discovery & Target Validation
- Enables mechanistic de-risking by clarifying anatomical pathways relevant to surgical intervention.
- Supports functional validation of anatomical landmarks for procedural reproducibility.
- Facilitates predictive confidence in surgical outcomes by standardizing intraoperative navigation.
Screening & Assay Development
- Prepares validated anatomical models for evaluating surgical devices or imaging agents.
- Promotes reproducibility and standardization in preclinical surgical simulation studies.
- Enables quantitative assessment of intraoperative bleeding and navigation accuracy.
Translational & Preclinical Research
- Aligns surgical models with disease-relevant anatomical features for translational continuity.
- Supports risk-adjusted advancement of minimally invasive surgical techniques.
- Provides a platform for evaluating intraoperative imaging and navigation technologies.
Pipeline & Workflow Integration
This anatomical-guided LLLS method integrates into the surgical innovation continuum from preclinical model development to translational research and device evaluation.
- Discovery Biology: Clarifies anatomical targets and pathways for surgical intervention.
- Screening: Establishes reproducible models for device and imaging agent assessment.
- Analytics: Enables quantitative measurement of intraoperative bleeding and navigation precision.
- Translational Research: Bridges preclinical findings with clinical procedural standards.
- Enterprise Reuse: Provides a standardized approach adaptable across surgical research programs.
Operational & Enterprise Impact
- Scientific Value: Increases predictive confidence and reduces procedural ambiguity in surgical models.
- Operational Value: Enhances reproducibility and standardization in surgical research workflows.
- Strategic Value: Improves decision-making for surgical technique adoption and device development.
- Portfolio Impact: Supports risk-adjusted prioritization of minimally invasive surgical innovations.
Implementation Considerations
- Requires expertise in hepatobiliary anatomy and minimally invasive surgical techniques.
- Demands access to advanced imaging modalities for intraoperative guidance.
- Necessitates cross-team standardization of anatomical landmark identification.
- Adaptation may be needed for anatomical variability across preclinical models.
- Limitations include dependency on imaging quality and operator proficiency.
