Ante-situm Liver Resection for Giant Hepatic Tumour - Case Report and Review of LiteratureVladislav Braşoveanu, Mihail Pautov, Mihnea Ioan Ionescu Ionescu, Claudiu Anghel, Dan Ionut Dudus, Manish Moothoor, Florin Ichim, Eliza Gangone, Ion Barbu
Surgical Techniques, no. 3, 2017
Article DOI: 10.21614/chirurgia.112.3.326
Ex-situ liver surgery refers to complex liver resections involving hepatic vascular exclusion and a warm ischemia time (WIT) of more than 90 minutes that allows liver resection and vascular reconstruction in patients with giant liver tumours with a difficult approach . Ante-situm liver resections, otherwise called Ã¢Â€Âœex-situ in-vivoÃ¢Â€Â resections is achieved through externalization of the liver outside of the abdominal cavity by clamping and sectioning of the efferent pedicles (suprahepatic veins) (Ã¢Â€Âœex situÃ¢Â€Â) without cutting the afferent vascular pedicle (Ã¢Â€Âœin vivoÃ¢Â€Â), thus leaving the hepatic pedicle intact. We present a case report of a 36 yo male patient diagnosed by MRI scan with giant liver tumor in the left hemiliver. A left "ex-situ in-vivo" hepatectomy was performed by dissecting and ligating the left and middle hepatic veins, clamping and sectioning the right hepatic vein, Pringle maneuver, externalization of the liver followed by the tumor resection and right hepatic vein reimplantation. The short warm ischemia time (hepatic resection + liver reimplantation - 30 minutes) allowed us to perform the procedure without installing a veno-venous or porto-caval shunt otherwise used in all of ex-situ procedures described in the literature reviewed in this presentation. Ex-situ liver resection is a viable procedure for giant liver tumours in highly selected cases. It facilitates resection of large liver tumours that would be otherwise unresectable, extending the indications of surgical treatment.
Keywords: ante-situm, liver surgery, ex-situ in-vivo, giant liver hemangioma