Feasibility of Right Upper Transversal Hepatectomy in the Absence of an Inferior Right Hepatic Vein: New Insights regarding This Complex Procedure

Figure 3

(Patient2) (a) Colorectal metastasis with right and middle hepatic vein invasion. (b) Inferior right hepatic vein draining the right inferior segments (S5 and S6). (c) Segment 5 liver metastasis and post FOLFOX “blue liver aspect.” (d) Liver mobilization and preservation of IRHV (asterisk). (e) Right hepatic vein isolation during liver transection (yellow arrow). (f) Middle hepatic vein isolation during liver transection (white arrow). (g) Immediate postoperative aspects of the liver, distal right (yellow arrow), and middle hepatic vein (white arrow) ligated at the vena cava confluence. (h) Right upper transversal hepatectomy and segment 5 resection. (i, j) Postoperative CT: right (yellow arrow) and middle hepatic vein (white arrow). (k) Postoperative CT: inferior right hepatic vein draining segment 6.

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