Anatomical multiple hepatic segmentectomy by selective occlusion of hepatic inflow for the treatment of primary hepatic cancer

Anatomic hepatic resection not only enables enough tumor free resection margin, but also guarantee the maximal remnant of normal liver tissue. A 61 year old male patient with hepatic cancer was admitted to the Affiliated Hospital of Hainan Medical College in February 2012. Multiple space occupying lesions were found in segment Ⅵ, Ⅶ and Ⅷ by computed tomography (CT). The results of CT volumetry analysis showed that the left hemihepatic volume was lesser than the minimal limit of survival, so anatomic hepatic segmentectomy of Ⅵ, Ⅶ and Ⅷ with preservation of segment Ⅴ was designed to guarantee the maximal remaining of normal liver tissue. Glisson′s pedicle transection was used twice to divide the right hemihepatic Glisson′s pedicle, segment Ⅵ and Ⅶ Glisson′s pedicle, respectivley, then the resection line was determined, and anatomical hepatic  segmentectomy  of Ⅵ, Ⅶ and Ⅷ was completed. With the procedures  adopted, the hepatic ischemia reperfusion injury and  hemodynamic instability were maximally reduced during operation.