Anatomical liver resection is usually based on Couinaud’s anatomical concept. In contrast, Hjortsjo’s concept, which divides the right anterior section of the liver into ventral and dorsal segments by the vertical plane named the ventral segment fissure (VSF), has been rarely utilized for liver resection. Identification of the VSF is the most difficult step in liver resection based on Hjortsjo’s concept. This study aimed to detail liver resection based on Hjortsjo’s concept and report surgical outcomes of this procedure.
We reviewed the records of 166 consecutive patients who underwent liver resection between September 2009 and June 2012 at Kyoto Medical Center and identified seven liver resections in which Hjortsjo’s concept was utilized. These patients consisted of four men and three women aged 55–79 years. Four patients had hepatocellular carcinoma and cirrhosis and three patients had metachronous colorectal liver metastasis.
Liver resection along the VSF consisted of two extended left medial sectionectomies, three extended right posterior sectionectomies, and one Sg 7+8-dorsal resection by a venous-drainage-guided approach and one Sg 8-dorsal resection by a Glissonian approach. In all patients, the VSF was successfully identified as a congested or ischemic border on the liver surface. Mortality and major morbidity were nil. No patients underwent blood transfusion. After a median follow-up of 15 months, there were no deaths or local recurrence.
Anatomical liver resection based on Hjortsjo’s concept is feasible and advantageous over conventional liver resection because it preserves more parenchyma. The venous-drainage-guided approach is an effective method for identifying the VSF.
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Couinaud C (1989) Surgical anatomy of the liver revisited. Couinaud, Paris
Bismuth H (1982) Surgical anatomy and anatomical surgery of the liver. World J Surg 6:3–9
Terminology Committee of the International Hepato-Pancreato-Biliary Association (2000) The Brisbane 2000 terminology of liver anatomy and resections. HPB 2:333–339
Hjortsjo CH (1951) The topography of the intrahepatic duct systems. Acta Anat (Basel) 11:599–615
Kogure K, Kuwano H, Fujimaki N et al (2002) Reproposal for Hjortsjo’s segmental anatomy on the anterior segment in human liver. Arch Surg 137:1118–1124
Macchi V, Porzionato A, Parenti A et al (2005) Main accessory sulcus of the liver. Clin Anat 18:39–45
Shindoh J, Satou S, Aoki T et al (2012) Hidden symmetry in asymmetric morphology: significance of Hjortsjo’s anatomical model in liver surgery. Hepatogastroenterology 59:519–525
Cho A, Okazumi S, Makino H et al (2004) Relation between hepatic and portal veins in the right paramedian sector: proposal for anatomical reclassification of the liver. World J Surg 28:8–12
Cho A, Okazumi S, Makino H et al (2004) Anterior fissure of the right liver—the third door of the liver. J Hepatobiliary Pancreat Surg 11:390–396
Cho A, Okazumi S, Miyazawa Y et al (2004) Limited resection of the right hemiliver based on reclassification of the right anterior segment of the liver. Hepatogastroenterology 51:820–821
Kondo S, Katoh H, Hirano S et al (2004) Venous-drainage-guided selective hepatectomy: a novel approach to liver surgery. Hepatogastroenterology 51:1–3
Cho A, Yamamoto H, Kainuma O et al (2010) Extended left hepatectomy of the left and middle hepatic venous drainage areas along the anterior fissure. Am J Surg 200:186–190
Tanaka K, Matsumoto C, Takakura H et al (2010) Technique of right hemihepatectomy preserving ventral right anterior section guided by area of hepatic venous drainage. Surgery 147:450–458
Cho A, Okazumi S, Miyazawa Y et al (2004) Limited resection based on reclassification of segment 8 of the liver. Hepatogastroenterology 51:575–576
Takasaki K, Kobayashi S, Tanaka S et al (1990) Highly anatomically systematized hepatic resection with Glissonean sheath code transection at the hepatic hilus. Int Surg 75:73–77
Sano K, Makuuchi M, Miki K et al (2002) Evaluation of hepatic venous congestion: proposed indication criteria for hepatic vein reconstruction. Ann Surg 236:241–247
Igami T, Yokoyama Y, Nishio H et al (2009) A left hepatectomy and caudate lobectomy combined resection of the ventral segment of the right anterior sector for hilar cholangiocarcinoma—the efficacy of PVE (portal vein embolization) in identifying the hepatic subsegment: report of a case. Surg Today 39:628–632
Torzilli G, Donadon M, Marconi M et al (2008) Systematic extended right posterior sectionectomy: a safe and effective alternative to right hepatectomy. Ann Surg 247:603–611
Suzuki S, Sakaguchi T, Yokoi Y et al (2001) Impact of repeat hepatectomy on recurrent colorectal liver metastases. Surgery 129:421–428
Nakajima Y, Ko S, Kanamura T et al (2001) Repeat liver resection for hepatocellular carcinoma. J Am Coll Surg 192:339–344
Hasegawa K, Kokudo N, Imamura H et al (2005) Prognostic impact of anatomic resection for hepatocellular carcinoma. Ann Surg 242:252–259
Kaneko T, Kaneko K, Sugimoto H et al (2000) Intrahepatic anastomosis formation between the hepatic veins in the graft liver of the living related liver transplantation: observation by Doppler ultrasonography. Transplantation 70:982–985
Okano K, Yamamoto J, Moriya Y et al (1999) Macroscopic intrabiliary growth of liver metastases from colorectal cancer. Surgery 126:829–834
Takasaki K (1998) Glissonean pedicle transection method for hepatic resection: a new concept of liver segmentation. J Hepatobiliary Pancreat Surg 5:286–291
Kanemura E, Togo S, Shizawa R et al (2000) Subdivision of liver anterior segment into two units according to hepatic venous drainage. Hepatogastroenterology 47:1056–1059
Study concept and design: Satoshi Ogiso and Iwao Ikai; acquisition of data: Satoshi Ogiso, Masato Narita, Takahide Murakami, Hiroaki Hata, Takashi Yamaguchi, and Tetsushi Otani; analysis and interpretation of data: Satoshi Ogiso, Iwao Ikai, and Masato Narita; drafting of manuscript: Satoshi Ogiso; critical revision of manuscript: Iwao Ikai.
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Ogiso, S., Ikai, I., Narita, M. et al. Parenchyma-sparing anatomical liver resection based on Hjortsjo’s concept. Langenbecks Arch Surg 398, 751–758 (2013). https://doi.org/10.1007/s00423-013-1069-2
- Liver resection
- Hjortsjo’s concept
- Parenchyma-sparing resection
- Venous drainage
- Venous congestion