Liver tunneling procedure not done for which segment?
Ans. (c) VRef: Blumgart's 6th edition Page 1705.* This is even high standard for MCh Preparatory exams, Think the Examiner has misplaced the paper for PG JIPMER.* In short, there are several difficulties in planning resections in liver as you cannot imagine. Just the criteria for liver resection based on size alone not sufficient in planning. Finer details like its proximity to secondary and tertiary porto biliary radicles and hepatic vein is necessary to guide liver resection.* Common liver resections are right and left hepatectomy and its extended versions based on the segments removed.New terminologies and their removed segmentsProcedure nameRemoved liver segmentsRight hemihepatectomySegments 5, 6, 7 and 8Left hemihepatectomySegments 2, 3 and 4Right trisectionectomySegments 4, 5, 6, 7 and 8Left lateral sectionectomySegment 2 and 3Left trisectionectomySegments 2, 3, 4, 5 and 8High level resections or named liver resections with limitations to specific conditions based on the extent of involvement in Hilar cholangiocarcinoma and colorectal metastases and certain forms of HCC in unusual locations like involving caudal lobe.Taj mahal resectionFor hilarcholangiocarcinomaSegments IVa, V and I (caudate lobe) removed (hence the shape of Taj Mahal dome)Dumbbell form resection for cholangiocarcinomaSegments IVb, I (caudate lobe) and partial segment V resection about the right hepatic pedicleMini-Mesohepatectomy(MMH)For lesions involving the middle hepatic vein at caval confluence (not involving caudate lobe)Liver tunnel procedure (if caudate lobe involved as in above condition)Segments I, IV and VIII are removed as part of parenchymal preserving liver surgery for selected liver tumors which are involving middle hepatic vein along with caudate lobeLiver hanging Maneuver (LHM)It uses a tape between the anterior surface of retro hepatic IVC and liver surface to help in better lifting of the liver and efficient vascular control if anterior approach for liver resection is planned (it is the preferred procedure nowadays as it is a no-touch technique)Figure A represents the typical lesion needing Liver Tunnel Procedure (CV- Communicating veins); Figure B represents the post-operative resection including MHV.
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Liver