Anatomical Segmental and Subsegmental Resection of the Liver for Hepatocellular Carcinoma

In Brief Background: Anatomic resection is considered the gold standard approach for liver resection in patients with hepatocellular carcinoma. The use of intraoperative ultrasound (IOUS) as guidance is indispensable in this sense but methods available up to now were rather complex and for that reason of limited use. We herein describe a novel technique for the demarcation of the resection area by means of IOUS-guided finger compression to systematically accomplish anatomic segmental and subsegmental resections. Methods: Thirty-three patients met the eligibility criteria. This technique consisted in the demarcation of the resection area by IOUS-guided finger compression of the vascular pedicle feeding the tumor at the level closest to the tumor but oncologically suitable. Median age was 65 years (range, 36–81). There were 25 men and 8 women. Median tumor number was 1 (range, 1–2); median tumor size was 2 cm (range, 1–10). Twenty-five (76%) patients had cirrhosis or chronic hepatitis, and 8 (24%) had steatosis (ClinicalTrials.Gov ID: NCT00829335). Results: Procedure resulted feasible in all eligible patients, and demarcation area was obtained in all patients within 1 minute of bimanual IOUS-guided compression. There was no mortality or major morbidity: only 7 (21%) patients experienced minor morbidity. No blood transfusions were administered. Conclusions: Systematic segmentectomy and subsegmentectomy by IOUS-guided finger compression is a feasible, safe, and effective technique, which could be considered as a simpler alternative to those up to now proposed. Intraoperative ultrasound is indispensable for performing a true anatomic segmental resection of the liver, but methods available are rather complex. We describe a technique for performing anatomic segmental resections by means of intraoperative ultrasound-guided finger compression, which could be considered a simpler alternative to those proposed up to the present (ClinicalTrials.Gov ID: NCT00829335).