Image-Guided Proper Liver Segmentectomy.

Abstract

The new cross-sectional radiological tools, 3D computed tomography and magnetic resonance, allow a precise study of the liver anatomy. Thanks to these imaging techniques, a new space inside the liver parenchyma, the "hepatic core," was recently recognized, where the hila of liver segments are present. On the basis of anatomical and radiological observations, we identified a new virtual plane of dissection, named "hepato-portal," which is useful in liver segmentectomy, if integrated with the classical planes of dissection. Simulated surgical procedures can be intra-operatively transferred by ultrasounds. In this way, we performed ten "proper" liver segmentectomies through preliminary sections of the hilar vessels and a precise dissection of the boundaries of each segment. Our experience underlines the value of integrating anatomy and radiology in the simulated liver surgery.