the East meets West

AtsushiNanashima (Uni.Miyazaki,JPN)Shunichi Ariizumi,

MasakazuYamamoto(TokyowomensUni.,JPN)

Preoperativemanagements

PVE(PTPE/TIPEPVligation

HAEALLPS

Anatomical liverresection(identification)

RightsideLeftsideSection/Segment(orsubsegment)

LiveranatomyGlissonRex/CantlieHealey&SchroyCouinaudHjortsjCho&Ryu

VascularcontrolIschemiaCongestionInflowExtra (Glissonspedicle)IndividualtransectionPringle/Semiclamp/nonPringle

OutflowTHVEIVCclamp

Position(ReverseTrendelenburg)Anesthetics(CVP)

ApproachesMobilizationThoracic(thoracotomy)/NonIncisionAnteriorapproachHanging(lifting)maneuverLaparoscopicPosition

Others

nonEnglishlanguages

Post1945,basically

Expertsopinion

Search(Sept.2015May2017)

Searchengines,Nationallibrarian,Expertsprovide(Medicalwebserches,Google,Ichushi (JPN)Articles,TextsEnglish/nonEnglish (JPN,French,German.)

Obtainedsupervisors(expert)adviceorcommentsProf.S.M.Strasberg(USA),Prof.T.L.Hwang(Taiwan),Prof.C.M.Lo(HongKong),Prof.N.Kokudo (Japan),Honoraryprof.M.Makuuchi (Japan).Honoraryprof.T.Takada(Japan),Prof.&presidentM.Yamamoto

H. Rex (Czech,German); Intrahepaticvasculatures (1888) J.Cantlie(Scotland);Borderbybloodsupply(1898)

RexCantliesline(orthemidline)

F.Glisson;vasculobiliarysheath(1654) TonThatTung&J.MeyerMay (Vietnam);

portalandhepaticvenoussystems(inFrench,1939)Liveranatomicalresections(1962,1979

HealeyJE&Schroy PC(USA);Portalsystem,falciform lig.(1953) ClaudeCouinaudFrance;Portalsystem(inFrench,1954,1989) IHPBA2000(Brisbane)LiverTerminology(HPB,2000)

S.M.Starsberg,J.Belghiti andP.A.Clavien

Keyofsurgicalanatomy

1888) , 1899)

TonThatTung

Pettinari Italy

W.WendelGerman 1911;Noprecisedescription,schemesmayNOT acceptable)

IchioHonjo(inJapanese 1950,English1955

Op.1949.3

*BasedoncadaveranatomyRHA,PV~extrahepaticIntrafascialaccess

*LiverparenchymaremainedaroundIVCMHV:notexposedBUTintentionally

*Preciserecordsperiop.,specimen

EvaluatedinFostersSolidlivertumors(1977)

JeanLouisLortatJacobFrench 1952

Op.1951.10

*ThoracoabdominalincisionapproachTotreatriskofinjury,IVCandhepaticveinsExposeofVC,shortHV(Bachillier)TransectionofMHVatplane

Recent righttrisegmentectomy?*Preciseperioperativerecords(predicative)*Intrafascialaccess,inflowcontrolmethod,extrahepatic

Recognizedasafirstpioneerinarticlesandtextsworldwide.

AnniversaryinFrance

Incredibly,breakthroughoperationwasachieved

bythesegreatsurgeonsbetweenEastandWest

atthesameperiod.

LigationofinflowvasculatureFingerfracturetechniqueHypothermic perfusionExposeofMHV,segmentalbranches

LigationofintrahepaticinflowvasculaturesFingerfracture techniqueLinsclamp(forceps)

RHincreasedintheWestPack(USA,1953),Quattlebaum (USA,1953)Mersheimer (1953),Clatworthy (1956)Caprio (Spain),Longmire (USA)Fortner (1969USA etc.Kajitani(inJapanese 1966)

IntheEasttrans orextra fascialaccess)reportedinEnglishLinTienYu(Taiwan1960) TonThatTung(Vietnum 1963)

VariousanatomicalhepatectomybyGlissonean (orGlissonian)approach*K.Takasaki(Japan),Japanese 1986,English1990

*E.Okamoto(Japan)Japanese,1986

Vascular(inflow)control1)intrafascial,2)extrafascial,3)extrafascialandtransfissual access

*HenriBismuth(France1982)Combinedprocedureofpreliminaryvascularcontrol(Jacob)+ parenchymaous transection(Tungstechnique)

*Inflow occlusion,extrafascialapproachRHVtransectedinthefinaltransection

(SMStrasberg,2001,review2007)

Vasculo-biliary sheaths. C. Couinaud, ed.Surgical anatomy of the liver revisited.

Paris: Couinaud; 1989

Galperin;Anatomyofcadaver liver,1989Launois;rightportalpedicleisolation,1992Batignanis;

Couinaud+Launois procedure,2000

Tungsanatomy(1939)

*LBlumgart(UK1979)liversplitproceduretoapproachthehepatichilumbyexposingtheentireMHVbetweenlobes

STFan;midplaneonMHV(2007)toavoidcomplicationandsecurecancerfreemargin.

*H.Hasegawa(Japan;inJapanese 1976,French 1980)

MiddleHVasintersegmentalplaneAlandmarkofbothhemiliver

BasisofthelivingdonorliverTx.rightorleftliver;problemofcongestion(Nakamura1981,Sano2002)

*TEStarzl(USA1975,1980,1982)RighttrisegmentectomyConfluenceofMHVwasfinallytransected

M.Makuuchi (Japan)1984 87

1. USguidedpunctureanddyeinjection

2. Hemihepaticvascularocclusion

However.

~NOTdescribed

NJLygidakis&GNJTygat(1989)

Hepatoiliary andpancreaticmalignancies(Thieme)

AMazziotti,ACavallari,JBelghiti, EMGonzalez,L.Hannoun,etal.(1997)

TechniqueinLiverSurgery(Thieme)

Colorectal1940Cattell;firstliverresectionforcolorectallivermets.

review,Schwartz19901948Raven1963Pendenperformedrightlobectomy1976FosterJH,WilsonSM+AdsonMA(USA) 60cases1977,1978Foster1978Wanebo HJ:Synchronoushepatectomy

Melanoma,pancreas,stomach,others;1936Mller (inGerman,1963Woodington

Thoracolaparotomy;JLLortatJacob1951)Firstreport;Unknown

*M.Makuuchi (JapanForsafetransection,safeapproachtorightHV(1991)

1. JshapeincisionwiththoracotomyToreduceinvasivenessoflargethoracotomy

2.IdentificationandtransectionofIVCligament

Anteriorapproach(AA);

*K.Takasaki(in Japanese 19834)Nontouchisolationmethodwithoutmobilization

forlargeHCCtoreducemassivebleeding

*K.Ozawa,Y.ShimaharaSignificancebypointofviewofpostoperativehepaticfunction(inEnglish;1990,1996)

ECLaiandC.Liu (HongKong);AAreducesbloodloss&

mortality(1996,2000,2006)

*J.Belghiti (France);LiverhangingmaneuverforAA

AppliedtolaparoscopicRH

TakasakisfirstAA~Videoreport@CongressinJapan(1984)

Hilarapproach;1)Hilardissection(individualvesselpreparation)(Dagher 2014,Lainas 2015,Palanisamy 2015,Kawaguchi 2016)

2)GlissonianapproachpitfallofinjuryofcontralateralBD (Wakabayashi,AnnSurg 2015)a)Intrahepatic(Machad 2008,Ogiso 2015,)b)extrahepatic(Cho 2011,Ikeda 2013,Kruger2016)

Position;1)Supine,2)Semilateraldecubitus(Machad 2008),3)Semiprone (Ikeda 2013)

Mobilization1)yes (Eguchi 2011,Ikeda 2013)2)no;AnteriorapproachLiverhanging1)Yes (Wakabayashi 2009,Soyama 2012,Dokmak S2014)2)No(Cho 2012,Afanch 2013,Herman2013)

ExposeofMiddleHV;1)Yes (Ikeda 2013,Palanisamy 2015,Ogiso 2015 )2)No(Sandri2015,Ratti 2015 )

completeexposureofMHVorvenacavamightnotbealwaysaccomplishedinall

Newapproachfromcaudalside Tomishige (2013)

LAPliversurgery

not

infuture LAPsurgery