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Background <p>Variation along the right intersectional plane is pronounced when the portal branch P6a courses ventral to the right hepatic vein (RHV), complicating laparoscopic right posterior sectionectomy (Lap-RPS) and segmentectomies of segments VII (Lap-SS7) and VIII (Lap-SS8). We sought to characterize the relevant venous anatomy and propose procedure-specific strategies.</p> Methods <p>We retrospectively analyzed computed-tomography datasets from 55 hepatectomy patients. Cases were classified as Dorsal-P6a or Ventral-P6a; the latter was subtyped by whether the RHV reached the S5–S6 interface (Long- vs Short-RHV). Focusing on features pertinent to Lap-RPS, Lap-SS7, and Lap-SS8, we measured the inferior vena cava (IVC)–RHV angle, axial venous angles, depth of P7, and venous drainage territories.</p> Results <p>Ventral-P6a occurred in 23/55 (42%): Long-RHV (n = 15) and Short-RHV (n = 8). Ventral-P6a showed a stepwise widening in IVC–RHV angle (median 34.6° in Dorsal-P6a; 51.8° in Ventral-P6a/Long-RHV; 76.7° in Ventral-P6a/Short-RHV). An inferior RHV (IRHV) was universal in Ventral-P6a/Short-RHV and had the largest drainage territory; a middle hepatic vein (MHV) branches draining S6 occurred only in Ventral-P6a (39%). The axial IRHV angle correlated positively with its drainage territory (P &lt; 0.001).</p> Conclusions <p>In Ventral-P6a/Long RHV, the RHV often requires mid-course division during Lap-RPS. In Ventral-P6a/Short RHV, the wide IVC–RHV angle makes dorsal exposure of the RHV difficult. In 39% of Ventral-P6a, MHV branches cross the S5–S6 transection plane; during Lap-RPS it should be identified, and during Lap-SS8 it should be preserved. For Lap-SS7 in Ventral-P6a/Short-RHV, the IRHV typically runs deep and drains a large territory, favoring preservation.</p>

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Surgical strategy for laparoscopic right posterior sectionectomy and segmentectomies of segments VII and VIII, considering the courses of P6a and the right hepatic vein

  • 期刊论文

  • 发表日期：

    2025年12月1日

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  • Yusuke Yamamoto,
  • Ryo Morimura,
  • Taisuke Imamura,
  • Hidemasa Kubo,
  • Rie Shibata,
  • Gakushi Kitamura,
  • Hiroyuki Inoue,
  • Kento Kurashima,
  • Keiji Nishibeppu,
  • Kenji Nanishi,
  • Jun Kiuchi,
  • Hiroki Shimizu,
  • Tomohiro Arita,
  • Toshiyuki Kosuga,
  • Hirotaka Konishi,
  • Hitoshi Fujiwara,
  • Atsushi Shiozaki

摘要

Background

Variation along the right intersectional plane is pronounced when the portal branch P6a courses ventral to the right hepatic vein (RHV), complicating laparoscopic right posterior sectionectomy (Lap-RPS) and segmentectomies of segments VII (Lap-SS7) and VIII (Lap-SS8). We sought to characterize the relevant venous anatomy and propose procedure-specific strategies.

Methods

We retrospectively analyzed computed-tomography datasets from 55 hepatectomy patients. Cases were classified as Dorsal-P6a or Ventral-P6a; the latter was subtyped by whether the RHV reached the S5–S6 interface (Long- vs Short-RHV). Focusing on features pertinent to Lap-RPS, Lap-SS7, and Lap-SS8, we measured the inferior vena cava (IVC)–RHV angle, axial venous angles, depth of P7, and venous drainage territories.

Results

Ventral-P6a occurred in 23/55 (42%): Long-RHV (n = 15) and Short-RHV (n = 8). Ventral-P6a showed a stepwise widening in IVC–RHV angle (median 34.6° in Dorsal-P6a; 51.8° in Ventral-P6a/Long-RHV; 76.7° in Ventral-P6a/Short-RHV). An inferior RHV (IRHV) was universal in Ventral-P6a/Short-RHV and had the largest drainage territory; a middle hepatic vein (MHV) branches draining S6 occurred only in Ventral-P6a (39%). The axial IRHV angle correlated positively with its drainage territory (P < 0.001).

Conclusions

In Ventral-P6a/Long RHV, the RHV often requires mid-course division during Lap-RPS. In Ventral-P6a/Short RHV, the wide IVC–RHV angle makes dorsal exposure of the RHV difficult. In 39% of Ventral-P6a, MHV branches cross the S5–S6 transection plane; during Lap-RPS it should be identified, and during Lap-SS8 it should be preserved. For Lap-SS7 in Ventral-P6a/Short-RHV, the IRHV typically runs deep and drains a large territory, favoring preservation.