Mid-transversal hepatectomy: breaking new ground in parenchymal sparing hepatectomies

We, herein, describe a case of complex parenchyma-sparing hepatectomy for multiple bilobar colorectal liver metastases (CRLMs). A 61-year-old woman, previously operated for an occlusive adenocarcinoma of the transverse colon and undergoing adjuvant chemotherapy, developed metachronous bilobar CRLMs. After administration of a II line chemotherapy with partial response, she was referred to our hospital. The pre- and post-treatment imaging recognized seven liver lesions, with a bilobar distribution involving segments 3, 4, 5, 8, and 7. After multidisciplinary team evaluation, the surgical strategy was planned by means of three-dimensional reconstruction and simulation software. The planned and executed procedure consisted of a unique transection plane comprising partial resection of segments 3-4-5-8-7, thus removing the central transversal portion of the liver. Accurate preoperative planning and intraoperative ultrasound for resection guidance allowed us to achieve a complex parenchymal sparing procedure in an advanced disease that would be usually candidate for major resection and staged hepatectomy.