Right inferior phrenic vein indicating the right hepatic vein confluence into the inferior vena cava

Torzilli, Guido; Montorsi, Marco; Palmisano, Angela; Del Fabbro, Daniele; Gambetti, Andrea; Donadon, Matteo; Olivari, Natale; Makuuchi, Masatoshi

doi:10.1016/j.amjsurg.2005.10.022

« Previous Next »The American Journal of Surgery
Volume 192, Issue 5 , Pages 690-694, November 2006

Right inferior phrenic vein indicating the right hepatic vein confluence into the inferior vena cava

Guido Torzilli, M.D., Ph.D.
- 3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089 Rozzano, Milano, Italy
- Hepatobiliary Surgery Unit, 1st Department of Surgery, Ospedale Maggiore di Lodi, Azienda Ospedaliera della Provincia di Lodi, Lodi, Italy
- Corresponding author. Tel.: +39-02-8224-4083; fax: +39-02-8224-4590.
Marco Montorsi, M.D.
- 3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089 Rozzano, Milano, Italy
Angela Palmisano, M.D.
- 3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089 Rozzano, Milano, Italy
Daniele Del Fabbro, M.D.
- 3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089 Rozzano, Milano, Italy
Andrea Gambetti, M.D.
- Hepatobiliary Surgery Unit, 1st Department of Surgery, Ospedale Maggiore di Lodi, Azienda Ospedaliera della Provincia di Lodi, Lodi, Italy
Matteo Donadon, M.D.
- 3rd Department of Surgery, Istituto Clinico Humanitas, IRCCS, University of Milan, Via Manzoni, 56, I-20089 Rozzano, Milano, Italy
Natale Olivari, M.D.
- Hepatobiliary Surgery Unit, 1st Department of Surgery, Ospedale Maggiore di Lodi, Azienda Ospedaliera della Provincia di Lodi, Lodi, Italy
Masatoshi Makuuchi, M.D., Ph.D.
- Hepato-Biliary-Pancreatic Surgery Division, Artificial Organ and Transplantation Division, Department of Surgery, Graduate School of Medicine, University of Tokyo, Tokyo, Japan

Received 27 June 2005; received in revised form 26 October 2005 published online 02 May 2006.

Abstract

Background

Limiting backflow bleeding from the hepatic veins is a priority when performing hepatectomy. However, hepatic vein encirclement is difficult, especially in re-resection. We verified the presence and trajectory of the right inferior phrenic vein (RIPV), which could be a useful anatomic landmark to guide surgeons in targeting the extrahepatic right hepatic vein (RHV) before dissection.

Methods

Between May 2001 and January 2005, 100 consecutive patients with liver tumors were enrolled and underwent hepatectomy: 77 patients underwent surgery for tumors located in the right hemiliver.

Results

RIPV was detected in all but 1 patient (99%), and its trajectory was always guided toward the extrahepatic RHV. The only patient in whom RIPV was not detected had undergone prior liver resection and interstitial therapies for colorectal cancer liver metastases.

Conclusions

Apart from exceptional conditions, detection of the RIPV is always feasible and allows safe surgical dissection while approaching the extrahepatic RHV before hepatic resection.

Keywords: Liver anatomy, Liver surgery, Liver neoplasms, Inferior vena cava, Hepatic vein, Phrenic vein