Liver tunneling procedure not done for which segment?

Liver tunneling procedure not done for which segment?

a) I
b) IV
c) V
d) VIII

Ans: C Reference: Blumgart’s 6th edition Page 1705. Explanation:

This is even high standard for MCh Preparatory exams. In short, there are several difficulties in planning resections in liver as you cannot imagine. Just the criteria for liver resection based on size alone not sufficient in planning. Finer details like its proximity to secondary and tertiary portobiliary radicles and hepatic vein is necessary to guide liver resection.

Common liver resections are Right and Left hepatectomy and its extended versions based on the segments removed.

New Terminologies and their removed segments Procedure Name Removed Liver segments Right hemihepatectomy Segments 5, 6, 7 and 8 Left hemihepatectomy Segments 2, 3 and 4 Right trisectionectomy Segments 4, 5, 6, 7 and 8 Left lateral sectionectomy Segment 2 and 3 Left trisectionectomy Segments 2,3, 4, 5 and 8

High Level Resections or Named liver resections with limitations to specific conditions based on the extent of involvement in Hilar cholangiocarcinoma and Colorectal metastases and certain forms of HCC in unusual locations like involving caudal lobe.

Taj Mahal Resection For Hilar cholangiocarcinoma

Segments IVa, V and I (caudate lobe) removed (hence the shape of Taj Mahal dome)
Dumbbell Form Resection For Cholangiocarcinoma
Segments IVb, I (caudate lobe) and partial Segment V resection about the right hepatic pedicle Mini-Mesohepatectomy (MMH) For lesions involving the Middle hepatic vein at caval confluence (not involving caudate lobe) Liver Tunnel Procedure (if caudate lobe involved as in above condition) Segments I, IV and VIII are removed as part of parenchymal preserving liver surgery for selected liver tumors which are involving Middle hepatic vein along with Caudate lobe
Liver Hanging Manoeuvre (LHM) It uses a tape between the anterior surface of Retrohepatic IVC and liver surface to help in better lifting of the liver and efficient vascular control if Anterior Approach for liver resection is planned (it is the preferred procedure nowadays as it is a no-touch technique)

Figure A represents the typical lesion needing Liver Tunnel Procedure ( CV- Communicating veins) Figure B represents the post-operative resection including MHV.