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Precise hepatectomy guided by the middle hepatic vein

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Hepatobiliary & Pancreatic Diseases International 2007年第4期6卷 430-434页

作者： sheung-tat fan Department of Surgery The University of Hong Kong Pokfulam Hong Kong China

The middle hepatic vein (MHV) lies in the midplane of the liver. The classical teaching of right or left hepatectomy is transection of liver I cm to the right or left wall of the MHV in order to avoid bleeding. However, guidance of liver transection is lost if the course of the MHV is not known. By exposing the MHV early in the phase of liver transection and following its course to the inferior vena cava, a precise liver transection plane could be obtained. Such technique has the potential of achieving adequate tumor-free resection margin, avoiding damage to intrahepatic portal pedicles, preserving venous drainage and functional liver tissue, and less postoperative infection.

关键词： middle hepatic vein hepatectomy

Historical perspective of living donor liver transplantation

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World Journal of Gastroenterology 2008年第1期14卷 15-21页

作者： See Ching Chan sheung tat fan Department of Surgery The University of Hong Kong Pokfulam Hong Kong China

Living donor liver transplantation (LDLT) has gone through its formative years and established as a legitimate treatment when a deceased donor liver graft is not timely or simply not available at all. Nevertheless, LDLT is characterized by its technical complexity and ethical controversy. These are the consequences of a single organ having to serve two subjects, the donor and the recipient, instantaneously. The transplant community has a common ground on assuring donor safety while achieving predictable recipient success. With this background, a reflection of the development of LDLT may be appropriate to direct future research and patient-care efforts on this life-saving treatment alternative.

关键词： Historical perspective Living donor liver transplantation

Selection of HCC patients for liver transplantation: the Milan criteria,Hangzhou criteria and beyond

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Hepatobiliary & Pancreatic Diseases International 2008年第3期7卷 233-234页

作者： sheung tat fan Department of Surgery The University of Hong Kong Queen Mary Hospital 102 Pokfulam Road Hong Kong China

Deceased or living liver graft should be considered as a valuable community resource. They should be implanted in patients who

关键词： HCC the Milan criteria,Hangzhou criteria and beyond

Absent middle hepatic vein in a right liver graft donor

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Hepatobiliary & Pancreatic Diseases International 2008年第4期7卷 430-432页

作者： sheung tat fan Yik Wong Department of Surgery The University of Hong Kong PokfulamHong Kong SARChina Department of Diagnostic Radiology The University of Hong Kong PokfulamHong Kong SARChina

BACKGROUND: The middle hepatic vein (MHV) is normally in form of a large trunk lying within the midplane of the liver. An anomaly in form of two separate trunks, each draining segment V/VIII and segment IV, has been described by Couinaud but not been well documented in the literature. METHOD: We report a right liver donor in whom the MHV was absent and not encountered during liver transection along the midplane of the liver. RESULTS: On computed tomography (CT) scan and intraoperative ultrasonography, there was a large segment VIII hepatic vein mistaken as the MHV on preoperative assessment and a large segment IV hepatic vein close to the ligamenturn venosum. CT volumetry based on either segment VIII or IV hepatic vein led to major error in liver volume calculation. Transection of the liver guided by segment VIII or IV hepatic vein would lead to sacrifice of liver parenchyma unnecessarily or presence of necrotic liver in the graft. CONCLUSION: Absent MHV is a rare anomaly. It is revealed by careful study of the CT scan.

关键词： middle hepatic vein inferior vena cava computed tomography

Technical note on complete excision of choledochal cysts

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Hepatobiliary & Pancreatic Diseases International 2013年第2期12卷 218-221页

作者： Tan To Cheung sheung tat fan Department of Surgery The University of Hong Kong State Key Laboratory for Liver Research The University of Hong Kong

BACKGROUND: Choledochal cysts are congenital cystic dilatations of the extrahepatic or intrahepatic portion of the biliary tree. Complete excision of choledochal cysts is currently regarded as the gold standard treatment, while less extensive procedures including cystoduodenostomy have become obsolete due to the potential for malignant change in the remnant cyst. For type-1 choledochal cysts, which sometimes extend to the main pancreatic duct closely, some surgeons may adopt a less aggressive approach in order to avoid damage to the main pancreatic duct as such damage can lead to serious consequences. However, incomplete excision of choledocha cysts may also cause problems. METHOD: Here we report on a reoperation treating incomplete excision of a choledochal cyst with focus on the technical aspect. RESULTS: In the reoperation, meticulous dissection of the live hilum which had been previously operated on was performed The hepaticojejunostomy was left intact. With the assistance o intraoperative cholangiography, the residual pancreatic portion of the choledochal cyst was completely excised. The pancreatic opening and the lower end of the common bile duct were reconstructed. Whipple operation was avoided. CONCLUSION: Careful planning with the aid of precise imaging before and during the operation largely enhanced the accuracy of the excision of the choledochal cyst.

关键词： choledochal cyst re-excision incomplete excision

Protection of the liver during partial hepatectomy

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Hepatobiliary & Pancreatic Diseases International 2004年第4期3卷 490-494页

作者： sheung tat fan Centre for the Study of Liver Disease and Department of Surgery The University of Hong Kong Pokfnlam Hong Kong China

BACKGROUND: Liver failure is the most common cause of mortality for patients undergoing partial hepatectomy. Given adequate liver function and remnant liver volume and absence of co-morbid illness, the cause of liver failure is frequently related to technical errors, which induces mas- sive bleeding and ischemic damage to the liver remnant. DATA RESOURCES: From author' s practice at Queen Mary Hospital, the University of Hong Kong. RESULTS: To avoid technical errors leading to liver ische- mia and failure, adequate exposure, control of bleeding during liver transection, and planning of transection plane are important. Ultrasonic dissector is the best instrument in liver transection. Its careful use can reduce blood loss and help recognize the hepatic vein, the exposure of which serves as an important landmark for a correct transection plane. Even without Pringle maneuver, minimum bleeding during transection could be achieved. CONCLUSION: Protection of the liver remnant is impor- tant to patient survival after partial hepatectomy. It is achieved by meticulous surgical techniques that reduce bleeding to a minimum.

关键词： anterior approach middle hepatic vein ultrasonic dissector

Live donor liver transplantation in adults: graft size, related anatomical anomaly and imaging evaluation of donor

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Hepatobiliary & Pancreatic Diseases International 2002年第1期1卷 14-17页

作者： sheung-tat fan From the Centre for the Study of Liver Disease Department of Surgery University of Hong Kong Medical Centre Queen Mary Hospital Hong Kong China

The shortage of cadaveric livers has sparked aninterest in adult live donor liver transplantation. Rightlobe donor hepatectomy is frequently required to ob-tain a graft of adequate size for adult recipients. Thisprocedure requires not only a precise understanding ofliver anatomy and anatomic anomaly, but also themeans of assessing them. This review focuses on thekey points in adult live donor liver transplantation us-ing the right lobe combined with our own experiencein 81 cases including graft size, related anatomicalanomaly and imaging evaluation of donor.

关键词： live donor liver transplantation graft size anatomy

Simplifying living donor liver transplantation

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Hepatobiliary & Pancreatic Diseases International 2010年第1期9卷 9-14页

作者： See Ching Chan Chung Mau Lo sheung tat fan Department of Surgery The University of Hong KongQueen Mary Hospital

BACKGROUND: Living donor liver transplantation is a complex surgical operation. Treatment policies and operative techniques evolved in the last two decades. DATA SOURCES: Our center's experience in living donor liver transplantation was reviewed in conjunction with relevant publications in the literature. RESULTS: The surgical techniques and perioperative surgical therapeutics could be modified towards simplicity. Examples include regular inclusion of the middle hepatic vein without compromising the venous outflow of the donor's remnant left liver. This provides excellent venous outflow, which is crucial for a small-for-size graft. Immunosuppression and hepatitis B suppression are steroid free and hepatitis B immunoglobulin free respectively. CONCLUSION: The most practical way to achieve high graft and recipient survival rates with an acceptably low donor risk is through design of a protocol that simplifies the surgery and postoperative management.

关键词： simplifying right liver living donor liver transplantation

Emergency re-routing of anterior sector venous outflow for right lobe living donor liver transplantation including the middle hepatic vein

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Hepatobiliary & Pancreatic Diseases International 2011年第3期10卷 325-327页

作者： Kenneth SH Chok See Ching Chan Chung Mau Lo sheung tat fan Department of Surgery Queen Mary Hospital The University of Hong Kong State Key Laboratory for Liver Research

BACKGROUND:Controversy remains over whether the middle hepatic vein should be included in the liver graft in right liver living donor liver *** in the anterior sector of a right liver graft can cause graft malfunction,which is especially devastating in the case of a graft with marginal size in relation to recipient body size on top of poor pre-transplant recipient *** case we report here highlighted the importance of the middle hepatic vein in right liver living donor liver ***:We illustrated the rectification of outflow obstruction of the middle hepatic vein in the anterior sector of right liver graft caused by technical error during *** rectification was performed with emergency re-routing using an artificial ***:Congestion in the anterior sector of the graft improved immediately and the patient’s postoperative liver function test results improved ***:The middle hepatic vein is important for effective drainage of the anterior sector of a right liver *** re-routing technique described in the report can also be applied to cases in which the middle hepatic vein is injured during hepatectomy requiring immediate reconstruction.

关键词： Gore-Tex graft vein graft liver graft cirrhosis hepatitis B infection