PMC6452762_01
(a) Abdominal tomography that shows a tumoral mass, measuring approximately 20 cm x 15 cm, which almost fills in the left liver lobe and invades the middle and left hepatic veins and the inferior vena cava. (b) Reconstruction of the inferior vena cava by a synthetic graft and appearance after insertion of a portocaval shunt. (c) Ex situ transection of the liver parenchyma by Cavitron Ultrasonic Surgical Aspirator. (d) The appearance of the remnant liver after resection of segments 1, 2, 3, 4, 5, and 8. (e) The appearance of the remnant liver after implantation. (f) Postoperative day 5 follow-up liver tomography of the first case
NJS-25-97-g001.jpg
PMC6452762_02_NJS-25-97-g001.jpg
F1
The inferior vena cava was reconstructed using a synthetic graft, and then, a temporary portocaval shunt was placed [Figures 1b and 2b]. Liver parenchyma was transected using Cavitron Ultrasonic Surgical Aspirator (Sonoca 300; Soring GmbH, Quickborn, Germany) [Figures 1c and 2c]. Liver segments 1, 2, 3, 4, 5, and 8 were resected in the first case, while segments 4a, 8, and partially segment 5 were resected in the second case [Figures 1d and 2d]. The bile ducts were closed by 4/0 absorbable sutures [Figures 1e and 2e]. There was no major surgical complication in the first case, and the patient was discharged on the 7th postoperative day [Figure 1f].
PMC6452762_02
(a) Abdominal tomography that shows a tumoral mass, measuring approximately 20 cm x 15 cm, which almost fills in the left liver lobe and invades the middle and left hepatic veins and the inferior vena cava. (b) Reconstruction of the inferior vena cava by a synthetic graft and appearance after insertion of a portocaval shunt. (c) Ex situ transection of the liver parenchyma by Cavitron Ultrasonic Surgical Aspirator. (d) The appearance of the remnant liver after resection of segments 1, 2, 3, 4, 5, and 8. (e) The appearance of the remnant liver after implantation. (f) Postoperative day 5 follow-up liver tomography of the first case
NJS-25-97-g001.jpg
PMC6452762_02_NJS-25-97-g001.jpg
F1
The inferior vena cava was reconstructed using a synthetic graft, and then, a temporary portocaval shunt was placed [Figures 1b and 2b]. Liver parenchyma was transected using Cavitron Ultrasonic Surgical Aspirator (Sonoca 300; Soring GmbH, Quickborn, Germany) [Figures 1c and 2c]. Liver segments 1, 2, 3, 4, 5, and 8 were resected in the first case, while segments 4a, 8, and partially segment 5 were resected in the second case [Figures 1d and 2d]. The bile ducts were closed by 4/0 absorbable sutures [Figures 1e and 2e]. There was no major surgical complication in the first case, and the patient was discharged on the 7th postoperative day [Figure 1f].
(a) The appearance of the second case ready for the explanation after hepatoduodenal ligament dissection. (b) Reconstruction of the inferior vena cava and appearance of the portocaval shunt in the second case. (c) The appearance of the malignant mass after explantation. (d) Ex situ transection of segments 4, 8, and 5 by Cavitron Ultrasonic Surgical Aspirator. (e) The appearance of the remnant liver after implantation in the second case. (f) The liver functional tests of second case after surgery
NJS-25-97-g002.jpg
PMC6452762_02_NJS-25-97-g002.jpg
F2
As peritoneal deposits were not detected during abdominal extrapolation, the hepatoduodenal ligament was dissected, and the choledoc, main portal vein, and main hepatic vein were hanged [Figure 2a]. The inferior vena cava was reconstructed using a synthetic graft, and then, a temporary portocaval shunt was placed [Figures 1b and 2b]. Liver parenchyma was transected using Cavitron Ultrasonic Surgical Aspirator (Sonoca 300; Soring GmbH, Quickborn, Germany) [Figures 1c and 2c]. Liver segments 1, 2, 3, 4, 5, and 8 were resected in the first case, while segments 4a, 8, and partially segment 5 were resected in the second case [Figures 1d and 2d]. The bile ducts were closed by 4/0 absorbable sutures [Figures 1e and 2e]. The second case developed adult respiratory failure on the 2nd postoperative day, and the patient died on the 4th postoperative day with functional liver [Figure 2f].