PMC10159741_01
Dissection around the common hepatic artery (CHA). The portal vein (PV), splenic vein (SV), inferior mesenteric vein (IMV), and superior mesenteric vein (SMV) are taped individually. The tumor was left adherent on the PV-SMV axis afterward the artery first approach.
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fig1
Finally, the specimen was attached only on the right circumference of the PV-SMV axis (Figure 1).
Arrow indicates the resected segment of the PV-SMV axis.
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fig2
Operative finding. Sutured inferior vena cava (IVC) after left renal vein (LRV) harvesting (arrow).
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fig3
Circumferential LRV resection was carried out after subsequent venous clamping, proximally at the confluence with the inferior vena cava, and distally, before the junction of the adrenal, lumbar, and left ovarian veins, to enable venous drainage of the left kidney via collateral venous blood flow (Figure 3).
Intraoperative finding. A segment of the PV-SMV axis was removed and reconstructed using an LRV patch. CHA: common hepatic artery; SV: splenic vein; IMV: inferior mesenteric vein; SMV: superior mesenteric vein; PV: portal vein.
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fig4
The LRV was opened longitudinally and used as a "patch" graft to reconstruct the partially resected PV-SMV axis (Figure 4).