RESUMO
BACKGROUND: Certain variations in liver anatomy can aid in parenchymal-preserving hepatectomy.1,2 Inferior right hepatic vein (IRHV) is an accessory vein in the right side of liver draining segment 6.2 We present a case of 67-year-old man with HBV cirrhosis. One HCC in segment 7 abutting the right hepatic vein (RHV) and another large HCC in segment 8/4a were found. After two sessions of TACE, liver resection was scheduled. Resection of RHV was inevitable to get free margin. Fortunately, a significant IRHV was present, so we could preserve segment 6. Central bisectionectomy with segment 7 resection using the Glissonean pedicle approach, and hepatic vein guided transection was planned.3 METHODS: After placement of trocars, pneumoperitoneum was created. The main surgical steps were: (1) Right anterior Glissonean pedicle control; (2) Parenchymal transection along the umbilical fissure; (3) Transection of the right anterior portal pedicle, middle, and right hepatic vein; (4) Parenchymal transection between segments 5 and 6; and (5) Identification of IRHV and resection of segment 7. RESULTS: The operative time was 330 min, and estimated blood loss was 80 mL. The total intermittent inflow occlusion time was 90 min. The histopathologic diagnosis was well-differentiated HCC. The tumors size of segments 8 and 7 was 4 cm and 2.9 cm, respectively. The resection margin was negative. The patient was discharged uneventfully on postoperative day 5. CONCLUSIONS: The preserved liver parenchyma after hepatectomy demands good vascular inflow and outflow. A large IRHV could be adequate outflow of segment 6, allowing more distinct operations.