Anatomical Right Posterior Sectionectomy of the Liver by IOUS-Guided Finger Compression

Study Overview
=================
Brief Summary
-----------------
The use of intraoperative ultrasound (IOUS) allows us to perform new conservative hepatectomies. The investigators previously reported the systematic subsegmentectomy by IOUS-guided finger compression for segments 2-3, which is currently applied for patients with hepatocellular carcinoma (HCC)on cirrhosis. The investigators herein describe a novel technique, which consists in the systematic right posterior sectionectomy by IOUS-guided finger compression.

Detailed Description
-----------------
A novel technique for the demarcation of the resection area by means of IOUS-guided finger compression to accomplish a right posterior sectionectomy is described. Dissection or encirclement of the sectional pedicles for resection area demarcation is thus avoided. Ten patients underwent this technique successfully without mortality or major morbidity. IOUS-guided finger compression of sectional portal pedicle feeding the right posterior section is a feasible, safe, and effective method.

Official Title
-----------------
A Novel Simple Technique for Performing Anatomical Right Posterior Sectionectomy of the Liver: the Ultrasound-Guided Finger Compression

Conditions
-----------------
Liver Malignancies, Colorectal Liver Metastases, Hepatocellular Carcinoma

Intervention / Treatment
-----------------
* Procedure: Anatomical right posterior sectionectomy of the liver by IOUS-guided finger compression.


Participation Criteria
=================
Eligibility Criteria
-----------------
Inclusion Criteria: Patients with tumors at least at 1 cm distally to the bifurcation of the right portal vein (bifurcation of P5-8 and P6-7) eligible for right posterior sectionectomy, namely the anatomical removal of segment 6 and 7, were considered potential candidates to this procedure. Precisely, these criteria were adopted: Patients with hepatocellular carcinoma (HCC) with infiltrative growing pattern in contact with P6-7; Patients with any type of HCC in contact with P6-7 with distal bile duct dilation; Patients with colorectal liver metastasis (CLM) in contact with P6-7. Exclusion Criteria: Exclusion criteria for carrying out the herein described procedure was considered the presence of tumoral thrombosis in P6-7.

Ages Eligible for Study
-----------------
Minimum Age: 18 Years
Maximum Age: 85 Years

Sexes Eligible for Study
-----------------
All

Accepts Healthy Volunteers
-----------------
No

Study Plan
=================
How is the study designed?
-----------------

Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Right posterior section group<br>Patients with tumors in the right posterior section of the liver (segments 6-7) | Procedure: Anatomical right posterior sectionectomy of the liver by IOUS-guided finger compression.<br>* The technique consists in IOUS-guided finger compression of the right posterior portal pedicle at the level closest to the tumor but oncologically suitable. This method allows us to anatomically mark the area of resection with nor hilar plate nor IOUS-guided puncture of vessels, which are up to date the only two techniques available to perform anatomical right posterior sectionectomy - namely the removal of segment 6 and 7.<br>* Other names: anatomic resection of segment 6-7;|

What is the study measuring?
-----------------
Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The primary outcome is the safety of the anatomical right posterior sectionectomy performed IOUS-guided finger compression. |  | 6 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| The secondary outcome is the efficacy of the anatomical right posterior sectionectomy performed by IOUS-guided finger compression. |  | 1 year | 

 Terms related to the study
=================
Keywords Provided by Centre Hospitalier Valida
-----------------
Colorectal liver metastasis, hepatocellular carcinoma, liver surgery, intraoperative ultrasound, finger-compression