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[Members Only] J.Jpn. Surg. Soc.. 120(2): 159-164, 2019
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BASIC TECHNIQUES USED FOR VASCULAR HANDLING AND ANASTOMOSIS IN SURGERY FOR HEPATOBILIARY CANCER
Vascular reconstruction is frequently necessary in surgery for hepatobiliary cancer. Surgeons should be accustomed to handling vessels such as the hepatic vein, hepatic artery, portal vein, and vena cava and should gain experience in a number of cases requiring vascular reconstruction under the guidance of senior surgeons. Vessels should be treated carefully in every case. Veins are grasped with tweezers with weak pressure on the venous wall and on as large a surface as possible. The hepatic artery should not be grasped with tweezers. Hepatic veins are encircled in the liver parenchyma after the hepatic vein is widely exposed on the transected surface of the liver. The portal vein, surrounded by massive connective tissue, is dissected without any connective tissue on it. End-to-end anastomosis of the portal veins is performed allowing for a “growth factor” and with the stitching pulled as loosely as possible in order to prevent stenosis after reconstruction.
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