Anatomical right posterior sectionectomy: a further expansion of the ultrasound-guided compression technique

Dissection or encirclement of the sectional pedicles for resection area demarcation is generally required for anatomical right posterior sectionectomy (RPS). These maneuvers are sometime unfeasible and potentially dangerous. A new technique for performing an RPS is herein described. Among the last 289 consecutive patients who underwent hepatic resection, 15 met the eligibility criteria for anatomical RPS by ultrasound-guided finger compression. This technique consists in demarcating the resection area by ultrasound-guided finger compression of the right posterior portal pedicle at the level closest to the tumor but oncologically suitable. Five patients had HCC; 11 had colorectal liver metastases. Median tumor number was 2 (range 1-46); median tumor size was 2.4 cm (range 0.4-13). Six patients had cirrhosis or chronic hepatitis, and ten had steatosis. Results show that the procedure resulted feasible in all eligible patients, and demarcation area was obtained in all patients within 1 min of bimanual IOUS guided compression. There was no mortality or major morbidity: only 2 (12%) patients experienced postoperative morbidity. Blood transfusions were not given. Ultrasound-guided finger compression of sectional portal pedicle feeding the right posterior section is a feasible, safe, and effective method, and introduces a new modality for performing RPS.