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Hashida et al. Mini-invasive Surg 2024;8:14 Mini-invasive Surgery
DOI: 10.20517/2574-1225.2023.139

Technical Note Open Access

Optimized approach for blood vessel excavation

within liver parenchyma

Kazuki Hashida , Goro Honda, Yusuke Ome, Toru Tanahashi, Chikai Ubukata, Yusuke Kawamoto,
Yutaro Matsunaga, Shunichi Ariizumi

Department of Surgery, Tokyo Women’s Medical University, Tokyo 162-8666, Japan.
Correspondence to: Prof. Goro Honda, Department of Surgery, Tokyo Women’s Medical University, 8-1 Kawada-cho Shinjuku-
ku, Tokyo 162-8666, Japan. E-mail: ghon67@outlook.jp

How to cite this article: Hashida K, Honda G, Ome Y, Tanahashi T, Ubukata C, Kawamoto Y, Matsunaga Y, Ariizumi S.
Optimized approach for blood vessel excavation within liver parenchyma. Mini-invasive Surg 2024;8:14. https://dx.doi.org/10.
20517/2574-1225.2023.139

Received: 24 Dec 2023 First Decision: 20 Jun 2024 Revised: 15 Jul 2024 Accepted: 19 Jul 2024 Published: 23 Jul 2024

Academic Editors: David A. Geller, Giulio Belli Copy Editor: Dong-Li Li Production Editor: Dong-Li Li

Abstract
The most practical approach for dissecting the liver parenchyma involves first visualizing and subsequently
addressing the blood vessels within the parenchyma while maintaining a dry operative field. This process is similar
to “excavation” of ancient artifacts from soil without causing any damage. To excavate the blood vessels in a dry
operative field during liver parenchymal dissection, proficiency in both blood flow control and parenchymal
dissection techniques is mandatory. For blood flow management, inflow control is achieved using an externally
applied Pringle maneuver, whereas outflow control is achieved by decreasing the central venous pressure. Precision
in parenchymal dissection lies in dissecting the liver parenchyma in areas devoid of the Glissonean branch, such as
the intersegmental plane, using the back-scoring technique with a cavitron ultrasonic surgical aspirator (CUSA) to
read the grain of the blood vessels.

Keywords: Laparoscopic hepatectomy, blood vessel excavation, blood flow control skill, cavitron ultrasonic surgical
aspirator

INTRODUCTION
The most practical approach for dissecting the liver parenchyma involves first visualizing and then
addressing the blood vessels buried in the parenchyma while maintaining a dry operative field. This process

© The Author(s) 2024. Open Access This article is licensed under a Creative Commons Attribution 4.0
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