Hepatic Cone Unit Resection Anatomical Subsegmentectomy

This is a method by which part of a segment is resected systematically, taking "cone unit(s)" into consideration, i.e., so-called Couinaud's segment resection. Four or five cone units correspond to one Couinaud's segment. The number of cone units to be resected depends upon the size and location of the tumor.

Here the cone unit resection is explained, using a cauliflower as a model (Fig. 7.1). The trunk of the cauliflower corresponds to the segmental branch of the liver and the stalks represent the liver tertiary branches. Each stalk with the cauliflower clump on top represents a liver cone unit. One of the stalks is ligated and then a dye solution is introduced (Fig. 7.2). The pig-mented part represents a cone unit. The pigmented part is then removed (Fig. 7.3). Figure 7.4 shows a three-cone-unit resection and resected specimen (Fig. 7.5).

Fig. 7.1. (Step 1) One of stalk is ligated

Cone unit resection

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Transection of the corresponding tertiary branch

Fig. 7.2. (Step 2) One cone unit is pigmented

Fig. 7.3. (Step 3) Pigmented area is removed
Fig. 7.4. Schema of resection of three cone units
Fig. 7.5. Resected specimen of three cone units. Each cone unit is dyed with different color solution (see Fig. 34, p. 153)
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