Ultrasound-guided finger compression in liver subsegmentectomy for hepatocellular carcinoma

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Abstract
Systematic subsegmentectomy is now accepted as the best option for the surgical management of hepatocellular carcinoma in patients with cirrhosis because it optimizes the balance between oncological requirements and the need to spare functioning liver parenchyma. However, this technique can be difficult because it requires a strong background in ultrasound-guided interventional procedures. We describe a new, simplified technique for the anatomical subsegmental hepatic resection of segment 2 or 3. It consists of IOUS-guided blunt portal branch compression to disclose the subsegmental area to be removed. This technique is a further evolution of so-called systematic subsegmentectomy for tumors located in segments 2 and 3. Its main advantages are that it is easy, fast, and reversible. We believe that it has the potential to lead to new opportunities in subsegmental anatomic liver resection.