Case Scenario

• A 52 year old woman was diagnosed with biliary cystadenoma, with a tumour found in the left lobe.
• The tumour abuts the left portal vein at the porto-umbilical fissure, as well as the origin of the left hepatic vein.
• The middle hepatic vein is free from the tumour, and will serve as a landmark for parenchymal transection.
• An umbilical tape will be passed behind the root of the left hepatic vein, brought along the caudate groove, posterior to the course of the left portal vein and left hepatic artery, emerging at the gallbladder fossa.
• The tape will act as a 'sling' to indicate the transection plane, which lies close to the course of the middle hepatic vein.