Case Description
- The patient is in his 70s, diagnosed with hepatocellular carcinoma.
- The tumor was found in liver segments 5 and 8, above the right anterior pedicle.
- A laparoscopic right hepatectomy was planned, using an ultrasound aspirator as well as the Pringle maneuver to occlude portal and hepatic artery inflow.
- The right anterior pedicle is isolated using an extra-Glissonian approach. By occluding the pedicle with a bulldog clamp, transection margins can be drawn on the liver surface following the demarcation on segments 5 and 8.
- The left transection plane will be developed following the middle hepatic vein, from periphery to root, dividing segment 5 and segment 8 vein branches as they are encountered.
- The right anterior pedicle will be divided after the left plane is complete; this allows the specimen to pivot to the right.
- The right plane is developed starting from the root of the right hepatic vein, following the vein from root to periphery.
- This approach allows for reduction in bleeding, as the branches encountered will be less prone to 'splitting', as seen in typical transection planes.
CT scans (venous)