Access to Sg7 is gained through a straight thoracoabdominal incision via the 8th intercostal space (left semilateral position), or through a right subcostal incision. An overview of the important anatomical structures is shown in the Figure.
STEP 1 Identification of the intersegmental plane and ligation of small hepatic vein branches
The intersegmental plane between segments 7 and 6 is identified by injecting the die into P6 (a counterstaining technique). A crushing method is applied using Pringle's maneuver (A).
When a peripheral branch of the RHV is exposed, it is carefully traced proximally and the trunk of the RHV is exposed. Tiny branches of the RHV are carefully ligated with 4-0 silk (B).
STEP 2 Division of the portal pedicles for Segment 7 and exposure of the RHV
The two major portal pedicles are exposed. Both are ligated and divided (A). The RHV is exposed and a thick drainage vein of Sg7 is ligated (B). After removal of Sg7,land-marks including RHV and stumps of P7 are exposed.
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