Anatomical Resection of Segments 2 and

The Figure depicts the important anatomical structures for this procedure.

STEP 1 Hepatic parenchymal transection along the left edge of the falciform ligament

(the left intersectional plane)

By pulling up the left liver via the round ligament, hepatic parenchymal transection is done along the left edge of the falciform ligament. The left wall of the portal pedicle for the umbilical portion of the portal vein is exposed, and all of the tributaries running into the lateral section are ligated and divided. When liver parenchyma of segment 3 and 4 is connected in the visceral side of the umbilical portion, the connecting part is divided during parenchymal transection.

STEP 2 Division of portal pedicles for segment 2 and 3

Along the left wall of the umbilical portion of the portal vein, there are a few thick portal pedicles for segment 3 (P3). All of them are ligated and divided. Portal pedicles for segment 2 (P2) are located in the cranial edge of the umbilical portion of the portal vein. They are usually thicker than P3s and only 2 or 3 cm caudal to the root of the left hepatic vein (LHV). They are ligated and divided.

STEP 3 Division of the left hepatic vein (LHV)

At the end of the hepatic parenchymal transection, the root of the left hepatic vein (LHV) is exposed and divided. The stump of LHV is ligated or is closed by running suture. The Figure shows the situation at the end of the procedure.

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