The extended right hemihepatectomy (also called right trisectionectomy) includes resection of segments 4-8. For cholangiocarcinoma of the liver hilum (Klatskin's tumor) or carcinoma of the gallbladder, an en-bloc resection including segments 1 and 9 is usually performed. This procedure should only be performed if the remnant liver (segments 2 and 3) provides sufficient liver function. Therefore, preoperative assessment of liver function, a volumetric assessment of the expected remnant liver volume, and exclusion of liver fibrosis or cirrhosis are essential before extended resections.
Dependent on the vascular anatomy, two different approaches can be used for the anatomic resection of Sg4 in addition to segments 5-8. The classical anatomic resection of Sg4 is performed by selective ligation of the pedicle to Sg4 prior to tissue transsection. Alternatively, tissue transsection can be performed first with ligation of the pedicle to Sg4 during parenchymal transsection. Here, we describe the classical approach of resection.
STEPS 1-7 are the same as for a right hemihepatectomy.
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