The left hepatic duct can be found where the parenchymal dissection line meets the hepatic hilus region (right side of the left portal branch) (B). The left hepatic duct is cut at the previously determined site. The hilar plate and the stiff fibrous tissue are dissected with a cautery knife. The left hepatic duct is closed with 6-0 Prolene suture on the donor side.
In the left lateral segment graft, reconstruction of the Sg4 hepatic duct is not necessary and it can be closed after confirming the direction. The Sg4 duct can be closed on the donor side too.
It is crucial to free the left portal vein branch completely through ligation and isolation of the caudate branches. They extend from the horizontal part of the origin of the branch.
For the parenchymal dissection, curved DeBakey forceps are used as a guide. The tip of the forceps is inserted between the caudate lobe and the lateral segment from the head direction of the portal vein. The forceps are lifted and fixed. The cutting line of the parenchyma is made between the marked incision of the surface and the tip of the forceps (C).
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