STEP 10Ligation of the right and middle hepatic veins

Approaching the hepatic veins, the middle hepatic vein is now isolated. As the right hepatic vein has been prepared before, both can be divided at the end of the parenchymal dissection by means of a vascular stapler.

Of note, the middle and left hepatic veins usually share a common trunk. Make sure that the left hepatic vein is preserved!

In addition to this extended right hemihepatectomy, the caudate lobe (segments 1,9) can be approached and resected en bloc, if needed (see Section 4).

STEP 11 Reattachment of the falciform ligament

The falciform ligament must be reattached to prevent rotation of the remnant liver, since this can result in an acute Budd-Chiari syndrome (obstruction of the venous outflow of the liver), which is a fatal complication after extended right liver resections .

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