Access is gained through a bilateral subcostal incision with cranial extension. The falciform ligament is divided leaving enough length on the liver side as it needs to be fixed in the recipient. Finally a retractor (e.g., Takasago retractor) is installed (A).
The lateral segment is lifted up and a towel is placed in front of the spleen for its protection. A sponge is placed behind the left triangular ligament and the lateral segment is placed back. The left liver is pulled downward and the left coronary ligament and the left triangular ligament are divided by a cautery knife (B).
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