STEP 1Removal of the native left hemiliver and preparation of the graft

The resection of the native left hemiliver can be performed under selective occlusion of the left portal triad (see chapter "Segmentectomies, Sectionectomies and Wedge Resections") and includes resection of segment 1 with preservation of the median hepatic vein in the right hemiliver. The left side of the retrohepatic segment of the inferior vena cava is widely exposed to facilitate the left hepatic graft implantation.

For the preparation of the graft, resection of Sg1 is recommended, regardless of the type of graft (Sg2 and 3 or left hemiliver) or the type of donor (cadaveric or living). The left grafts include:

■ The left branch of the hepatic artery (living donor) or the entire hepatic artery including the celiac trunk (cadaveric donor)

■ The left branch of the portal vein

■ The left hepatic duct

■ The retrohepatic IVC is never left attached to the left graft

■ Either segments 2 and 3, drained through the left hepatic vein (left lateral section)

■ Segments 2,3 and 4, drained through the left and the median hepatic vein (left hemiliver graft) (A-1,A-2)

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