The bifurcation of the portal vein should be convincingly identified. A small branch to the caudate process is often present. By ligating it, about 2 cm of length along the right portal vein is obtained to facilitate safe ligation of the right portal vein (A-1).
Once the right branch of the portal vein is freed from the adventitial tissue, a right-angle clamp is passed around the vein (A-2).
A vascular clamp (e.g., small Satinsky clamp) is placed distally and the right portal vein is ligated with 1-0 silk. The distance to the bifurcation should be about 5 mm to avoid portal vein stenosis and subsequent thrombosis (A-3).
An alternative (e.g., in the case of a short right portal vein) is to use a small Satinsky clamp on the proximal right portal vein and a running Prolene 6-0 suture (A-4). As another alternative, a vascular stapler can be used in this position, but usually the small window in the porta hepatis through which this dissection is being performed lends itself more to a suture ligation than to a stapling. The portal vein on the liver side is controlled through suture ligature as a single ligature could slip away and cause bleeding. Now the demarcation line between the left and right hemiliver can be observed.
Was this article helpful?
For centuries, ever since the legendary Ponce de Leon went searching for the elusive Fountain of Youth, people have been looking for ways to slow down the aging process. Medical science has made great strides in keeping people alive longer by preventing and curing disease, and helping people to live healthier lives. Average life expectancy keeps increasing, and most of us can look forward to the chance to live much longer lives than our ancestors.