STEP 4Transsection of the right portal vein

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.

Portal Vein Ligature

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