STEP 5Dissection of the Arantiusligament and exposure of the left hepatic vein

The anterior walls of the left and middle hepatic vein are usually exposed by extending the dissection of the falciform and coronary ligament to the vena cava. In order to access the posterior wall, the left hemiliver is lifted up and the lesser omentum is cut up to the diaphragm. Next, the Arantius' ligament (ligamentum venosum) is identified between the left hemiliver and Sg1. It runs from the left portal vein to the left hepatic vein or to the junction between the left and the middle hepatic veins and is divided at its portal origin between ties (a remnant of the ductus venosus might be present). The stump of the ligament can now be grasped and dissected upward toward the inferior vena cava until the ligament broadens into its attachment. By traction of the ligament cephalad and to the left an avascular plane between the left hepatic vein and Sg1 can be seen and developed. The left hepatic vein can be isolated by means of a right-angle or a Kelly clamp. The left hepatic vein can be disconnected at this stage, but it is also possible to divide it at the end of the parenchyma dissection as shown in Step 7.

Arantius Ligament

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