STEP 5Isolation of portal vein

The superior retractor is repositioned medially so that it retracts the liver at the point of entrance of the portal triad. The portal vein is located in the posterolateral aspect of the portal triad and is approached from behind. The fibrofatty tissue on the posterolateral aspect of the portal triad, which contains nerves, lymphatics, and lymph nodes, is divided by blunt and sharp dissection. This technique is a safe maneuver because there are no portal venous tributaries on this aspect of the portal triad. As soon as the surface of the portal vein is exposed, a vein retractor or Gilbernet retractor is inserted to retract the common bile duct medially. The portal vein is mobilized circumferentially at its midportion and is encircled with an umbilical tape. It then is isolated up to its bifurcation in the liver hilum. Several tributaries on the medial aspect are ligated in continuity with fine silk and divided.

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