STEP 6Dissection of the liver parenchyma

As the blood supply to the left hemiliver is now interrupted, a clear demarcation between the left and the right hemiliver is seen and identifies the line of resection along the main portal plane. Two stay sutures (2-0 silk) are placed at the inferior margin of the liver, one on each side of the demarcation line. At this point, verify that CVP is low (below 3mmHg). The liver capsule is incised with diathermy a few millimeters on the ischemic side. The Pringle maneuver for intermittent or continued inflow occlusion is used as needed. The dissection starts on the inferior margin of the liver and is continued first on the caudate lobe, then right onto the surface of the vena cava. During the parenchyma dissection, care must be taken to protect the mid hepatic vein. The left bile duct is isolated and carefully ligated within the parenchyma.

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