The right hepatic vein is prepared (separated from the mid and left hepatic vein) from the top and below on the cava by means of a Kelly clamp (A-1). A 1-0 silk or vessel loop is placed around the right hepatic vein. The transsection can be performed by means of a vascular stapler (A-2). An alternative technique is to occlude the right hepatic vein with a vascular spoon clamp and ligate the proximal hepatic side with a 1-0 silk ligature in combination with a large clip (A-3). Should bleeding occur despite the combined ligature and clip, it can easily be controlled by putting a finger on the transsected right hepatic vein. Just continue on the caval side, which is secured by a running 4-0 polypropylene suture. Once the caval side is secured, the bleeding on the transsected proximal hepatic vein can be controlled by a suture ligature.
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