STEP 6Transsection of the right hepatic vein

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.

A-3

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