How Far Can We Go with Laparoscopic Liver Resection for Hepatocellular Carcinoma? Laparoscopic Sectionectomy of the Liver Combined with the Resection of the Major Hepatic Vein Main Trunk

Figure 5

Schema of the steps for case 3 operation (right anterior sectionectomies combined with middle hepatic vein resection). (a) Front view and (b) side view. Step  1 is as follows: the anterior branch of Glissonian pedicle is encircled and clamped under the laparoscopic magnified view. Step  2 is as follows: transection of the liver parenchyma on the ischemic line, as straight as possible, in the caudal to cranial direction is performed. (Part of the left transaction line protrudes the ischemic line due to combined resection of middle hepatic vein.) Step  3-1 is as follows: the clamped anterior Glissonian pedicle is divided with lineal stapler at the time of the transection line reaching the level of the structures on both sides, during liver transaction. Step  3-2 is as follows: the peripheral part of middle hepatic vein is divided with lineal stapler at the time of the transection line reaching the level of the structures on both sides, during liver transaction. Step 4 is as follows: after the completion of parenchymal transaction, good view and approach to the root of middle hepatic vein are obtained from caudal and dorsal direction. The vein is divided with lineal stapler under the laparoscopic magnified view and the resection is completed.

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