Right hemihepatectomy - general and visceral surgery

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  • Laparotomy

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    Transverse right epigastric incision with careful hemostasis, in the midline carried to the xyphoid process; exploration of the abdominal cavity; after covering the wound edges with moist surgical towels insert the retractor system.

  • Dividing the falciform ligament

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    After ruling out extrahepatic metastasis divide the falciform ligament.

  • Freeing the liver

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    Divide the right triangular ligament; free the liver from its adhesions with the diaphragm and expose the hepatocaval confluence.

  • Exposing the inferior vena cava

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    Free the liver from caudad as well; expose the posthepatic inferior vena cava and manage the contributing veins there with clips or suture-ligatures. Encircle the right hepatic vein with a vessel loop.

  • Resecting the gallbladder

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    After exploration of the hepatic hilum dissect the gallbladder in antegrade fashion from its bed and resect.

  • Local findings

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    Examine the liver and verify the preoperative findings for vascular anatomy, location and size of tumor; rule out other masses by inspection, palpation and intraoperative ultrasound.

  • Exposing the hepatoduodenal ligament

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    Longitudinal incision of the peritoneum forming the anterior leaf of the hepatoduodenal ligament which is then dissected. Expose the common hepatic artery, ligate and divide the right gastric artery.

  • Lymphadenectomy

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    Follow and free the common hepatic artery to the superior margin of the pancreas. Extirpate all lymphatic stations there.

    Encircle with a vessel loop and free the common hepatic/bile duct and extirpate all lymphatic tissue of the hepatoduodenal ligament.

  • Vessel ligation

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    Clamp and divide the right hepatic artery. Clamp and divide the right lobar branch of the portal vein, encircle the right hepatic duct with a vessel loop.

  • Ischemic demarcation

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    Once the blood supply has been interrupted, the right hepatic lobe will demarcate; follow the demarcation line between segments 4a and 8, and also between 4b and 5, with electrocautery and divide the liver capsule.

  • Dividing the hepatic parenchyma

  • Dividing the right hepatic vein

  • Dividing the right hepatic duct

  • Checking for bile leakage, resecting the gallbladder

  • Checking for hemostasis

  • Sealing and draining

  • Reattaching the ligamentum teres hepatis

  • Closing the abdominal wall