Right hemihepatectomy

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.

After ruling out extrahepatic metastasis divide the falciform ligament.

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

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.

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

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.

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.

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.

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.