Right hemihepatectomy - general and visceral surgery

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  • Laparotomy

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    Laparotomy
     

    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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    Dividing the falciform ligament
     

    After ruling out extrahepatic metastasis divide the falciform ligament.

  • Freeing the liver

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    Freeing the liver
     

    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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    Exposing the inferior vena cava
     

    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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    Resecting the gallbladder
     

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

  • Local findings

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    Local findings
     
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  • Exposing the hepatoduodenal ligament

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    Exposing the hepatoduodenal ligament
     
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  • Lymphadenectomy

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    Lymphadenectomy
     
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  • Vessel ligation

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    Vessel ligation
     
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  • Ischemic demarcation

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  • Dividing the hepatic parenchyma

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    Dividing the hepatic parenchyma
     
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  • Dividing the right hepatic vein

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  • Dividing the right hepatic duct

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    Dividing the right hepatic duct
     
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  • Checking for bile leakage, resecting the gallbladder

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  • Checking for hemostasis

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  • Sealing and draining

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  • Reattaching the ligamentum teres hepatis

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  • Closing the abdominal wall

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  1. Laparotomy
  2. Dividing the falciform ligament
  3. Freeing the liver
  4. Exposing the inferior vena cava
  5. Resecting the gallbladder
  6. Local findings
  7. Exposing the hepatoduodenal ligament
  8. Lymphadenectomy
  9. Vessel ligation
  10. Ischemic demarcation
  11. Dividing the hepatic parenchyma
  12. Dividing the right hepatic vein
  13. Dividing the right hepatic duct
  14. Checking for bile leakage, resecting the gallbladder
  15. Checking for hemostasis
  16. Sealing and draining
  17. Reattaching the ligamentum teres hepatis
  18. Closing the abdominal wall
date of update: 20.08.2022
date of publication: 25.04.2009

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