Right hemihepatectomy

Anatomy Perioperative management Technique Complications Evidence Total Video Medical Equipment

Laparotomy

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Laparotomy via upper abdominal right-angle incision with meticulous hemostasis; transverse in the right upper abdomen, median cranially to the xiphoid; Exploration of the abdomen, folding back of the wound edges and insertion of the retraction device.
Transection of the falciform ligament of the liver

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After exclusion of extrahepatic metastases, transection of the falciform ligament of the liver.
Mobilization of the Liver

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Division of the right triangular ligament; Mobilization of the liver from the adhesions to the diaphragm with exposure of the venous star
Preparation of the Inferior Vena Cava

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Mobilization of the liver also from caudal; the retrohepatic inferior vena cava is prepared and the veins draining into it are secured by clips or ligations; Looping of the right hepatic vein.
Mobilization of the Gallbladder

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After exploration of the hepatic hilum, the anterograde mobilization of the gallbladder is performed.
Local Exploration

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Examination of the liver and verification of the preoperative findings regarding vascular anatomy, tumor localization and size; exclusion of additional tumors through inspection, palpation and intraoperative sonography.
Preparation of the Hepatoduodenal Ligament

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Dissection of the ligament with longitudinal splitting of the peritoneum. Exposure of the common hepatic artery with transection and ligation of the right gastric artery.
Lymphadenectomy

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The common hepatic artery is followed to the upper border of the pancreas and dissected free. The lymphatic stations located here are resected.
The common bile duct is now looped and dissected free, and overall, the entire lymphatic tissue of the hepatoduodenal ligament is resected.
Vascular ligation

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Clamping and transection of the right hepatic artery. The same is done with the right portal vein branch; Ligation of the right hepatic duct.
Ischemic Demarcation

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After interruption of the blood supply, the right liver lobe demarcates itself; the demarcation line between segment 4a and 8, as well as 4b and 5, is traced with the electrosurgical knife, the liver capsule is transected.
Parenchymal transection

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Along the demarcation line, the liver parenchyma is transected using CUSA; in the process, smaller vessels are coagulated, larger ones are clipped or transfixed.
Transection of the right hepatic vein

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The right hepatic vein is divided using a transfixion ligation.
Division of the right bile duct

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After complete parenchymal transection, the right bile duct is centrally transected at the bile duct bifurcation and oversewn with 5-0 PDS after bacteriological swab collection; removal of the specimen, if necessary, frozen section from the peripheral right bile duct stump.
Exclusion of bile leaks, removal of the gallbladder

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Blue injection through the cystic duct and check for bile leaks in the area of the resection surface. Removal of the gallbladder.
Check for Hemostasis

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Inspection of the resection surface for hemostasis; use of the argon beamer, if necessary, transfixion ligation.
Sealing and Drainage

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Sealing of the resection surface with Tachosil® (see Medical Equipment tab); subhepatic insertion of a 19 Blake drain.
Refixation of the ligamentum teres hepatis

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To avoid torsion of the liver hilum, the ligamentum teres hepatis is refixated!
Abdominal wall closure

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Layered closure of the abdominal wall, staple suture, sterile wound dressing.

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Right hemihepatectomy

Laparotomy

Transection of the falciform ligament of the liver

Mobilization of the Liver

Preparation of the Inferior Vena Cava

Mobilization of the Gallbladder

Local Exploration

Preparation of the Hepatoduodenal Ligament

Lymphadenectomy

Vascular ligation

Ischemic Demarcation

Parenchymal transection

Transection of the right hepatic vein

Division of the right bile duct

Exclusion of bile leaks, removal of the gallbladder

Check for Hemostasis

Sealing and Drainage

Refixation of the ligamentum teres hepatis

Abdominal wall closure