Major hepatic resection: Left liver

Inflow control

The hilar plate is lowered. The left hepatic artery is ligated and divided. Any accessory or replaced hepatic artery arising from the left gastric artery is similarly ligated.

Dissection at the base of the umbilical fissure exposes the left portal vein. It should be controlled at this point and not at its origin from the main portal venous trunk. If the caudate lobe is to be removed together with the left lobe, the vein is secured below the takeoff of the caudate branches. If the caudate lobe is to be preserved, the vein is divided distal to the takeoff of the caudate branch (see Fig. 5.1 B). The left hepatic duct usually is easily identified just above and behind the left portal vein and can be encircled with a suture and divided as it curves into the umbilical fissure. These steps are illustrated in Fig. 5.1 . A line of demarcation in the Glissonian plane extending from the gallbladder fossa to the left of the vena cava is now visible on the liver surface ( Fig. 5.2 ) and is marked with a diathermy.