Right hemihepatectomy

The laparotomy is performed via an upper abdominal right-angle incision with meticulous haemostasis, whereby the incision in the right upper abdomen runs transversely to the midline and then cranially up to the xiphoid. After exploration of the abdomen to exclude an extrahepatic tumour or peritoneal carcinomatosis, the wound edges are draped with towels and the retractors are inserted.

The mobilisation of the liver begins with the transection of the falciform ligament of the liver. To allow optimal exposure of the liver, including the posterior segments, transection of the right triangular ligament as well as detachment of the liver lobe from the adhesions to the diaphragm, with exposure of the venous star, is required.

The retrohepatic vena cava is exposed coming from caudally up to the hepatic vein junction cranially. The small hepatic veins draining dorsally into the vena cava are transected between Overholt clamps and secured on the caval side with transfixing ligatures. The right hepatic vein is initially looped.

After exploration of the hepatic hilum, the gallbladder is mobilised anterogradely, i.e. from the fundus, out of the liver bed. The cystic artery is divided centrally. The cystic duct is initially preserved, e.g. for a later intraoperative cholangiography or as a sling for exposing the hilum.

Next, the liver is examined with regard to the preoperative findings. The vascular anatomy, tumour localisation and size, as well as the presence of further tumours, are checked by inspection, palpation and intraoperative ultrasonography.