Resection of the Middle Inferior Area Couinauds S5

Hilus The Liver

The feeders of this area are a few tertiary branches ramified from the middle segmental branch near the hepatic hilum (Fig. 7.32). The procedure for this resection is essentially the same as that for an S6 resection. First, the border between the left and the middle segment is identified by the clamping of the middle segmental branch. Then, the liver parenchyma is dissected along this plane to a depth of about 5 to 6 cm caudally, reaching the trunk of the middle segmental branch (Fig. 7.33a)....

Resection of the Right Superior Area Couinauds S7

Dorsal Part Liver

In this procedure, some tertiary branches which ramify from the right segmental branches are transected, and some cone units fed by these tertiary branches are resected (Fig. 7.36). The tertiary branches of the upper part of right segment ramify from the right segmental branch distant from the hepatic hilum. Transection takes place at the mid-portion of the right segmental branch of the Glissonean pedicle. The tertiary branches supplying this area branched out from the main trunk of the right...

Selective Clamping of Segmental Branches Figs 520 to 523

Intersegmental Plane The Live

In patients with severe liver cirrhosis, alternate selective clamping of the segmental branches must be done during the dissection, to reduce liver damage and prevent congestion of the portal system. During the dissection between the middle and left segments, the left segmental branch of the Glissonean pedicle must be temporarily clamped, instead of using the Pringle maneuver. Likewise, at the time of dissection on the intersegmental plane between the middle and right segments, the right...