Resection of the Caudate Process Area

The hepatoduodenal ligament is taped and pulled up perpendicularly, exposing several small branches nourishing the caudate area behind the right and left primary branches. The right primary branch of the Glissonean pedicle is detached from the hepatic hilum (Fig. 6.6). Pull this branch upward and detach the surrounding liver parenchyma. There are some short Glissonean

Fig. 6.6. Right primary branch of the Glissonean pedicle is detached from the hepatic hilum

pedicles ramifying from the right primary branch. These are each transected, one by one. After the caudate process area is resected, the right inferior hepatic vein is exposed at the cut surface between the right segment and the caudate area (Fig. 6.7). Total caudate area resection is done after several thin Glissonean pedicles branching from the right and left primary branches have been transected (Fig. 6.8).

Fig. 6.7. Exposure of right inferior hepatic vein
Fig. 6.8. Total caudate area resection

The border of the parenchyma between the right segment and the caudate area is dissected on the lateral triangle (Fig. 6.9). The border between the left segment and the caudate area is dissected on the paracaval triangle by the right lateral approach, after mobilization of the right lobe (Fig. 6.10).

The total caudate area resection is completed (Fig. 6.11). The remaining liver is connected only to the main hepatic veins.

Fig. 6.9. Dissection on lateral triangle and paracaval triangle
Fig. 6.10. Dissection on paracaval triangle
Fig. 6.11. Completion of total caudate area resection
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