Resection of the Lateral Area of the Left Segment See DVD

This resection consists of the transection of several Glissonean pedicles ramifying from the left side of the left segmental branch of the Glissonean pedicle, and the dissection of the liver along the line of attachment of the falciform ligament (Fig. 7.23).

All of the Glissonean pedicles that flow into the lateral area of the left segment branch from the left side of the umbilical portion. The round ligament is detached from the abdominal wall and pulled upward to expose the umbilical portion en face.

Fig. 7.23. Schema of resection of lateral area of left segment

As shown in Fig. 7.24a-f, when proceeding with the dissection of the liver parenchyma around the upper side of the umbilical portion, a tertiary branch coming from the umbilical portion will be in full view. This pedicle is that of the tertiary branch of Couinaud's S3. Several of these tertiary branches must be ligated and cut, one after another.

The tertiary branches near the round ligament feed the inferior part of the left lateral segment, while the branches near the hilum feed the superior part of the left lateral segment.

Fig. 7.24a. Dissection of liver parenchyma around upper side of umbilical portion

Fig. 7.24e. Strip the liver parenchyma along the main trunk of the left segmental branch toward the hepatic hilum. The tertiary branch for Couinaud's S2 comes into view 118

Fig. 7.24e. Strip the liver parenchyma along the main trunk of the left segmental branch toward the hepatic hilum. The tertiary branch for Couinaud's S2 comes into view 118

Fig. 7.24f. Transection of tertiary branches to the left lateral area is completed
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