Resection of the Left Lateral Inferior Area Couinauds S3

This procedure—an example of a one-cone-unit resection—is indicated for small tumors in the lower left lateral part of the liver (Fig. 7.8).

Fig. 7.8. Left lateral inferior area resection

The round ligament is pulled upward to expose the umbilical portion en face. Detach the upper left side of the left segmental branch from the surrounding liver parenchyma to place a tertiary branch bifurcating from the umbilical portion in full view. This pedicle is that of the tertiary branches of Couinaud's S3 (Fig. 7.9). Figure 7.10 shows the demarcated S3 area from an abdominal view. The liver parenchyma is dissected on the demarcated line; the left hepatic vein is exposed on the cut surface (Fig. 7.11).

Fig. 7.9. Detachment of the left side of surrounding liver parenchyma from left segmental pedicle. There are 1-2 tertiary branches

Fig. 7.10. Demarcated S3 area—abdominal view

Fig. 7.10. Demarcated S3 area—abdominal view

Fig. 7.11. Left lateral inferior area resection is completed

Resection of the Lateral Inferior and the Medial Inferior Areas of the Left Segment 101

Resection of the Lateral Inferior and the Medial Inferior Areas of the Left Segment (Couinaud's S3 plus Lower Part of S4) (See DVD 2)

This procedure (Figs. 7.12 and 7.13) is indicated for small tumors located just under the falciform ligament.

Fig. 7.12. Schema of resection of Couinaud's S3 plus lower part of S4
Fig. 7.13. Small tumor is located just under the falciform ligament

Resection of the Lateral Inferior and the Medial Inferior Areas of the Left Segment 103

In this procedure, the left segmental branch is transected at the middle part of the trunk; this resection corresponds to an S8 resection. The left segmental branch is detached circumferentially from the liver parenchyma at its midpoint to free it from its surroundings, and it is then ligated and cut (Figs. 7.14 and 7.15).

Fig. 7.14. Round ligament is lifted up. Middle part of left segmental branch is dissected from liver parenchyma
Fig. 7.15. Ligature at the middle portion of left segmental branch
Fig. 7.16. Demarcated area—abdominal view

Figure 7.16 shows the demarcated area from an abdominal view and Fig. 7.17 shows the completed resection. The cut stump of the left segmental branch is visible at the apex of the triangular-shaped space after resection. The S2 and upper part of the S4 areas remain.

Fig. 7.17. Completed resection
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