Resection of the Right Inferior Part Couinauds S6 Resection

Tertiary branch(es), single or multiple, close to the hepatic hilum arising from the right segmental branch should be resected (Fig. 7.27). In order to see the intersegmental plane between the right and middle segments, clamp the already taped right segmental branch (Fig. 7.28). Several centimeters of liver parenchyma should be dissected on the hilum along the intersegmental plane. The liver parenchyma that is supplied by several tertiary branches which control the S6 area should be dissected.

Fig. 7.27. Tertiary branches that ramify from the right segmental pedicle near the hepatic hilus are the branches of S6
Fig. 7.28. Intersegmental plane between the right and middle segments is clearly shown by clamping of right segmental branch
Fig. 7.29. After dissection of liver parenchyma, the right segmental branch and some tertiary branches which ramified from this branch come into view
Fig. 7.30. Some tertiary branches must be cut under the control of the area which must be resected according to color change of the applicable area of the liver parenchyma

The number of cone units which must be dissected is controlled by change of color of liver surface after clamping the applicable tertiary branches. If the demarcated area is too small for radical resection of the tumor, another tertiary branch should be clamped. Further incision of the hepatic parenchyma to open the hepatic hilum is required if the tertiary branch(es) to be ligated is (are) too deep to manipulate. Then the tertiary branch(es) is (are) ligated and cut.

Transection is done on the demarcated line on the liver surface. The resection incision should be directed from the liver surface to the cut end of the tertiary branch(es) deep in the liver.

Fig. 7.31. Lower part of right segment resection is completed
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