Separation of the Tertiary Branch at the Left Segment

The round ligament is pulled upward, and the whole length of the trunk of the left secondary branch can then be seen from the outside (this occurs in about 50% of patients). In the other 50%, the left secondary branch is covered with the liver parenchyma. The condition in which a secondary branch is hidden by the parenchyma is referred to as a parenchymal bridge (Of note, in almost 30% of individuals, the umbilical portion of the left segmental branch is covered by an umbilical bridge of liver parenchyma). As shown in Figs. 7.6 and 7.7, the main trunk of the left segmental branch is not visible.

Fig. 7.6. In about 30% of cases, the main trunk of the left segment branch is covered by a thin parenchymal bridge. In these cases, this must be opened using an electric coagulator

Fig. 7.7. After cutting the parenchymal bridge, the main trunk of the left segmental branch can be seen

Fig. 7.7. After cutting the parenchymal bridge, the main trunk of the left segmental branch can be seen

The back of the parenchymal bridge is not fixed to a Glissonean pedicle, and therefore the bridge can easily be transected and opened.

The upper left branch(es) feed(s) the lower part of the left lateral area of the left segment, while the lower left branch(es) nourish(es) the upper part of the left lateral area of the left segment.

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