Transection of the Left Segmental Branch Fig 541

The round ligament is freed from the abdominal wall. Then the round ligament is lifted upward so that the umbilical portion can be seen en face. The umbilical portion (left segmental branch) is vertical to the flat position of the left primary branch. The separation of the right side of the left segmental

Fig. 5.41. Right side of the left segmental branch is detached from hepatic hilus

branch begins at this corner and the separation continues behind the umbilical portion.

Then (Fig. 5.42), the left lateral liver is lifted upward with forceps to be able to confirm the whole length of the duct of Arantius. The liver capsule is dissected along the frontal surface of the duct of Arantius from the cranial to the caudal aspect, reaching behind the left segmental branch. Appropriate forceps are introduced from the right side of the umbilical portion to the left side in front of the duct of Arantius (Fig. 5.43).

Fig. 5.42. Lifting the left lateral liver, and left side of the left segmental branch is detached on hepatic hilus. The liver capsule is dissected along the duct of Arantius
Fig. 5.43. The left segmental branch is taped at this origin

Transection of the left segmental branch is done at the level of the anterior surface of the lesser omentum (Fig. 5.44) so that any branches feeding the caudate area cannot be injured. In many individuals, the root of the left segmental branch is wide. In these patients, transection using a liner cutter is useful (Fig. 5.45a,b).

Fig. 5.44. Transection of left segmental branch is done at the level of the anterior surface of the lesser omentum

Fig. 5.45b. The left segmental branch is transected by a suture instrument b

Fig. 5.45b. The left segmental branch is transected by a suture instrument

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