Right Hepatic Lobectomy: Intrahepatic Glissonian Approach

Abstract

Indications • Primary liver carcinoma confined to the right liver lobe • Metastatic cancer localized to the right liver lobe Essential Steps 1. Upper midline incision with (optional) right lateral extension/right Chevron incision/ bilateral subcostal incision. 2. Explore abdomen to rule out extrahepatic disease. 3. Mobilize the right lobe of the liver. 4. Intraoperative ultrasound. 5. Identify middle hepatic vein and mark tran-section plane with electrocautery. 6. Cholecystectomy. 7. Incise capsule and divide hepatic parenchyma. 8. Divide segment VIII and VII branches of middle hepatic vein. 9. Staple or ligate right hepatic Glissonian pedicle. 10. Divide short hepatic veins and right IVC ligament. 11. Divide right hepatic vein. 12. Close the abdomen. Note These Variations • Right Chevron incision/bilateral subcostal incision • Extrahepatic ligation of inflow and outflow vasculature (Chap. 105) • Separate division of the right anterior and posterior Glissonian pedicles Complications • Bleeding • Bile leak • Injury to contralateral hepatic ducts • Postoperative liver failure Template Operative Dictation Preoperative Diagnosis Primary liver/meta static ___ cancer of the liver. TNM stage _______