Resection of the Right Superior Area Couinauds S7

In this procedure, some tertiary branches which ramify from the right segmental branches are transected, and some cone units fed by these tertiary branches are resected (Fig. 7.36).

The tertiary branches of the upper part of right segment ramify from the right segmental branch distant from the hepatic hilum. Transection takes place at the mid-portion of the right segmental branch of the Glissonean pedicle.

The tertiary branches supplying this area branched out from the main trunk of the right segmental branch deep inside the liver; therefore, the parenchymal approach must be taken.

First, the right segmental branch is clamped temporary (Fig. 7.37). The borderline between the right segment and middle segment is confirmed by the demarcation line.

Fig. 7.37. Intersegmental plane between middle and right segments is recognized by change of color after clamping of right segmental branch

Dissection proceeds along this demarcated line; then the right hepatic vein is seen along the incision face. The right hepatic vein must remain intact (Fig. 7.38).

The peripheral part of the right segmental branch can be seen (Fig. 7.39). Transection of the peripherla part of the right segmental is done. Liver parenchymal dissection may be done on the demarcated line (Fig. 7.40).

Fig. 7.38. Dissection of liver parenchyma is started on the upper part of demarcated line
Fig. 7.39. Dissection proceeds deeply into the liver. The tertiary branch which distributes the upper part of the right segment comes into existence on dorsal side of right hepatic vein
Fig. 7.40. Upper part of right segment is demarcated after transection of the tertiary branch

The cut stump of the segmental branch lies at the bottom, and right hepatic vein lies on the cut surface of the liver parenchyma (Fig. 7.41).

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