Separating the Middle Segmental Branch

See Fig. 5.10. First, perform a cholecystectomy and then remove the connective tissue of the triangle of Calot from the liver bed. The middle segmental branch and the liver parenchyma of the hepatic hilum come into view. All tissue is totally cleared from around the middle segmental branch right up to the point where the middle segmental branch enters the opening of the hepatic hilum.

Fig. 5.10. Cholecystectomy was done first

Then (see Figs. 5.11 and 5.12) detach the middle segmental branch from the parenchyma. This must be done by making a very fine lineā€”cut just between the connective tissue of the middle segmental branch and the liver parenchyma. It is imperative to be "just between" in order to prevent bleeding and to keep the operative field clean. When dissection is done "just between" these tissues, there usually appear a few tiny branches. Ligate all of them. The dissection is carried out behind the middle segmental branch in a similar fashion.

Fig. 5.11. Detaching the middle hepatic branch from the liver parenchyma

Fig. 5.12. Disection of the liver

Fig. 5.12. Disection of the liver

middle segmental branch

Then (see Figs. 5.13, 5.14) choose one of four special forceps, each of slightly varied curvature, to introduce tape around the middle segmental branch. After clamping this branch (Fig. 5.15), the area of the middle segment can be recognized by its change of color.

Fig. 5.14. Tape is pulled around middle segmental branch

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