Figure 4.

Liver parenchyma dissecting-first method for right hepatolobectomy. For right anterior lobectomy, the right Glissonean pedicle is clamped by a bulldog clamp temporarily to identify the ischemic range of the right liver, the parenchyma is transected along the labeled ischemia line (the left resection line) to reveal the right anterior Glissonean pedicle (RAGP), then the pedicle is encircled with a suture for traction (A). After that, the pedicle is transected using a vascular stapler (B) to reveal the demarcation of right anterior and posterior lobe (the right transection line) for further dissection. For right posterior lobectomy, the parenchyma along the right side of right hepatic vein localized by intraoperative ultrasound was dissected toward the cephalic direction at first to fully reveal the right posterior Glissonean pedicle (RPGP) (C). After sufficient dissection, the pedicle is clamped by hem-o-lok clips before transection (D).