Figure 3.

Hypothermic perfusion strategies. (A) In situ hypothermic perfusion: total vascular exclusion is in place and a perfusion cannula is inserted in the portal vein. A cavotomy is also performed, to be used for venting. (B) Ante situm technique: total vascular exclusion is in place, hypothermic perfusion is used and the vena cava has been sectioned below the superior clamp. (C) The liver can now be rotated anteriorly towards the surgical team, to perfectly expose the caval plane. (D) Resection is completed and reconstruction requires grafting of the IVC and hepatic vein re-implantation. (E) Ex situ technique: TVE and hypothermic perfusion are followed by PV, hepatic artery and biliary division and subsequent complete hepatectomy with IVC resection. (F) Reconstruction requires IVC grafting and portal and arterial anastomosis. Biliary anastomosis is also required (not depicted).