Fig. 9.

a–h Patient with HCC of the right liver lobe infiltrating the inferior vena cava (IVC) as well as the right hepatic vein and the middle hepatic vein. Preoperative portal vein embolization of the right portal vein was performed. The left hepatic vein was dissected within parenchyma and preserved. After transection of liver parenchyma, tangential IVC resection was performed to complete tumor resection. a–b Patient’s CT scan shows the tumor infiltrating the IVC, the right and the middle hepatic vein. c–e Complete mobilization of the IVC to obtain vascular control: c Infrahepatic IVC with blue rubber bands around the infrarenal and suprarenal IVC as well as around the left renal vein. d Suprahepatic IVC and liver veins for bleeding control. Yellow rubber band around the suprahepatic IVC; blue rubber band around the left hepatic vein. e Complete mobilization of the retrohepatic vein before transection of the liver parenchyma. f Complete transection of the liver parenchyma (anterior approach) before partial resection of the IVC. g Reconstruction of the ICV by inserting a peritoneal patch harvested from the right abdominal wall. h Final result after completed reconstruction of the IVC