Left hemihepatectomy

Open surgery was performed by using a 20 cm abdominal incision under the arch of right rib. Exploration: No ascites, no peritoneal metastasis, the tumors located in the junction of left and right bile ducts, involving the middle hepatic vein. 1. To dissect common hepatic artery and to sweep group 8 lymph nodes. To skeletonize proper hepatic artery, hepatic artery, GDA, and to group 12 lymph nodes. Because the dominant branch of right hepatic artery originated from SMA, proper hepatic artery and left branch of portal vein were dissected, ligated and cutted off respectively, by skeletonizing the portal vein. CBD was cutted above the pancreas and group 13 lymph nodes were dissected, with a negative distal margin. 2. The short portal vein of caudate lobe was dissected. After dissociating the left lateral lobe, turn it to the right, to dissect and to cut off the short hepatic vessels until the confluence of the left and middle liver. 3. To dissect liver from bottom to top, from front to back, ensuring CVP ≤ 5 cmH2O. Three staples were used to cut off the left hepatic vein, and the left half of the liver and caudate lobe were completely removed. The length of the tumor invading the middle hepatic vein was about 2cm. The distal and proximal part of the middle hepatic vein was blocked by using clamp, and the middle hepatic vein was anastomosed by using 6-0 Prolene suture. In the section of liver, the broken ends of four bile ducts in Ⅴ, Ⅵ, Ⅶ and Ⅷ segments were seen, with a clear negative margin. Roux-en-Y anastomosis of bile duct jejunum was performed after the formation of four bile ducts. Key words: Bile duct neoplasms; Hepatic veins; Hepatectomy