Associating liver partition and portal vein ligation for staged hepatectomy: From technical evolution to oncological benefit

Figure 1 Exposure of the portal vein by lifting the common bile duct and right hepatic artery using a lid retractor. Here the right portal vein branches were transected.

Figure 2 Liver parenchyma transection along the falciform ligament.

Figure 3 Computed tomography scan before associating liver partition and portal vein ligation for staged hepatectomy in a patient with intrahepatic cholangiocarcinoma and on day 10 after liver partition. A: The future liver remnant consisted of segment 2 and 3 with volume of 347 mL (23% of the standardized total liver volume); B: Showing the hypertrophy of the segment 2 and 3 with volume of 610 mL (41% of the standardized total liver volume).

Figure 4 Completion of right trisectionectomy.

Figure 5 Partial associating liver partition and portal vein ligation for staged hepatectomy. The non-total liver parenchymal transection is indicated by the clips, left along the liver split area in a computed tomography scan performed on day 10 after the liver partition.

Figure 6 The future liver remnant was separated by two Penrose drains from the right liver lobe in a patient with bilobar colorectal liver metastases during the first stage operation. Three lesions at the left hemi-liver were resected.