The document outlines a detailed surgical procedure for mobilizing the right lobe of the liver, including dissection techniques and handling of hepatic and portal veins. Key steps involve the use of clamps, retraction methods for ducts, and the transection of liver tissue. Finally, the process emphasizes careful hemostasis and specimen delivery.

2. • Right subcostal with midline extension
(hockey stick incision)
• Dissect falciform ligament until right
hepatic,middle and left hepatic seen inserting
in to IVC (dissection of suprahepatic IVC)
• Dissect groove between right and middle-left

3. Suprahepatic
IVC

4. Dissection of
Groove betweeen
Right and middle left hepatic veins

5. Dissected veins

6. MOBILIZATION OF LIVER
• After that right lobe is mobilized from it’s
ligamentous attachments as shown in figures.
• Several short hepatic veins corsing from liver
to IVC needs to be ligated.
• Idea should be to elevate right lobe of liver
from the IVC.

12. Dissecting Right Hepatic Vein
• Make a good groove between right and
middle-left during top dissection.
• As shown in first figure, you will encounter
hepato- caval ligament.
• Dissect it and divide it between clamp (few
small veins may run through it)
• After that you will find right hepatic vein.
Create tunnel behind ir and connect it to the
initial groove you have created. Now Loop It.

13. Hepatocaval or
Makuchhi’s ligament

16. Portal dissection
• DO Fundus first cholecystectomy.
• Tie cystic duct. Keep the threads long (act as retractor.)
• By retracting you will have idea where the cbd is.
• Retract CBD with ties.
• Now try to dissect hepatic artery by pulsation (you will find it until it
course anterior to the CBD)
• Dissect hepatic artery, clamp and feel pulsation of left hepatic
artery. IF ok.
• Suture ligate and cut it.
• Posterior to it you will Find portal vein and its right and left branch.
Dissect right portal vein loop it and cut it with staplers or suture
ligate it or close the remaining end with prolene 5-0.
• While dissecting right portal vein you will find one or two branches
going in to caudate process. Ligate it.

32. Parechchymal Transection
• Now you will find transection line on the liver
surface mark it.
• Extend it up to junction of right and left bile
duct.(you will get idea by lowering hilar plate)
• Transect it by any method. (clamp
crush,cusa,harmonic whatever you have)
• You can ligated any horizontal small vessels
going to right side.(middle hepatic vein runs
vertically)

33. Hanging Maneuver
• Now pass Ryle’s tube below right hepativ vein
that you dissected. Bring it anterior to IVC and
take it out through porta and lift liver by
holding both the end of ryle’s tube.(assistant
holds the below end and upper end can be
secure with artery forceps etc.
• Will help and lifting the liver and prevent
injury to IVC

38. • At last loop the right bile duct and cut it and
tie it with continuous PDS 4-0,5-0,6-0 or
stapler it.
• Deliver the specimen out.
• Secure hemostasis at the cut surface.
• ( all these pictures are screenshots from
blumgart video atlas)