Anatomic left hepatic trisegmentectomy.

The technique of left trisegmentectomy was first published in 1982 and consists in the removal of the left liver (segments II, III, and IV) along with the right anterior sector (segments V and VIII). This procedure is based on the knowledge of the segmental liver anatomy. There are only a few technical reports describing this complex procedure. We describe an anatomic and standardized way to identify and isolate the glissonian sheaths of the left liver segments along with the portal pedicles from right anterior sector (segments V and VIII). The middle and left hepatic veins are dissected using Arantius ligament as landmark. With this technique, it is possible to achieve inflow and outflow control of the involved liver segments without hilar dissection or clamping. This technique provides a safe way to perform a left extended hepatectomy without warm ischemia of the relatively small remnant liver.