Anterior approach to dorsal short hepatic and right hepatic veins in a right hepatic lobectomy.

A simple procedure of right hepatic lobectomy for bulky liver tumors is proposed. The procedure is named "Anterior approach", which is characterized by transection of hepatic parenchyma without mobilization and rotation of the right hepatic lobe. The transection directly reaches the ventral surface of the retrohepatic inferior vena cava first at the portion of caudate process. The hepatic parenchymal transection proceeds from ventral to dorsal and from caudal to cranial. Several dorsal short hepatic veins are severed on the ventral surface of the IVC and the right hepatic vein is finally severed from inside. This method enables the minimization of operative stress and is especially useful for cases with a huge tumor in the right hepatic lobe which invades the diaphragm or thoraco-abdominal wall.