Các hình tam giác và các dây chằng động mạch vành phải được lấy xuống phơi bày khía cạnh posterolateral của tĩnh mạch chủ dưới (IVC). Gan được trả về vị trí giải phẫu của nó và phúc mạc nằm phía trên mặt trước của infrahepatic IVC là chia cắt và giải phóng. | 58 Liver Transplantation Figure 12. Hepatico-jejunostomy. Figure 11. Right lobe vascular anastamosis. 5 vein should be freed on all sides in this manner until a right angle forceps can be safely passed around the right portal vein. The right triangular and coronary ligaments are taken down exposing the right posterolateral aspect of the inferior vena cava IVC . The liver is returned to its anatomical position and the peritoneum overlying the anterior surface of the infra-hepatic IVC is dissected and freed. Dissection is continued up towards the liver. The caudate lobe is elevated off the cava and small tributaries from the caudate lobe are ligated and divided. Small tributaries from the right lobe are likewise ligated and divided. Larger tributaries 5 mm are preserved for re-implantation. In such a manner the entire anterior and right lateral surfaces of the cava are exposed up to the level of the right hepatic vein which is now dissected working both from above and below until it can be isolated with a vessel loop. The Liver Transplant Operation 59 The caudate process between the right portal vein and the IVC is scored. The line of resection is marked on the surface of the liver. This line runs from between the middle and right hepatic veins to the left side of the gallbladder fossa and then down the inferior surface of the liver to the IVC. Parenchymal dissection is undertaken using the technique preferred by the operating team. During this dissection it is usual to encounter two significant middle hepatic vein tributaries one from segment V and one from segment VIII. When these are large some centers re-implant one or other of these into the recipient cava using a venous conduit. Once completed the two parts of the liver with their respective blood supplies should be left until the recipient hepatectomy is completed. A completion cholangiogram can be performed to exclude stricture or leak at the sight of the oversewn right hepatic stump. The liver segment is .
