Blood into the left lateral lobe (including the S2 and S3) is supported by the left Glisson’s pedicle branches along the left side of the fissure of the round ligament. A small incision on the left side is the basis for the fissure of the round ligament (Fig. 12.1); then, make an incision on the front of the left venous ligament and left Glisson’s pedicle branch confluence (Fig. 12.1). Use long curved forceps for blunt dissection from site C to site D until the curved forceps pierce site D. Then, a tourniquet can surround the left Glisson’s pedicle branches with the curved forceps traction until the branches are broken off.

Resect the liver at the diaphragmatic surface along the left border of the falciform ligament, at the visceral surface along the left border of the round ligament, and toward the Arantius ligament follows an order of a superior-inferior movement and then an inferior-superior movement. Because the inflow of the left lateral lobe and bile duct has been amputated, the hepatectomy can be performed more quickly. After exposing the left hepatic vein trunk, amputate it, and reinforce the stump with 5/0 polydioxanone suture (PDS) wire. Remove the entire specimen, staunch the bleeding, place the drainage tube, and close the abdomen.

Dissect the left Glisson’s branches at the left side of the hilar plate, which will avoid injury to the blood vessels and bile ducts if there is anatomical variation of the hepatic portal. Using the confluence of the left Arantius ligament and left Glisson’s pedicle branches as a guide, safely and quickly dissect the left Glisson’s pedicle branches. Make a small incision at the inferior border of the fissure of the round ligament, and dissect the front confluence of the left Arantius ligament and left Glisson’s branch (Fig. 12.1) to expose the back of left Glisson’s pedicle branch. Then, use long curved forceps for blunt dissection from site B to site D, encircle the left Glisson’s branch with a tourniquet and amputate the left branch (Fig. 12.2).

After occlusion of the left hepatic inflow, a significant ischemic line appears on the liver surface; the hepatectomy starts from this line. Make an incision along the left hepatic vein following an order of a superior-inferior movement and then an inferior-superior movement. Intraoperative ultrasound can help locate the middle hepatic vein when necessary. After exposing the left hepatic vein trunk, amputate it, and reinforce the stump with 5/0 PDS wire. When the tumor affects the caudate lobe and the caudate lobe must be resected, resect the liver along the line as described until arriving in the front of the inferior vena cava. Then, pull the caudate lobe and left liver to the left, expose the front and left side of the retrohepatic inferior vena cava, and ligate the short hepatic vein from inferior to superior. After the back of left hepatic vein is completely exposed, ligate and suture it. Remove the entire specimen, staunch the bleeding, place a drainage tube, and close the abdomen.

Make a small incision on the right side of the confluence of the caudate lobe, gallbladder bed, and far right side of the hilar plate (Fig. 12.1), up to the level of the hepatoduodenal ligament. Expose the connective tissue at the inferior border of the hilar plate. Reveal the caudate branch after careful dissection. Dissect, ligate, and suture this branch; blunt dissection can occur from this branch to incision E until the entire right Glisson’s pedicle trunk is dissected. Amputate the trunk, and suture the ends (Fig. 12.3).