Hepatic hilar transection method for liver surgery (with video).

The procedure used to isolate the hepatic artery, the portal vein and the bile duct separately at the hepatic hilum was first reported in the 1940s, and remains significant as an essential technique for liver surgery in the era of more complicated liver surgery and liver transplantation. The anatomy of the vessels at the hepatic hilum is highly variable; therefore, preoperative imaging studies are indispensable for understanding the anatomy in each individual patient. The minimal extent of the transection should be defined according to the operative procedure, as excessive disruption of the blood flow and lymphatic vessels can induce postoperative complications. When isolating the vessels, gentle handling and appropriate ligation/division of the vessels are required to avoid bleeding and injuries to the vessels to be preserved. The bile duct is wrapped with perivascular connective tissue and is difficult to isolate separately. Therefore, the hilar plate should be divided together with the bile duct, under the guidance of intraoperative cholangiography.