[Right hemihepatectomy using a frontal approach--alternative to the conventional procedure].

Right hemihepatectomy is an anatomically based major resection technique for primary and metastatic liver cancer. The most dangerous step in the procedure is to mobilize the right liver lobe from the retroperitoneum and the inferior vena cava. Large tumors or those with extension to the diaphragm, adrenal gland, or kidney may be more easily resected if a frontal approach to dividing the liver is followed. After dissection of the hilus, the liver is divided and during this step all vessels draining to the vena cava are separated. Then the right liver lobe is mobilized together with surrounding structures if necessary, but with no significant risk of bleeding. Our experience in four patients operated on for metastases or different primary tumors demonstrated that this frontal approach may be safely used and allows minimal manipulation of the tumor. Intraoperative ultrasound may be helpful in the detection of the middle and right hepatic vein.