A method for protection of the left hepatic duct during right hepatic trisegmentectomy

Right hepatic trisegmentectomy which removes the right lobe and the medial segment of the left lobe is necessary to remove completely lesions which extend beyond the true right lobe of the liver. The procedure has been described in detail in excellent reviews. We describe a technique of bile duct preservation during right trisegmentectomy. This is accomplished by cannulating the left hepatic duct with a Silastic catheter which is introduced through the stump of the right hepatic duct. This technique allows palpation of the duct during the dissection. With positive identification, the numerous small branches to the medial segment of the left lobe can be ligated safely. A completion cholangiogram through the catheter is always done to identify and repair any extensive bile duct leaks. Finally, the technique can be adapted for use in other resections, such as left trisegmentectomy by simply cannulating the appropriate duct.