Extreme liver resections with preservation of segment 4 only

Figure 1 Schematic representation of two-stage hepatectomy with preservation of segment 4 only using outflow modulation. A: During the first stage, a right hepatectomy with middle hepatic vein is performed along with an associated induction of congestion in the left lobe; B: Redistribution of portal flow (increased inflow to segment 4 after territorial congestion of segments 2/3) optimizes hypertrophy of segment 4 and avoids hypertrophy of segment 2 and 3; C: The second stage of procedure, a left lobectomy, is performed.