Laparoscopic liver resection utilizing the ventral avascular area of the inferior vena cava: A retrospective cohort study

Figure 5 Computed tomography and 3-dimensional reconstruction image of the liver tumor and the surgical procedure of laparoscopic left hemihepatectomy for tumors invading the right adrenal gland and inferior vena cava. A and B: Computed tomography and 3-dimensional reconstruction images reveal that the tumor invaded the right adrenal gland and inferior vena cava (IVC, arrow); C: Blunt dissection for exposing the avascular area in the retrohepatic tunnel; D-F: Splitting the liver parenchyma along the surface of the IVC in a caudal to cranial direction to expose the root of the middle hepatic vein; G and H: Transection of the short hepatic veins of the third hepatic hilum; I: Transection of right hepatic vein; J: The excision of the tumor and the involved right adrenal gland and IVC and subsequent repair of the IVC; K: Transection of the Makuuchi ligament. AT: Anterior trunk; PP: Posterior pedicle; IVC: Inferior vena cava; MHV: Middle hepatic vein; SHV: Short hepatic vein; RHV: Right hepatic vein.