After appropriate prep and drape a bilateral subcostal incision was made. Exploration of the abdominal contents revealed tumor on the right that was adherent to the right diaphragm and kidney. There was no other evidence of metastatic disease.

The hepatic veins and falciform ligament were dissected free. The suprahepatic vena cava was dissected out and dissection carried to the adrenal vein which was ligated and divided. Dissection and division of the right renal vein, right renal artery, and ureter was completed. The right hepatic lobe was then mobilized and the portion of diaphragm adherent to the liver was resected with the tumor.

Attention was now turned to the gallbladder which was taken down. Intra-operative ultrasound verified two small cysts in the left lobe of the liver and the tumor was identified in the right liver lobe, both in dome and segments 6 and 7. Pedicle ligation was accomplished by making a hepatotomy in the caudate lobe and medial to the gallbladder fossa, putting the Pringle up and using finger dissection encircling the portal pedicle at the level of the bifurcation into the right and left sectoral branches. A TA 30 was used to staple across the region and the Pringle maneuver let down. The parenchyma was then divided. An Argon beam coagulator was used to coagulate the cut surface.

The abdomen was then closed in the usual manner without drainage.

Pathology Results