General Surgery · HPB

Right Hepatectomy

OPERATION: Right Hepatectomy (Open) — Formal Right Hepatic Lobectomy (Segments 5-8)
ANAESTHETIC: General anaesthesia with epidural
ANTIBIOTICS: IV cephalosporin at induction. VTE prophylaxis. Cell salvage in circuit.
POSITION: Supine. Nasogastric tube and urinary catheter. Invasive monitoring (arterial line ± CVP). Type and crossmatch — 2 units. [Autologous blood donation if colorectal metastases — elective].

INDICATION:
[Colorectal liver metastases / hepatocellular carcinoma / cholangiocarcinoma / benign lesion requiring formal hepatectomy]. Preoperative imaging: CT three-phase / MRI liver — hepatic anatomy, tumour location, segmental involvement, vascular and biliary anatomy confirmed. [FLR volumetry performed — adequate remnant confirmed]. No extrahepatic disease on staging.

PROCEDURE:
WHO Checklist performed. Long right subcostal incision extending across the left rectus with superior midline extension. Costal margin retractor system applied.

INITIAL STEPS:
Ligamentum teres ligated and divided. Falciform ligament divided to coronary ligament with diathermy. Full exploratory laparotomy — extrahepatic disease excluded. [Intraoperative USS — tumour location and margins confirmed, relationship to hepatic veins defined, any additional lesions identified].

GALLBLADDECTOMY:
Cholecystectomy performed — cystic artery and duct divided. Gallbladder rotated laterally and kept en bloc with specimen if adjacent to tumour.