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identify the right hepatic artery which can be encircled and hanged on a vessel loop but a gen­tle pulling toward the abdominal wall from the assistant. In this way, the space between the artery and the right portal vein opens, and the right portal vein can be dissected and encircled (either in its main right trunk or by separate approach to ventral and dorsal portion). Right artery and portal vein can be at this stage clamped to obtain an ischemic demarcation along the Cantlie line, patency of ow toward the left liver can be checked by ultrasound, and ICG injection can be performed at this stage to obtain a nega­tive staining of the hemiliver to be resected. While the right artery can be comfortably sec­tioned at this stage, the room to place hem-o­locks or vascular stapler to section the right portal vein may be not enough: In this situation, the sec­tioning can be postponed during liver transection phases when the hepatic parenchyma is open, and this procedure can be safer and more effective. Isolation and section of right biliary duct should generally be performed transparenchymally, in order to rule out the possibility of iatrogenic lesions of the biliary tree of the remnant liver in the case of undetected biliary anatomy variations.

middle hepatic vein should be exposed, leaving the vessel in the remnant liver sectioning tribu­tary branches on its right side. Along parenchy­mal transection, vessels can be either coagulated or clipped according to their size. After the sec­tion of the biliary duct (and eventually of the right portal vein if not performed before paren­chymal transection), the transection should pro­ceed following the anterior aspect of the inferior vena cava until the hepatocaval conuence, to identify the shelter between the right vein and the inferior vena cava. In right trisectionectomy, the transection proceeds along the right side of the falciform ligament until identication of the middle hepatic vein, then sectioned, before pro­ceeding as described for right hepatectomy (Video 19.1).

requires an incision large enough to allow its retrieval without the risk of squeezing or mor­cellation especially in the case of procedures performed for malignancies. The extraction is generally accomplished by Pfannenstiel inci­sion or upper midline incision. The decision to use a supraumbilical or a midline should be done according to several items: the presence of previous laparotomy and consequently adhe­sions in the lower abdomen, presence of porto­systemic shunts, and lesion rupture in the case of huge and fragile lesions. In a previous series by our group, the concern about jeopardization of minimally invasive benet because of the use of a midline incision was analyzed: No differ­ences in postoperative recovery from hemi-hep­atectomies were observed between those patients whose specimen was retrieved through supraumbilical or midline incision [17]. Consequently, both accesses can be used alter­natively after careful evaluation of patient’s characteristics.