Operative steps In GI Surgery- Caudate lobe excision

1. Abdomen is opened from the Bilateral Subcostal incision or Midline Incision.

2. Omni retractor, Thomson's or similar retractor is used to lift up the rib cage. There should be good exposure of the stomach, lesser omentum, greater omentum and duodenum

3. Dissection at the base of umbilical fissure and identify caudate vessels arising from left side of portal vein and left hepatic artery

4. Left lobe of liver is mobilized and turned to right

5. Left lateral margin of caudate is freed by division of fibrous extension of the tissues as it courses posteriorly

6. This allows access to the caudate veins

7. Now attention is turned to the right side and retrohepatic veins are tied

Veins are tied from below upwards and anterior surface of Inferior Vena Cava is freed

8. If CAudate excision is with Right or left hepatectomy, Middle hepatic vein is tied and caudate removed with it.

9. If isolated caudate lobe excision is bein done, there is a danger of middle hepatic vein tearing posteriorly, Control of left and middle hepatic vein should be taken

10. Another technique is to split the liver anteriorly and divide the right margin of segment IV