A solitary 6 cm lesion is identified in the right hepatic lobe in the patient described above. Which of the following statement(s) is/are true concerning the initial operative management?

a.To facilitate mobilization and assessment with intraoperative ultrasound, complete mobilization including dividing the left and right triangular ligaments would be necessary

b.In dividing the right triangular ligament, care must be taken to avoid injury to accessory right hepatic veins draining directly into the vena cava

c.Unless a considerable length of hepatic vein is found outside the hepatic parenchyma, early hepatic vein ligation should be avoided

For major hepatic resections and for complete intraoperative ultrasound, complete mobilization of the liver will be required. After detachment of the hepatic flexure of the colon and division of the falciform ligament, both the left and right triangular ligaments must be sharply taken down to fully mobilize the liver. During division of the right triangular ligament, care must be taken to avoid injury to the right diaphragm, the right adrenal gland and adrenal vein, the right phrenic vein, and several moderate-size accessory right hepatic veins draining directly into the vena cava. After mobilization, digital and bimanual palpation is performed and intraoperative ultrasound may be performed. Dissection of the porta hepatis is performed by many hepatic surgeons to identify the main bifurcations of the hepatic artery, bile duct, and portal vein. This allows individual ligation of unilateral branches of each of these structures during hepatic lobectomy but prior to parenchymal dissection. An alternative approach has been recently described where the main portal structures are left undisturbed and branches to a given lobe are ligated during parenchymal transection. Hemorrhage can be minimized by intermittent portal inflow occlusion by clamping or compression of the portal triad (Pringle maneuver). There has been considerable debate over early versus late isolation and ligation of a given hepatic vein during lobectomy since the extraparenchymal component of the hepatic vein may be quite short or absent. Since hemorrhage in this location may be difficult to control, a safe strategy is to always avoid early isolation of a given hepatic vein or to attempt isolation only when a considerable length of vein is found on mobilization of the respective triangular ligament.