Overview
Removing the right liver to cure right-sided disease.
The liver is naturally divided into two parts that have separate blood supplies, drainage veins, and bile ducts. A total right hepatectomy removes the entire right side — segments 5, 6, 7, and 8 — which is roughly 60–70% of the liver volume. The left liver (segments 2, 3, and 4) is preserved and, because the liver is a regenerating organ, the remaining left side grows back over the following weeks and months until it does the work of a whole liver again. This operation is the cornerstone treatment for primary liver cancer, intrahepatic bile-duct cancer, and many metastases that involve the right side.
Because so much of the liver is being removed, careful planning matters. Before we operate we measure the volume of the liver we plan to leave behind (the "future liver remnant") on CT or MRI, assess liver function, and confirm that the left liver does not contain disease. When the planned remnant is borderline, we use portal vein embolization to grow the left liver before surgery — or, in selected cases, a staged operation. We discuss every case at multidisciplinary tumor board.
Who is a candidate?
Patients with disease confined to the right liver and enough healthy left liver to live on are candidates. We look for negative-margin resectability, good performance status, and either normal liver function or compensated cirrhosis with adequate reserve. Patients with diffuse disease, severe cirrhosis with portal hypertension, or distant metastases that cannot be controlled may be better served by ablation, chemotherapy, transplant evaluation, or hospice — and we are honest about which path makes sense. Every case is discussed at multidisciplinary tumor board.
How we perform it
You are asleep under general anesthesia with an epidural for pain control. The abdomen is entered through an upper-abdominal incision (or laparoscopic ports in selected cases). The right hepatic artery, right portal vein, and right hepatic duct are dissected, isolated, and divided. The line of color change marks the boundary between right and left liver and is the line of transection. We divide the liver using ultrasonic dissection and energy sealing, controlling small vessels and bile ducts as we go. The right hepatic vein is divided last as the specimen is freed. A drain is sometimes left.
Recovery
Most patients stay 5–7 days in the hospital. The first day or two are spent in step-down level care while we monitor liver function and recovery. You will walk the day after surgery and start a regular diet within a few days. Mild liver enzyme elevations are expected. We follow up at 2 weeks, repeat labs at 6 weeks, and image at 3 months — by which time the left liver has typically regrown to nearly the size of the original whole liver. Tiredness is normal for several weeks.
Why Florida Surgical
Dr. Shaw is fellowship-trained in hepato-pancreato-biliary (HPB) surgery and surgical oncology. Major liver resection is high-volume specialty work, and outcomes are tightly linked to the experience of the team. We use intraoperative ultrasound on every case, plan volumetric remnants before surgery, coordinate portal vein embolization through interventional radiology when needed, and present every case at multidisciplinary tumor board so the right operation is paired with the right systemic therapy.
Frequently asked questions
How much liver am I losing?
A total right hepatectomy removes about 60–70% of the total liver volume. The left liver (segments 2, 3, and 4) is left behind and will grow back over weeks to months. We measure the future remnant on imaging beforehand to make sure it is large enough.
What if the remaining liver is too small?
If the future liver remnant is borderline, we have several tools — portal vein embolization (a procedure that redirects blood flow so the left liver grows before surgery), staged hepatectomy, or the ALPPS technique. We do not operate until we are confident the liver you are keeping is large enough.
Can the operation be done robotically?
Selected cases yes. We choose between robotic, laparoscopic, and open based on tumor location, vessel involvement, body habitus, and prior surgery. The goal is always the same: complete anatomic resection with negative margins and safe control of the major vessels.
What is the recovery like?
Most patients stay in the hospital 5–7 days. The first few days focus on pain control, walking, and rebuilding nutrition. You will be tired for several weeks as the left liver grows. Most patients return to normal activity around 6–8 weeks.
What are the risks?
Major hepatectomy is a serious operation. Risks include bleeding, bile leak, infection, blood clots, and post-hepatectomy liver insufficiency. Careful preoperative planning (volume assessment, portal vein embolization when indicated), meticulous intraoperative technique, and an experienced HPB team minimize these risks.