Extended subcostal hinge incision for right hepatic lobectomy

The safe performance of a right hepatic lobectomy requires adequate exposur e of the hepatic veins and of the suprahepatic vena cava. An extended subco stal or midline incision is commonly used to provide exposure for this oper ation. The technique for an extended subcostal incision that uses the natur al hinge mechanism of the rib cage to provide exposure to the right upper q uadrant is described. This approach provides adequate exposure during a dif ficult hepatectomy, avoiding the need for a thoracotomy or sternotomy.