Fig. 4

A Intraoperative ultrasound comprehensive exploration to evaluate tumors. B Dissection and separation of the common bile duct (CBD), common hepatic artery (CHA), and gastroduodenal artery (GDA). C Freeing and skeletalizing of the CBD, CHA, and GDA and simultaneous dissection of lymph nodes in groups 8, 12, and 13. D Clamping of the CBD with a Hom-Loc clamp from the upper edge of the pancreas, followed by severing. E Frozen pathological examination of the distal resection margin of the CBD. F Dissection and separation of the right hepatic artery, left hepatic artery (LHA), and portal vein (PV). G Double ligation and transection of the LHA. H Temporary occlusion of the left portal vein (LPV) with a vascular clip. I Observation of change in liver color combined with intraoperative ultrasonography to determine the left hepatic ischemia line. PHA, proper hepatic artery