Hepatic Round Ligament Approach

The ligamentum teres hepatis provides a recognizable anatomical reference because it is the adult remnant of the fetal umbilical vein and follows a defined course within the free edge of the falciform ligament. Identifying this structure helps surgeons maintain orientation while approaching the liver’s inferior and medial surfaces, particularly near the hilum and portal structures.

Opening the peritoneal tissues next to the round ligament increases the operative field around the ligament and the nearby liver surfaces. This expanded exposure can make the relationship between the left liver, the hilum, and portal venous anatomy easier to visualize. Maintaining the ligament as a reference helps preserve anatomical orientation as access is developed.

The approach is relevant because the round ligament provides a route toward the left liver and nearby portal venous anatomy. Following it helps establish orientation around the liver hilum, where portal structures are located. This relationship can support controlled access when a procedure requires attention to portal anatomy rather than exposure of the liver surface alone.

The surgeon first identifies the round ligament within the free edge of the falciform ligament, then follows its course toward the relevant inferior or medial liver region. Adjacent peritoneal tissues are opened to improve exposure, while orientation is maintained around the hilum and portal structures. The resulting access can then support the selected liver procedure.

This strategy may be considered during minimally invasive liver surgery, including anatomical resections and selected procedures requiring controlled access to the left liver or portal venous anatomy. Its usefulness depends on the operative objective and the structures that must be visualized. The approach is therefore best understood as an access option for specific anatomical requirements, not a universal route.

Using a relatively consistent anatomical landmark can improve visualization by linking the access route to recognizable liver anatomy. Better orientation around the hilum and portal structures may help surgeons direct dissection toward the intended region and reduce uncertainty during exposure. In minimally invasive procedures, this organized access can support more precise handling of the targeted anatomy.