Standring describio tres conceptos acerca de la fisura de la porcion izquierda: la fisura umbilical, la fisura venosa y la fisura portal izquierda, como entidades diferentes, diferente ubicacion y diferente contenido, de una manera confusa que se contradice en cada definicion: 1) "Left portal fissure: It extends from the mid point of the anterior edge of the liver between the falciform ligament and the left triangular ligament to the point which marks the confluence of the left and middle hepatic veins
. It contains the left hepatic vein and separates the left anterior and left posterior sectors" ...
During HIPEC, HBF decreased sharply (Figures 1 and 2, Table 1) and Doppler signals became nonpulsatile in the right and middle hepatic veins, except for one patient in whom pulsatile signals were maintained despite a major decrease in HBF (70-80%).
Right and middle hepatic vein diameters and Doppler signals, inferior vena cava (IVC) diameter, and left ventricle ejection fraction (LVEF) obtained by Simpson method or 3D quantification were measured at end-expiration during three cardiac cycles and averaged.
Right, left and middle hepatic veins are veins with imperceptible wall and show triphasic pattern similar to IVC and flow pattern is phasic in response to both cardiac and respiratory cycles.
(19) In 3 cases of liver cyst, in 1(33.3%) case, we found change in hepatic vein diameter and loss of respirophasic pattern because this was very closely situated to middle hepatic vein and was compressing it.
The following findings were recorded: (1) tributaries of the middle hepatic veins (MHV) including segments V and VIII veins; (2) the presence of accessory inferior right hepatic vein (IRHV) or superficial right hepatic vein (SRHV); (3) the variable entering patterns of the RHV, MHV, and IRHV into IVC, and (4) the diameter of the veins at their point of connection to the major veins.
Over the period from January 2009 to January 2011, 40 patients underwent live donor liver transplant using a right lobe liver graft without the middle hepatic vein in the National Liver Institute, Menoufiya University, Egypt.
 The first is during initial mobilisation of the lobe to be resected, especially if the patient is deep-chested and the tumour is bulky, posteriorly situated, adjacent to the right or middle hepatic veins
and adherent to diaphragm or retrohepatic vena cava.
Inferior approach for the isolation of the left- middle hepatic veins
in liver resections: a safe way.
The falciform ligament was dissected to the ventral surface of the suprahepatic IVC to show the loose space between the right hepatic vein and the confluence of the left and middle hepatic veins. The liver was fully mobilized by separation of all the peritoneal attachments.
The venous ligament was divided near the left hepatic vein to partly release the tip of the caudate lobe and to facilitate the isolation of the confluence of the left and middle hepatic veins .
Mean on dissection was 74.0 [+ or -] 19.383, on X-rays was 41.267[degrees] [+ or -] 11.97[degrees] The angles between right and middle hepatic veins
and the angles between middle and left hepatic veins were acute in most of the cases.