Figure 3. Reoperation for recurrent liver tumor was performed via (A) an upper median plus transverse incision. (B) Intraoperative ultrasonography showed the round mass (thin arrow) as a hypoechoic lesion compressing the right hepatic vein (*) and the area adjacent to the inferior vena cava (IVC) stump (thick arrow). The middle hepatic vein (**) was not compressed by the tumor. (C) The confluence of the MHV was isolated, but dissection around the RHV and the front of the IVC was difficult due to tumor compression. (D) To control injury to the IVC, the IVC in the pericardium was encircled by a tourniquet (arrowhead) before hepatectomy.