Techniques of Hepatic Resection

Introduction Hepatic resection is the most effective treatment for patients with primary and selected secondary malignant tumors. It is also indicated for certain benign lesions. In nearly all instances involving patients with malignant hepatic disease, resection is the only treatment with curative potential. Over the past 30 years, improvements in perioperative care and surgical technique have dramatically decreased the morbidity and mortality of major hepatic resection, thus making it a viable treatment option for many patients. The risk of hemorrhage has been the major obstacle to the safety of hepatic resection. While this remains a concern, blood loss and transfusion requirements have been markedly reduced as a result of changes in operative technique. Although portal triad clamping reduces hepatic arterial and portal venous bleeding during parenchymal transection, this has no effect on bleeding from the hepatic veins which are usually the major source of blood loss. Inflow and outflow vascular control before parenchymal transection, low central venous pressure anesthesia, and anatomically based resections, are all important components of contemporary hepatic resection and play a role in minimizing operative blood loss. Total vascular isolation, a fundamentally different approach that is required in few cases, has not been shown to lower intraoperative blood loss or transfusion requirements.