Hepatic Resection Nomenclature and Techniques

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Nomenclature of anatomy and resection

One of the major advances in hepatic surgery has been the understanding of the internal segmental anatomy of the liver. With a thorough comprehension of the internal architecture of the liver, complex resections may be performed with greater safety with less insult to the liver than was possible in the past (Fig. 1).

An understanding of the segmental anatomy of the liver is also important for a consistent description of liver resections. In 1998 the International Hepato-Pancreato-Biliary

Resection technique

In liver surgery, there are many aspects that contribute to enhancing the safety of the operation and optimizing the outcomes. The anesthetic contributions, vascular control options, and parenchymal transection options are discussed in this section. This discussion is meant to be a basic primer and is not an exhaustive review.

When performing liver resections, the concept of low central venous pressure (CVP) has become a cornerstone in the effort to reduce blood loss. Inflow to the liver may be

Summary

To facilitate accurate communication regarding liver anatomy and resections, the standardized Brisbane 2000 terminology should be used uniformly by investigators. When performing liver resection, blood loss should be minimized by using low CVP anesthesia and vascular occlusion as appropriate. There are many options for transection of the liver parenchyma, and although no technique has been shown to be superior to clamp-crushing, hepatic surgeons should be familiar with the available techniques.

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