Techniques of liver resection

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Owing to both improved preoperative assessment and the use of established surgical techniques, liver resection can today be performed with low morbidity and minimal mortality. But no matter which technique is applied in liver resection, the most difficult event to manage is postresectional liver failure. All peri-operative efforts should therefore be directed to the prevention of this potentially lethal complication. This publication presents some of the current techniques of liver resection and the management of the most common complications associated with the procedures. The first part deals with the question of how much remnant liver is enough for a safe resection and describes appropriate techniques for optimal preservation. Then, several procedures for transection of the liver parenchyma and for clamping of the afferent vessels at the hepatic pedicle are presented, mainly aiming at limiting blood loss during resection. Bile leakage and its prevention after liver resection are considered last, followed by a discussion of indications for laparoscopic liver resection.