Protection of the liver during partial hepatectomy.

BACKGROUND: Liver failure is the most common cause of mortality for patients undergoing partial hepatectomy. Given adequate liver function and remnant liver volume and absence of co-morbid illness, the cause of liver failure is frequently related to technical errors, which induces massive bleeding and ischemic damage to the liver remnant. DATA RESOURCES: From author's practice at Queen Mary Hospital, the University of Hong Kong.
RESULTS: To avoid technical errors leading to liver ischemia and failure, adequate exposure, control of bleeding during liver transection, and planning of transection plane are important. Ultrasonic dissector is the best instrument in liver transection. Its careful use can reduce blood loss and help recognize the hepatic vein, the exposure of which serves as an important landmark for a correct transection plane. Even without Pringle maneuver, minimum bleeding during transection could be achieved.
CONCLUSION: Protection of the liver remnant is important to patient survival after partial hepatectomy. It is achieved by meticulous surgical techniques that reduce bleeding to a minimum.