title: The main indications and techniques for vascular exclusion of the liver.
abstract: BACKGROUND
  The purpose of vascular clamping during the course of liver resection is to reduce bleeding and subsequent complications.
  
  
  OBJECTIVE
  To show both step-by-step surgical techniques for vascular exclusion of the liver and their indications.
  
  
  METHODS
  It is described the following techniques: clamping of the hepatic pedicle, "Pringle" maneuver; intermittent clamping of the hepatic pedicle; intermittent vascular exclusion of the liver, without vena cava clamping, and hepatic vascular exclusion with vena cava clamping. Also metabolic and homodynamic consequences as well as the technical failure of the application of each of them are discussed.
  
  
  CONCLUSIONS
  The choice of technique to use for clamping during hepatectomy depends on the surgeon's judgment. Dogmatic or systematic attitude, is prejudiciable for the patient and liver surgeon must be able to use all kinds of clamping.
authors.affiliation: Liver and Portal Hypertension Surgery Unit, University of São Paulo School of Medicine, São Paulo, SP, Brazil. cientifico@uol.com.br
authors.forename: Eleazar
authors.initials: E
authors.lastname: Chaib
authors.forename: William Abrão
authors.initials: WA
authors.lastname: Saad
authors.forename: Ikurou
authors.initials: I
authors.lastname: Fujimura
authors.forename: Willian Abrão
authors.initials: WA
authors.lastname: Saad
authors.forename: Joaquim
authors.initials: J
authors.lastname: Gama-Rodrigues
mesh_terms: D003250:Constriction; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply* / Q000601:surgery