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.


METHODS
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.


CONCLUSIONS
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.
Fan
Sheung Tat
ST
Centre for the Study of Liver Disease and Department of Surgery, The University of Hong Kong, Pokfulam, Queen Mary Hospital, 102 Pokfulam Road, Hong Kong, China. hrmsfst@hkucc.hku.hk
D004210:Dissection / Q000295:instrumentation; D006488:Hemostasis, Surgical; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D017093:Liver Failure / Q000209:etiology / Q000517:prevention & control*; D010347:Patient Care Planning; D014465:Ultrasonics