title: Liver resection without hilus preparation and with selective intrahepatic hilus stapling for benign tumors and liver metastasis.
abstract: BACKGROUND
  Nowadays, liver resection is a routine operative procedure in surgical centers, and strategies must be aimed at avoiding additional risk factors. Extrahepatic isolation of portal vein, hepatic artery and hepatic duct, as well as lymphadenectomy of the liver hilum are generally accepted steps of liver resection, even for metastatic and benign indications. Our primary aim was to analyze the feasibility, blood loss, blood transfusion requirements, incidence of complications, and outcome using the approach for intrahepatic devascularization leaving the extrahepatic hilus untouched.
  
  
  METHODS
  Thirty-eight consecutive patients with resection for metastases and benign liver tumors were selected. After hilar examination, the extrahepatic structures remain intact, and during parenchyma dissection, the whole right or left or the appropriate bi-segmental pedicle is isolated intrahepatically and then transected using a stapler device.
  
  
  RESULTS
  The used technique was feasible in all cases, and no intra- or postoperative surgical complications were observed. To date, no tumor recurrence was found in the hilum during the follow-up period.
  
  
  CONCLUSIONS
  The intrahepatic pedicle stapling technique appears to be feasible and safe in liver resection. Hilar dissection can, thus, be avoided in liver metastasis and benign liver tumors.
authors.affiliation: Department of General, Visceral and Transplant Surgery, Tübingen University Hospital, Hoppe-Seyler-Strasse 3, 72076 Tübingen, Germany. alfred.koenigsrainer@med.uni-tuebingen.de
authors.forename: Ingmar
authors.initials: I
authors.lastname: Königsrainer
authors.forename: Wolfgang
authors.initials: W
authors.lastname: Steurer
authors.forename: Maria
authors.initials: M
authors.lastname: Witte
authors.forename: Alfred
authors.initials: A
authors.lastname: Königsrainer
mesh_terms: D000368:Aged; D015179:Colorectal Neoplasms / Q000473:pathology; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D017792:Surgical Stapling