title: A simple technique ligating the corresponding inflow and outflow vessels during anatomical left hepatectomy.
abstract: BACKGROUND
  Massive bleeding remains one of main factors of morbidity and death in liver resections. For this reason, the Pringle maneuver or total vascular exclusion is commonly used during liver resection. However, ischemic damage is still a major problem. Some surgeons used the "glissonean" approach for bleeding control, but the technique is tedious and also time consuming, with high incidence of bile leaks in the postoperative period. The aim of this paper is to describe a new bleeding control technique, rapid ligation of the corresponding inflow and outflow vessels without hilus dissection before the parenchyma transection during anatomical left liver resection and to analyze the feasibility, blood loss, transfusion requirements, and postoperative complications.
  
  
  METHODS
  During the past 18 years, we used the new hemorrhage control technique in left liver resection in 630 patients with malignant or benign tumors.
  
  
  RESULTS
  The median blood loss in all 630 patients was 110 +/- 250 ml (range 50-750), and no patient required blood transfusion. The median total operative time was 77 +/- 35 min (range 25-155). No bile leaks and liver failure of the patients occurred postoperatively. There was no death within 30 postoperative days.
  
  
  CONCLUSIONS
  The rapid ligation of the corresponding inflow and outflow vessels without hilus dissection before the parenchyma transection is a feasible, safe, and bloodless technique during the left liver resection.
authors.affiliation: Department of Surgery, Hepatic Surgery Center and Institute of HBP Surgery, Institute of Organ Transplantation, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, People's Republic of China. ChenXP@medmail.com.cn
authors.forename: Xiao Ping
authors.initials: XP
authors.lastname: Chen
authors.forename: Fa Zu
authors.initials: FZ
authors.lastname: Qiu
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D006488:Hemostasis, Surgical / Q000379:methods*; D006498:Hepatectomy / Q000379:methods*; D006503:Hepatic Veins / Q000601:surgery; D006801:Humans; D008026:Ligation; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000601:surgery*; D011169:Portal Vein / Q000601:surgery; D013525:Surgical Instruments