title: Principle of perioperative management for hepatic resection and education for young surgeons.
abstract: OBJECTIVE
  An expert technique and special anatomical or physiological knowledge are needed in the field of hepatic surgery compared to other abdominal surgeries. The establishment of basic policy and operative techniques for hepatectomy and stepwise training for young hepatic surgeons are necessary.
  
  
  METHODS
  We scheduled hepatic resection based on the indocyanine green retention rate at 15 minutes and volumetric analysis. Limited resection or preoperative portal vein embolization was often performed.
  
  
  RESULTS
  Between 1994 and December 2005, 338 hepatectomies were performed. Operative procedures included limited or segmental resection in 215 and hemihepatectomy or more extended hepatectomy in 123. Hyperbilirubinemia or hepatic failure after hepatectomy was observed in 15 (4%) and hospital death in 10 (3%). Although death from hepatic failure was observed in 9 of 152 (6%) between 1994 and 1999, the mortality rate has been improved since 2000 (1 of 186 [0.5%]). Senior residents start training with step by step hepatectomy from partial resection to sectionectomy. Hemi-hepatectomy for normal liver is finally permitted after technical consolidation. More complicated hepatectomy must be performed by experienced teaching surgeons.
  
  
  CONCLUSIONS
  Competent operative techniques under experienced surgeons and the achievement of safe resection at each stage are the educational policy for hepatectomy.
authors.affiliation: Division of Surgical Oncology, Department of Translational Medical Sciences, Nagasaki University Graduate School of Biomedical Sciences, Nagasaki, Japan. a-nanasm@net.nagasaki-u.ac.jp
authors.forename: Atsushi
authors.initials: A
authors.lastname: Nanashima
authors.forename: Yorihisa
authors.initials: Y
authors.lastname: Sumida
authors.forename: Takafumi
authors.initials: T
authors.lastname: Abo
authors.forename: Kenji
authors.initials: K
authors.lastname: Tanaka
authors.forename: Hiroaki
authors.initials: H
authors.lastname: Takeshita
authors.forename: Shigekazu
authors.initials: S
authors.lastname: Hidaka
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Yano
authors.forename: Terumitsu
authors.initials: T
authors.lastname: Sawai
authors.forename: Masayuki
authors.initials: M
authors.lastname: Obatake
authors.forename: Toru
authors.initials: T
authors.lastname: Yasutake
authors.forename: Takeshi
authors.initials: T
authors.lastname: Nagayasu
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000193:education* / Q000379:methods* / Q000592:standards; D006801:Humans; D008297:Male; D008875:Middle Aged; D016896:Treatment Outcome; D055815:Young Adult