Instrumentation and Approaches for Parenchymal Transection
摘要
Parenchymal transection is a pivotal phase in liver resection procedures. One of the main goals during this part is to minimize blood loss while also reducing the risk of injury to the remnant liver. Failure to achieve this can lead to higher postoperative complications, including liver failure and death. In addition, in patients undergoing liver resection for malignancies, increased blood loss and need for blood transfusion may impact long-term oncologic outcomes. Thus, a comprehensive and multidisciplinary planning is essential when a major liver resection is being contemplated. The preoperative evaluation includes an assessment of the volume of the remnant liver to gauge its functional capacity after surgery. If necessary, portal vein embolization is performed beforehand. A meticulous examination of the liver vasculature is also imperative for the surgical team’s preparedness. The anesthesia team should be well-versed in blood loss minimizing techniques, including maintaining a low central venous pressure, controlled hypoventilation, and acute normovolemic hemodilution. Autologous blood transfusion is also employed whenever possible, and its preparation is also initiated in the preoperative set ting.