n South African Journal of Surgery - Choosing the optimal tools and techniques for parenchymal liver transection : editorial




The modern era of safe liver resection is based on notable advances in non-invasive solid organ imaging, improved anaesthetic management, enhanced knowledge of segmental liver anatomy as described by Couinaud, better surgical technique, an appreciation of the functional reserve of the liver remnant, and the remarkable capacity of normal liver to regenerate. The evolution and development of the surgical techniques utilised during liver resection are largely an account of the efforts to minimise bleeding during hepatic parenchymal transection. Three decades ago, major liver resection was associated with mortality rates of up to 20%, and excessive bleeding was an important and common cause of operative mortality. Liver resection can now be accomplished with mortality rates of less than 3% in most specialised hepatopancreato-bilary (HPB) centres. While better patient selection and improved assessment of intrinsic liver reserve are important factors, reduced blood loss and the diminishing need for blood transfusion have been additional reasons for improved perioperative outcome. Other advances in operative technique, including improved delineation of the optimal transection plane with intra-operative ultrasound and the benefit of intermittent inflow occlusion, have also contributed to a reduction in blood loss during major liver resections.


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