Liver parenchymal transection techniques

While liver surgery has become safer with improvements in peri-operative management, parenchymal resection is the part of the procedure which is associated with major loss of blood and damage to important structures if not performed carefully. The ideal technique for hepatic parenchymal transection should be quick, easy to perform, reduce intra-operative blood loss and transfusion requirement, reduce post-operative bile leakage, and cause minimal damage to the surrounding hepatic parenchyma-- preferably at the lowest cost possible. This paper is a review of commonly used techniques for liver parenchymal transection during liver resections. According to the literature, there is little benefit of using the complicated and expensive devices over the simpler clamp crushing technique. We in our institution, who perform a large number of liver resections and living donor transplants, prefer to use the clamp crushing technique with a bipolar cautery for most resections and cavitron ultrasonic aspirator(CUSA) with a bipolar cautery for removal of part of the liver from a living donor.