Vascular Control and Parenchymal Transection Techniques

• Excessive intraoperative blood loss and the potential need for blood transfusion are major problems in hepatic resection for liver tumors.

• Decrease in blood loss is a goal in liver surgery, and several technical developments have been introduced for this purpose, such as the ultrasonic dissector, the water jet, the harmonic scalpel, the Ligasure®, and the tissue link dissecting sealer.

• Other advances in operative techniques have also contributed to reducing blood loss during liver transection: better determination of the liver transection plane with the use of intraoperative ultrasound, and better hepatic vein flow control (inflow and outflow) as well as strict central venous pressure control.This chapter aims to outline and overview the surgical techniques currently used in liver surgery.