The new limits of liver surgery.

Liver surgery has benefited from many technical advances and from a decreas e in postoperative mortality to less than 5%. Bleeding is reduced by clampi ng the vessels that supply the resected segment in segmentectomy procedures . The hepatic pedicle can also be clamped usually intermittently, taking ca re to avoid excesses. The inferior vena cava can be clamped on either side of the liver (vascular exclusion) when the surgical procedure targets sites located near the large hepatic veins. Hemostasis has benefited from new to ols, particularly those using ultrasound, and by treatment of sections usin g an argon coagulator or biological glue. Laparoscopic surgery can be used in selected indications but carries a number of specific risks such as blee ding and air embolism. Cryosurgery yields useful results in the palliative therapy of malignancies. Removal of tumors formerly considered inoperable i s being increasingly performed after chronochemotherapy or portal vein embo lization, Transplantation of part of the liver of a live donor, usually to the donor's child but in some cases to an adult, can be performed with the necessary legal precautions and after verification of the quality of the gr aft and health status of the donor, for whom the risk of death is around 0. 1 to 0.5%.