Liver resection using total vascular exclusion, scalpel division of the parenchyma, and a simple compression technique for hemostasis and biliary control

Recent improvements in perioperative morbidity and long-term outcome follow ing liver surgery have led surgeons to attempt larger and more technically challenging liver resections. Total vascular exclusion (TVE) of the liver d uring resection has been proposed as a technique that will facilitate these difficult resections while minimizing blood loss. Total vascular exclusion is performed by obtaining complete isolation of the vascular pedicle of th e liver. Once the hepatic vein is clamped, rapid resections may be performe d with a loss of only the blood volume contained within the liver itself. S afe performance of total vascular exclusion of the liver requires a thoroug h understanding of hepatic anatomy, patient selection criteria, and the phy siologic changes incurred by hepatic exclusion and subsequent ischemia and reperfusion. The following report discusses these issues, gives a detailed description of the steps involved in obtaining safe total vascular exclusio n, and presents a technique using rapid parenchymal excision with a scalpel and capsular compression to obtain hemostasis and prevent bile leaks. We b riefly discuss our experience with 144 consecutive resections in which this technique was used.