Hepatic resection is the treatment of choice for many secondary and primary hepatic tumors. With improvement in surgical techniques and earlier recognition of hepatic tumors, there has been a renewed interest in performing hepatic resections. In this operative review, we will describe the techniques for performing right-sided and left-side hepatic resections. A major hepatic resection can be performed with less than 5% mortality and approximately a 5% to 15% morbidity. Special mention will be made of performing a hepatic resection without vascular inflow occlusion. This is necessary in performing a hepatic resection for use in live donor liver transplantation.
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Segmental anatomy of the liver.
The right hepatic vein has been encircled and is free from tumor, allowing for a right hepatic lobectomy.
The right portal vein, hepatic artery, and hepatic duct have been divided, with the liver demarcating between the right and left lobes.
A parenchymal dissection is performed, preserving the middle hepatic vein. The right hepatic vein was divided before the parenchymal dissection but can be divided from within the parenchyma of the liver.
Division of the tissue bridge between segments 3 and 4.
Lowering of the hilar plate to assist in exposure of left portal triad.
Division of the hepatic parenchyma.
Division of the vascular branches supplying segment 4.
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