Hemostasis in liver resection surgery

Although patients with liver tumors are considered as challenging by hepatic surgeons, advances in liver resection procedures mean that virtually no liver tumor should be considered as unresectable. Newer techniques, such as in situ hypothermic perfusion, the "ante situm technique," and ex vivo liver resection have been recently introduced. The aim of these techniques is to provide a bloodless field and a prolonged and more precise dissection. The use of recombinant factor VIIa (rFVIIa), a hemostatic agent previously developed for bleed management in patients with hemophilia and inhibitors, has recently been investigated as a means of reducing red blood cell transfusion requirements during major liver surgery. This paper reviews details of this clinical trial, as well as current and future methods to manage hemostasis during liver resection surgery.