Recent advances in techniques of liver resection

The role of liver resection for benign and malignant hepatobiliary diseases is expanding because of the markedly reduced operative mortality in recent years, as the result of better patient selection, improved surgical techniques, and better perioperative management. The major technical challenge of liver resection is control of bleeding during transection of liver parenchyma. Ultrasonic dissector and clamp crushing are the two techniques used most frequently in liver transection. In recent years, new instruments have been developed for liver transection with an aim to reduce bleeding. Other important advances in liver surgery that have contributed to improved perioperative outcomes include intraoperative ultrasound (IOUS), use of vascular staplers, and reduced bleeding by the development of low central venous pressure anesthesia. Laparoscopy is useful for staging purposes, and laparoscopic liver resection is gaining popularity due to the availability of new laparoscopic instruments for liver transection. Development of local ablative therapies for liver tumors, such as radiofrequency (RF) ablation, is posing a competition to liver resection. However, such techniques also have allowed expansion of indication for hepatic resection to patients with bilobar tumors, and thermal ablative technologies have been used for liver transection. This chapter reviews the current techniques of liver resection.