[Clamping procedures in hepatic surgery]

The advance of liver surgery and transplantation offers a new procedures--vascular clamping. Results of hepatic resections depends essentially on proper control of intraoperative hemorrhage. We present here the different procedures for vascular clamping and discussing their indications. Four parametres can be used to define the type of clamping: 1) place of application--control of arterial or glisson pedicles and portal veins (pedicles, selective hilar, suprahilar and intrahepatic clamps), suprahepatic veins or vena cava; 2) selectivity--partial or total clamp of hepatic blood supply; 3) duration--continuous or intermittent; 4) association measures to favor tolerence to ischemia (cooling, preservation fluids) or to limit downstream consequences (extracorporal circulaton, derivation). The clamping procedures depends on the localisation of the lesion and its relationships with the great vessels, presence of liver desease and the patients general and cardiovascular status. The aim is to use clamp moderate, favoring selective clamps to avoid ischemia.