Liver resection without blood transfusion

A personal series of 58 liver resections was reviewed to identify technical factors minimizing blood transfusions. We identified a concept of vascular isolation prior to parenchymal division (VIP) which used singularly or in combination the following methods of vascular control: parenchymal compression, Pringle maneuver, hepatic venous tourniquet, hilar division, hepatic vein division, and Heaney maneuver. VIP significantly decreased the need for transfusion; of 34 patients with VIP only 2 (6 percent) required transfusion, whereas of 24 patients without VIP, 18 (75 percent) required transfusion (p less than 0.001).