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Updated: May 28, 2026
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Modified Laparoscopic Anatomic Hepatectomy: Two-Surgeon Technique Combined with the Simple Extracorporeal Pringle Maneuver
Published on: June 16, 2023
Hemodynamic and Respiratory Management During Liver Resection
Fabrizio Racca1, Valentina Girotto1, Elena Conti1
1Division of Anesthesia and Intensive Care, AO Ordine Mauriziano, Torino, Italy.
Journal of Intensive Care Medicine
|May 27, 2026
Summary
Optimizing hemodynamic and respiratory management during liver resections is crucial for minimizing blood loss and ensuring patient safety. Advanced strategies balance bleeding control with hemodynamic stability and lung protection.
Area of Science:
- Hepatobiliary surgery
- Anesthesiology
- Surgical critical care
Background:
- Hepatic resection outcomes have improved with minimally invasive techniques and specialized centers.
- Hemorrhage control remains a significant intraoperative challenge due to the liver's vascularity.
Purpose of the Study:
- To review advanced hemodynamic and respiratory management strategies for liver resections.
- To highlight perioperative considerations in living donor liver transplantation.
Main Methods:
- Discussion of blood-sparing techniques like vascular inflow occlusion (Pringle maneuver) and vascular exclusion.
- Review of fluid administration, low tidal volume (VT) ventilation, and positive end-expiratory pressure (PEEP) strategies.
- Emphasis on communication between surgical and anesthesiology teams.
Main Results:
- Blood-sparing strategies can cause hemodynamic instability.
- Restrictive fluid management and low ventilation pressures may increase risks of instability and atelectasis.
- Advanced management is essential for hemodynamic stability, bleeding control, and lung protection.
Conclusions:
- Effective hemodynamic and respiratory management is vital for successful liver resections.
- Balancing bleeding control with cardiopulmonary stability and lung protection is key.
- Continuous interdisciplinary communication optimizes intraoperative outcomes.
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