General Principles of Liver Surgery

In carrying out liver resections there are certain general principles to be observed and these are discussed in this chapter. Clearly, if part of the liver is to be removed, it is important to be sure that the remaining liver is adequate to maintain liver function and methods of determining this are discussed. In order to carry out sectorectomies and segmentectomies it is necessary to isolate the various parts of the liver. The traditional approach to this has been by dissecting structures outside the liver substance but in this chapter we concentrate on the approach in front of and behind the hilum of the liver, utilizing the Glissonian Sheaths to delineate the areas of the liver which are to be resected. Methods of inflow and outflow perfusion are detailed as well as the much less frequently used total vascular exclusion and in-situ perfusion of the liver. There are various methods for actually dividing liver substance and these also are discussed.