Major liver resections, perioperative issues and posthepatectomy liver failure: A comprehensive update for the anesthesiologist

Figure 2 Vascular occlusion techniques in hepatic surgery to reduce hemorrhage during hepatic resection. A: Pringle maneuver to occlude hepatic arterial and portal venous inflow to the liver; B and C: Selective hepatic vascular exclusion involves clamping of the vessels perfusing the hemi-liver which is being resected; D: Total hepatic vascular exclusion, clamping the inferior vena cava above and below the liver along with the hepatoduodenal ligament; E: Variant technique combining clamping of the infrahepatic Inferior vena cava with a clamp across the hepatoduodenal ligament (from Njoku DB, Chitilian HV, Kronish K. Hepatic Physiology, Pathophysiology, and Anesthetic Considerations. In Miller’s Anesthesia Michael A. Gropper, Ronald D Miller, Neal H. Cohen Lars I. Eriksson Kate Leslie, Jeanine P. Wiener-Kronish NINTH EDITION. Elsevier 2020: 420-443[27] ; and with permission).