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

Figure 1 Surgical anatomy of the liver and resection lines. Couinaud segmental liver anatomy and the normal portal venous structures biliary tract structures. Resection lines (---) and Hepatic segments (Arabic numbers) resected during major hepatectomies Right, Left and extended) (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).

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).