Hepatic vascular occlusion: which technique?

Vascular exposure and control are essential to safe hepatic surgery. Hepatic pedicle clamping remains the mainstay for hepatic resections. The addition of hepatic venous control using selective or total hepatic vascular exclusion is necessary for tumors abutting the suprahepatic veins or vena cava. Although the impact of ischemia-reperfusion associated with hepatic pedicle clamping is debated, hepatic pedicle clamping is being reconsidered as a means of protecting or "preconditioning" the liver for subsequent ischemia during complex resection or living-donor graft harvest. Dissection in preparation for vascular clamping can be used as a safe approach technique" for hepatic resection in difficult locations, and infrahepatic caval clamping and the liver-hanging maneuver are additional techniques enabling a safe, aggressive approach to liver resection.