Principles of liver surgery

Liver resectional surgery has become increasingly popular and patient outcomes continue to improve. In order to optimize postoperative outcomes several key principles of liver surgery require careful consideration. Major resection of the liver requires assessment of the future liver remnant to ensure adequate postoperative functioning, particularly when underlying liver disease is present. Appropriate extent of resection is mandated in order to achieve optimum long-term outcome, and the underlying pathology and liver parenchyma must be considered when trying to achieve this. Surgical technique can be adjusted to reduce perioperative morbidity. Techniques focused on reduction of intra-operative blood loss are low central venous pressure (CVP) resection and inflow occlusion via intermittent portal triad clamping and these can contribute to help minimize blood loss and improve outcome. Recently, laparoscopic liver resection is increasing in popularity and has achieved good short-term results and is likely to be used more widely in the future.