Optimized approach for blood vessel excavation within liver parenchyma

Abstract

The most practical approach for dissecting the liver parenchyma involves first visualizing and subsequently addressing the blood vessels within the parenchyma while maintaining a dry operative field. This process is similar to “excavation” of ancient artifacts from soil without causing any damage. To excavate the blood vessels in a dry operative field during liver parenchymal dissection, proficiency in both blood flow control and parenchymal dissection techniques is mandatory. For blood flow management, inflow control is achieved using an externally applied Pringle maneuver, whereas outflow control is achieved by decreasing the central venous pressure. Precision in parenchymal dissection lies in dissecting the liver parenchyma in areas devoid of the Glissonean branch, such as the intersegmental plane, using the back-scoring technique with a cavitron ultrasonic surgical aspirator (CUSA) to read the grain of the blood vessels.