Current status of hepatic resection.
During the past 2 decades, an improved understanding of hepatic anatomy and advances in surgical technique have allowed for hepatic resection to be performed with operative mortality rates between 1% and 5%. With this low mortality, hepatic resection is now well established as a safe and effective therapy for patients with a wide array of benign and malignant hepatobiliary disease, and the indications for its use continue to evolve. Hepatic resection using low CVP anesthesia with vascular inflow and outflow control before parenchymal transection is a safe, reliable, and effective approach and provides excellent results. Parenchymal-sparing techniques should be used whenever feasible technically, and in patients with preoperative hepatic dysfunction. For those who require a major sacrifice of functional parenchyma, PVE may reduce operative morbidity and should be considered. Minimally invasive techniques should only be used in setting of benign or small malignant lesions located peripherally. Advances in laparoscopic equipment and techniques will undoubtedly expand the use of these techniques and is the next frontier in hepatic resectional surgery.
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