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The principle of auxiliary liver transplantation is the implantation of a right or left hemiliver into the abdominal cavity to restore normal liver function temporarily, while the native liver recuperates. Once the native liver has recovered, the graft can be removed or left in place without immunosuppression leading to atrophy. [ABSTRACT FROM AUTHOR]

Access is gained through a bilateral subcostal incision with cranial extension. The falci-form ligament is divided leaving enough length on the liver side as it needs to be fixed in the recipient. Finally a retractor (e.g., Takasago retractor) is installed (A). [ABSTRACT FROM AUTHOR]

Age 18 and 60 yearsABO compatibility between donor and recipientNo major medical problemsSignificant long-term emotional relationship to the potential recipientDonor competent to give informed consent [ABSTRACT FROM AUTHOR]

In 1989 Pichlmayr et al. were the first to report a case of splitting a cadaveric liver for two recipients, an adult and a child. In the same year, Bismuth et al. performed the first transplantation of a single liver into two adult recipients with fulminant hepatitis. Today, donor livers are split for an adult and a pediatric recipient or, less frequently, for two adults. [ABSTRACT FROM AUTHOR]

Since its introduction into clinical practice in 1963 by Starzl et al., the technique of orthotopic liver transplantation has been refined progressively. The original technique included resection of the recipient inferior vena cava (IVC) and the use of extracorporeal venovenous bypass. More confidence with the technique and the more frequent use of technical variants in pediatric liver transplantation have led to the development of recipient cava-preserving hepatectomy techniques without use of venovenous bypass and with or without use of a temporary portocaval shunt, independently of anatomical and general status of the recipient. Regardless of the exact technique, orthotopic liver transplantation is characterized by three stages: the pre-anhepatic, the anhepatic and the post-anhepatic stage. The technique of orthotopic liver transplantation, either with or without preservation of the recipient IVC, will be described following these three stages. [ABSTRACT FROM AUTHOR]

The growing success of liver transplantation led to the development of a flexible procedure for multiple cadaveric organ procurement as introduced by Starzl in 1984. The subsequent development of pancreas, multivisceral and intestinal transplantation has required modification and improvement of the initially described technique. [ABSTRACT FROM AUTHOR]

Liver injuries most often (>90% of all cases) are associated with other injuries such as ipsilateral rib fractures, lung contusions, other intra-abdominal lesions, or injuries of the extremities, the pelvis and the head. Hepatic injuries are graded according to the Organ Injury Scale of the American Association for the Surgery of Trauma (AAST-OIS) (Table1). [ABSTRACT FROM AUTHOR]

Hepatic cysts are classified according to the presence or absence of a parasitic etiology. They seldom lead to hepatic dysfunction and are mostly asymptomatic. The treatment is always individualized according to the origin and presence of symptoms. The choice between unroofing versus resection is dictated by site, number of cysts, malignant potential (cystadenoma/cystadenocarcinoma), and parasitic infection (see next chapter). Malignant potential is rare and is not a primary concern. [ABSTRACT FROM AUTHOR]

Patients with hydatid cysts in the liver used to present a therapeutic challenge. Although surgical techniques have improved, considerable controversy still exists regarding the most effective operative technique. The main principle of the surgery is to eradicate the parasite and prevent intraoperative spillage of cyst contents avoiding peritoneal spread. Pericystectomy provides a radical treatment removing the whole cyst "en bloc" including the adventitia without resection of healthy liver tissue. [ABSTRACT FROM AUTHOR]

Hepatic intra-arterial infusion pump (HAIP) placement provides hepatic specific continuous infusion of chemotherapeutic agents. The chemotherapeutic agents selected for use with HAIP should exhibit a high degree of first pass kinetics in order to minimize systemic toxicity. Agents used include cisplatin, fluodeoxyuridine (FUDR), mitomycin C, and Adriamycin. [ABSTRACT FROM AUTHOR]

Unresectable malignant tumors of the liver (e.g., hepatocellular carcinoma, colorectal metastases, neuroendocrine tumors, selected other types of metastases)Tumors <5cm in size (most effective for lesions <3cm)Palliative treatment of symptomatic tumors (e.g., neuroendocrine metastases)Bridge to liver transplantation (hepatocellular carcinoma)Access: Open: In combination with resectionWhen resection is planned, but unresectability is found at time of laparotomyIn difficult locations or selected cases when multiple ablations are requiredpercutaneus: not discussed in this atlasLaparoscopic: Patient fulfills basic requirements to undergo surgeryLesion(s) amenable to laparoscopic approachpercutaneus: not discussed in this atlas [ABSTRACT FROM AUTHOR]

Unroofing of symptomatic simple liver cysts was the first laparoscopic liver procedure to be performed followed by resection of superficial, small-sized benign tumors. The first laparoscopic anatomical liver resection, a left lateral sectionectomy, was reported in 1996. More recently, larger hepatectomies and liver resections for malignant tumors have been described. Today, about 15-20% of liver resections might be considered for a laparoscopic approach. [ABSTRACT FROM AUTHOR]

The goal of hepatic cryosurgery is complete destruction of tumors for curative or palliative reasons as an alternative to resection where resection is not feasible. [ABSTRACT FROM AUTHOR]

The extended right hemihepatectomy (also called right trisectionectomy) includes resection of segments 4-8. For cholangiocarcinoma of the liver hilum (Klatskin's tumor) or carcinoma of the gallbladder, an en-bloc resection including segments 1 and 9 is usually performed. This procedure should only be performed if the remnant liver (segments 2 and 3) provides sufficient liver function. Therefore, preoperative assessment of liver function, a volumetric assessment of the expected remnant liver volume, and exclusion of liver fibrosis or cirrhosis are essential before extended resections. [ABSTRACT FROM AUTHOR]

Since hepatocellular carcinoma (HCC) and most metastatic diseases of the liver spread via intrahepatic portal branches, anatomical resection of a tumor bearing portal area, resection of a segment or a section, are basic procedures for treating liver tumors. [ABSTRACT FROM AUTHOR]

The abdomen is opened through a subcostal incision and the round and falciform ligaments are divided. The left hemiliver is mobilized by dividing the left triangular and coronary ligament (A). Once the left hemiliver is mobilized, the liver can be evaluated by ultrasound. After confirmation of the resectability, the Pringle maneuver is prepared for by opening the hepatogastric ligament as shown in the chapter "Techniques of Vascular Exclusion and Caval Resection."At this point an aberrant left hepatic artery can be isolated for later clamping with a bulldog clamp. [ABSTRACT FROM AUTHOR]

After a right subcostal incision, the round and falciform ligaments are divided, a retractor (e.g., Thompson) is installed and the abdomen is explored (A-1). Tumor size, number, and location in relation to vascular structures are evaluated by intraoperative ultrasound and a definitive decision regarding resectability of the lesion is made (A-2). [ABSTRACT FROM AUTHOR]

In addition to the conventional approach described for liver resection in the chapters on conventional hepatectomies, the hanging maneuver has gained wide acceptance among liver surgeons. Depending on the situation, it can be used for resective liver surgery or for living related liver donation. [ABSTRACT FROM AUTHOR]

Vascular exclusion techniques in liver surgery include continuous inflow occlusion (Fig. 1A) (first described by J.H. Pringle in 1908), intermittent inflow occlusion (Fig. 1B) (first described by M.Makuuchi in the late 1970s), and ischemic preconditioning (Fig. 1C) and (continuous) total vascular exclusion. The use of inflow occlusion varies considerably among centers - some use it routinely,while others use it only exceptionally. When using inflow occlusion, a low central venous pressure (CVP) (<3 mm Hg) needs to be maintained to reduce bleeding. The effect of a low CVP associated with a Pringle maneuver can be equivalent to total vascular exclusion. Total vascular exclusion, on the other hand, can lead to cardiovascular instability by reduced cardiac preload, and adequate volume loading with a high CVP (>10 mm Hg) needs to be maintained. A venovenous bypass is sometimes used in this setting. [ABSTRACT FROM AUTHOR]

Parenchyma dissection of the liver may cause complications including blood loss, hematoma, infection, bile leakage and liver failure.Various surgical techniques have been developed for careful and safe dissection of the liver parenchyma to prevent intraoperative and postoperative complications. [ABSTRACT FROM AUTHOR]

In 1998 at its meeting in Berne, Switzerland, the Scientific Committee of the International Hepato-Pancreato-Biliary Association (IHPBA) established a Terminology Committee to deal with the confusion in terminology of hepatic anatomy and liver resections (see below: members of the committee). The recommendations of the Terminology Committee were presented to the Scientific Committee at the biannual meeting of the IHPBA in Brisbane,Australia, in 2000. These recommendations, consisting of a new terminology termed The Brisbane 2000 Terminology of Liver Anatomy and Resections, were unanimously accepted by the Scientific Committee of the IHPBA and were presented to the membership as the official terminology of the IHPBA. The terminology was published in the official journal of the IHPBA in 2000. The terminology shown below is based on the hepatic artery and bile duct (Figures 1-3). A terminology based on the division of the portal vein was added as an addendum. [ABSTRACT FROM AUTHOR]

Primary and secondary malignancy (e.g., hepatocellular carcinoma, intrahepatic cholangiocarcinoma, colorectal metastases, neuroendocrine tumors)Benign neoplasia (e.g., adenoma, giant hemangioma)Echinococcus multilocularis (alveolaris)Abscesses refractory to conservative managementOther benign diseases (e.g., Caroli syndrome)Living donor liver transplantation (modified technique; see chapter "Living Donor Liver Transplantation")Klatskin's tumor (modified approach to the bile duct; see Section 4Traumatic liver lesions [ABSTRACT FROM AUTHOR]