Few surgical procedures pose a greater risk of major hemorrhage than hepatic resection, a risk due to the extensive network of thin-walled portal and hepatic venous branches throughout the liver. Whereas ligation and division of inflow and outflow vessels can occasionally present a challenge in patients with large liver tumors, hemorrhage more frequently becomes problematic during parenchymal transection, when there is difficulty defining, ligating, and transecting vascular structures. Several techniques have been developed to improve parenchymal transection, most notably ultrasonic dissection. Despite the popular acclaim of this and other new methods, few studies compare them objectively with finger fracture techniques.
Chapman WC. Randomized Comparison of Ultrasonic vs Clamp Transection of the Liver—Invited Critique. Arch Surg. 2001;136(8):928. doi:10.1001/archsurg.136.8.928