Advanced MCQ – Sequence of Steps in Liver Resection
During a standard anatomical liver resection (e.g., right hepatectomy), what is the correct sequence of operative steps?
Correct Answer: A
Explanation:
The classical sequence in anatomical liver resection is designed to minimize intraoperative bleeding and allow safe vascular control. First, the liver is mobilized by dividing the falciform, coronary, and triangular ligaments to expose the hepatic veins and operative field. Next, inflow control is achieved by isolating and controlling the portal triad structures supplying the lobe or segment (hepatic artery and portal vein). After inflow control, parenchymal transection is performed along the planned plane using techniques such as clamp-crush, CUSA, or energy devices. As transection approaches completion, the hepatic veins draining the resected portion are controlled and divided near the IVC (outflow control). Finally, the specimen is removed and meticulous hemostasis is secured.
Teaching Points:
• Inflow control precedes parenchymal transection in most anatomical resections.
• Hepatic vein division (outflow control) is performed toward the end of transection.
• Proper sequence significantly reduces blood loss during hepatectomy.
• Selective inflow control produces an ischemic demarcation line guiding the plane of resection.
Explanation:
The classical sequence in anatomical liver resection is designed to minimize intraoperative bleeding and allow safe vascular control. First, the liver is mobilized by dividing the falciform, coronary, and triangular ligaments to expose the hepatic veins and operative field. Next, inflow control is achieved by isolating and controlling the portal triad structures supplying the lobe or segment (hepatic artery and portal vein). After inflow control, parenchymal transection is performed along the planned plane using techniques such as clamp-crush, CUSA, or energy devices. As transection approaches completion, the hepatic veins draining the resected portion are controlled and divided near the IVC (outflow control). Finally, the specimen is removed and meticulous hemostasis is secured.
Teaching Points:
• Inflow control precedes parenchymal transection in most anatomical resections.
• Hepatic vein division (outflow control) is performed toward the end of transection.
• Proper sequence significantly reduces blood loss during hepatectomy.
• Selective inflow control produces an ischemic demarcation line guiding the plane of resection.
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