Overview

Anatomy

• The liver has eight (8) segments
  • RIGHT hepatectomy: Removes lobes 5, 6, 7, 8
  • EXTENDED RIGHT hepatectomy: Removes lobes 4, 5, 6, 7, 8, +/- 1
  • LEFT hepatectomy: Removes lobes 2, 3, 4, +/- 1
• Blood flow:
  • 25% of cardiac output
  • Hepatic artery: 25% of HBF, 45-50% O2
  • Portal vein: 75% HBF, 50-55% of O2

MELD: INR, Cr, Bili (total), Na+

Comprehensive Checklist

Pre-Operative Evaluation

• [ ] Varices → No TEE if banded within 7 days
• [ ] Extensive varices or prior upper abdominal surgery → consider VV or PV bypass
• [ ] Consider Octreotide if portal HTN, varices

Intraoperative

• Induction, Lines, Monitors, and Labs
• Dissection
• Anhepatic
• Reperfusion
• Blood Transfusion
• Veno-veno or porto-veno bypass