Selective Clamping of Segmental Branches Figs 520 to 523

In patients with severe liver cirrhosis, alternate selective clamping of the segmental branches must be done during the dissection, to reduce liver damage and prevent congestion of the portal system. During the dissection between the middle and left segments, the left segmental branch of the Glissonean pedicle must be temporarily clamped, instead of using the Pringle maneuver. Likewise, at the time of dissection on the intersegmental plane between the middle and right segments, the right segmental branch must be clamped. In right segment or left segment resection, this selective clamping of the neighboring branch may be beneficial (Fig. 5.24).

Fig. 5.20. Selective clamping of segmental branches, showing those segmental Glissonean pedicles are taped as a first step

Fig. 5.21. Middle segmental branch is transected

Fig. 5.22. Schema of selective clamping of segmental branches. During the dissection on intersegmental plane between left segment and middle segment, left segmental branch is clamped
Fig. 5.23. Schema of selective clamping of segmental branches. After 15 minutes, the clamp on right segmental branch is changed, and dissection of liver is done on the intersegmental plane between middle segment and right segment
Pringle Maneuver
Fig. 5.24. At the time of left seg-mentectomy, after a left segmental branch was transected, only middle segmental branch is clamped, instead of Pringle maneuver

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