There are many surgical methods of liver resection, and many books, and young doctors are very confused and feel very mysterious about liver surgery, and some of the bigwigs will talk more and more mysteriously, telling you that there are many methods, what precision hepatectomy la, whole liver blood flow block ah, half liver blood flow block ah, regional blood block ah, and around the liver lifting band, and the recent very popular ALPPS, and so on. It is very suspenseful. Actually, hepatectomy is not that complicated. I have completed nearly 500 liver surgeries myself over the years, and I thought that most of the liver surgeries can be done safely by mastering two key points. First, the liver must be sufficiently free during liver surgery. Adequate freeing of the liver is a prerequisite for safe completion of surgery. The left hepatectomy does not require a large extent of freeing, the left half of the liver can be completely free, but when doing the right hepatectomy, I am used to fully freeing both the left and right liver. On the right side, the sickle ligament, coronary ligament, left and right triangular ligaments, and hepatorenal ligaments of the liver should be severed, and the adhesions between the liver and the right adrenal gland should be separated to reach the right wall of the inferior vena cava, and sometimes even the short hepatic vein on the right side should be completely ligated and severed, and the anterior wall of the inferior vena cava should also be free. The second hepatic hilar is also completely exposed. This allows the right side of the liver to be completely turned over and held in the hand during surgery, and the lesion can sometimes even be held outside of the incision. This makes it very safe to cut the liver under direct vision, that is, sometimes when ruptured hepatic vein bleeding is encountered, it can be directly held in the hand and then exact suturing to stop bleeding are very convenient and no air embolism or hemorrhage will occur. Second, the blood flow into the liver is blocked. The most commonly used technique to block the blood flow into the liver is the Pringle technique, which is also the most practical. If you are patient, you can dissect out the left and right hepatic arteries and portal vein, which is called hemihepatic block, and then dissect into detail to reveal the Glisson sheath of each liver lobe and segment, which is hepatic segment resection and subhepatic segment resection. In fact, if the patient’s liver function is still okay, intermittent whole liver into the liver blood flow block can be done, simple and easy. It is this maneuver and there are many ways to do it. There are 12# latex tubes, traps, 8# catheters tied around the hepatoduodenal ligament, and so on. I use a relatively simple method, using an 8# catheter around the hepatoduodenal ligament, and then a small section of the suction tube, when the block is pulled tight catheter, in the suction tube behind the clamp a small curved clamp is good, the block is very convenient when released. The blood flow into the liver is blocked for 10 minutes, then released for 5 minutes and blocked again, and the cycle continues. This will reduce the bleeding when the liver is disconnected. As for hepatic dissection, there is nothing more to say. There are a lot of methods, a big bend of Wu Lao go to the end of the world, there are also fine clamp method, and super knife, CUSA, LIGASURE, etc., can be used, as long as you are used to good, proper ligature suture tie, section tight hemostasis, the principle is the same. There are a few tips: 1, the right adrenal gland is sometimes easy to bleed when separated, stopping the bleeding is preferred with 4-0 prolene line continuous suture, do not ligate or go to electrocoagulation. 2, the bleeding point on the middle hepatic vein, small sieve hole with gauze pressure on 5 minutes will stop itself, stop to live, under direct vision with 6-0 prolene suture a figure of eight on.