Extrahepatic control of the middle hepatic vein with inflow control by pedicle clamping in major liver surgery.

Surgical techniques commonly used for controlling bleeding during major liver surgery are hepatic inflow occlusion (Pringle maneuver) or total hepatic vascular exclusion (THVE), which are effective procedures of diminishing intraoperative blood loss. However, it is difficult to control retrograde bleeding from the hepatic veins using Pringle maneuver and some patients do not tolerate hemodynamic changes caused by THVE. We isolated the left and middle hepatic veins separately using Arantius' ligament approach to these hepatic veins, and extrahepatic control of the relevant to the liver segment to be resected hepatic veins with inflow control by Glissonian pedicle clamping was successfully performed.