Back-flow bleeding control during resection of right-sided liver tumors by means of ultrasound-guided finger compression of the right hepatic vein at its caval confluence

Background/Aims: Limiting the backflow bleeding from the hepatic veins is a priority in liver resections. We describe an ultrasound-guided technique for backflow bleeding control from the right hepatic vein (RHV) during right-sided Ever resection. Methodology: Right surface of the extrahepatic RHV is exposed to allow its compression by surgeon's finger-tips: the effectiveness of finger compression is checked by color-Doppler intraoperative ultrasonography. Results: This technique was adopted in 47 consecutive patients with tumors located in the right segments and not infiltrating the RHV close to its caval confluence. There was no hospital mortality or major morbidity. Mean blood loss was 310mL, and 4 patients required blood transfusion. The maneuver here described was used 2.3 times per patients, and taping of the RHV was never needed. Conclusions: The technique here described allows easy and safe control of the RH-V patency without its skeletonization and encirclement.