- Clamp-crush technique
- Use a clamp (e.g. Kelly or Pean) to bluntly fracture liver tissue along the resection line
- Small vessels and bile ducts are individually clipped, tied or coagulated
- Simple and widely used; can be fast but may lead to more blood loss if not done carefully
- CUSA (Cavitron Ultrasonic Surgical Aspirator)
- Uses ultrasonic vibration to fragment parenchyma while preserving vessels and ducts
- Allows precise dissection and good visibility
- Slower, but excellent for cirrhotic livers or when close to vascular structures
- Harmonic scalpel
- Ultrasonic energy both cuts and coagulates liver tissue
- Quicker than CUSA, but less precise around large vessels
- Bipolar or monopolar diathermy
- Coagulates and cuts tissue
- Effective for small vessels but can cause more thermal injury and risk bile leaks
- Ligasure or vessel sealing devices
- Seals vessels up to 7 mm with minimal thermal spread
- Often used with other techniques for hemostasis and bile duct sealing
- Stapler transection
- Linear staplers used to divide liver parenchyma and vessels in one step
- Useful for anatomical resections or peripheral wedges
- Limited use in deep or irregular planes
- Water jet dissection
- High-pressure saline jet separates hepatocytes while sparing vessels and ducts
- Preserves fine structures but less widely available