Major Hepatic Resection in a Residency Training Program*

Abstract

Records of 30 major hepatic resections performed at David Grant USAF Medical Center and Wilford Hall USAF Medical Center were analyzed to assess the feasibility, safety, and resources required for such procedures in a general surgery residency training program. The mean intraoperative blood loss during surgery was 2022 mL and the mean intraoperative transfusion volume was 4.2 units of packed red blood cells. Patients spent an average of 2.7 days in the intensive care unit, with a mean overall postoperative stay of 15 days. One death occurred within 30 days of operation due to a postoperative myocardial infarction, and another death during the hospital stay was due to hepatic insufficiency and Candida endocarditis. Overall, five major postoperative complications occurred (17%), one requiring reoperation. All but one procedure was done by a closely supervised surgical resident. This experience compares favorably with others in the literature and supports the practice of hepatic resection as part of surgical training.