Introduction: Systemic inflammatory response is a complication that occurs frequently in major liver resection patients. The surgical trauma and ischemia reperfusion injury due to the Pringle manoeuvre are the most important factors for triggering the inflammatory system. Aim of this study is to show the activation of the leukocytes in the microcirculation during surgery in order to introduce a new potential parameter; the rolling leukocytes. Methods: In this prospective observational study videos of the sublingual microcirculation were recorded using Cytocam, a handheld microscope which uses incident dark-field imaging technique. Two time points are measured, the baseline (T0) after induction of anesthesia, and the second time point (T1) at the end of the surgery. 14 patients were recruited, 12 are included, after undergoing evaluation using quality criteria in order to identify at least one post capillary venule (PCV) where focus is primarily important. Three clips for each time point with duration of 4 seconds (25 frames/sec) in different spots are captured. Identifying a PCV to count the activated leukocytes: sticking and rolling leukocytes in the wall of the PCV. Results: The count of the activated leukocytes from T0 (6.2±1.7 (L/PCV/4s)) to T1 (15.6±0.9 (L/PCV/4s)) increased significantly (P=< 0.0001). The count of the systemic leukocyte (8.2 ± 0.9 (x109/l)) and after (10.9 ± 1.4 (x109/l)) the surgery also increased significantly (p=0.0002). Conclusions: The leukocytes in the micro- and macrocirculation both increased. Monitoring the microcirculatory rolling leukocytes directly at the bedside can potentially assess the inflammatory status of the surgical patient.