The liver capsule is incised with diathermy. Careful identification of the correct plane of cleavage is crucial to avoid bleeding or spillage of the cyst contents (A). Intrahepatic vessels are coagulated selectively with bipolar forceps or ligated with metallic clips, ties or suture-ligatures depending on the diameter. Although several possible techniques for liver parenchyma dissection can be used (see chapter "Techniques of Liver Parenchyma Dissection"), we prefer the water jet, which enables a selective and safe separation of the cyst wall from the liver parenchyma (B). Small bile ducts should be carefully identified and tied. Hemostasia of the exposed raw surface of the liver can be improved with argon beam coagulator or topical fibrin derivates.
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