Ex-situ liver surgery refers to complex liver resections involving hepatic vascular exclusion and a warm ischemia time (WIT) of more than 90 minutes that allows liver resection and vascular reconstruction in patients with giant liver tumours with a difficult approach . Ante-situm liver resections, otherwise called "ex-situ in-vivo" resections is achieved through externalization of the liver outside of the abdominal cavity by clamping and sectioning of the efferent pedicles (suprahepatic veins) ("ex situ") without cutting the afferent vascular pedicle ("in vivo"), thus leaving the hepatic pedicle intact. We present a case report of a 36 yo male patient diagnosed by MRI scan with giant liver tumor in the left hemiliver. A left "ex-situ in-vivo" hepatectomy was performed by dissecting and ligating the left and middle hepatic veins, clamping and sectioning the right hepatic vein, Pringle maneuver, externalization of the liver followed by the tumor resection and right hepatic vein reimplantation. The short warm ischemia time (hepatic resection + liver reimplantation - 30 minutes) allowed us to perform the procedure without installing a veno-venous or porto-caval shunt otherwise used in all of ex-situ procedures described in the literature reviewed in this presentation. Ex-situ liver resection is a viable procedure for giant liver tumours in highly selected cases. It facilitates resection of large liver tumours that would be otherwise unresectable, extending the indications of surgical treatment.
Induction of Anaesthesia in swine may prove to be difficult because of the differences in anatomy and physiology. Intubation of large animals is especially difficult due to the length of the snout and the relative difficulty of obtaining adequate relaxation. The present study is aimed to compare two induction techniques for tracheal intubation in pigs. The secondary aim was to assess the effectiveness of a new anaesthetic protocol for experimental surgery. For this, six female pigs underwent two liver surgeries each. Induction of anaesthesia was performed either using intravenous propofol and fentanyl (IV intravenous group) or by using Sevoflurane (inhalatory group). The attending anaesthesiologist was asked to grade the ease of intubation from a scale between 1 and 5. Orotracheal intubation was easier to obtain in the inhalatory group (p=0.00) and a smaller number of attempts were necessary (p=0.00). A lower End-tidal CO2 after intubation was observed in the inhalatory group (p=0.05). There were no differences in both systolic (p=0.11) and diastolic (p=0.72) arterial pressure and heart rate (p=0.16) after induction of anaesthesia between the two groups. Maintenance of anaesthesia was made using Sevoflurane and boluses of fentanyl for adequate analgesia while no muscle relaxants were used. Intravenous morphine and ketoprofen were used for postoperative analgesia. In conclusion, volatile induction of anaesthesia is safe and offers a better view of the larynx in large swine, while the proposed anaesthetic protocol provides adequate anaesthesia for the surgeons and assures comfort to the animals.
Living donor liver transplant predisposes both the donor and the recipient to high risk of small residual liver volume (in donor) and small-for-size graft syndrome (in recipient) (1). Both of these risks can be overcomed by using two grafts from two different donors; this procedure is called "Living donor liver transplant using dual grafts" (2). We present a video case-report of a "Living donor liver transplant using dual grafts" performed in a 51 yo female recipient for VHB+VHD cirrhosis, MELD score 22. She received two liver grafts, a left hemiliver (Donor 2 in the video) and a left lateral section (Donor 1 in the video). The combined GRWR was 1.05 (0.71 + 0.34). For a better understanding of the technique, both donation and back-table procedures were combined in the same split-screen, being followed by the left lateral section (Donor 1) and left hemiliver (donor 2) implantations. Both donors had no postoperative complications. After 12 months of follow-up, both donors and the recipient are alive, with normal liver function. Dual-graft Living donor liver transplant is a feasible option to achieve the required liver volume using two suboptimal liver grafts.
scite is a Brooklyn-based organization that helps researchers better discover and understand research articles through Smart Citations–citations that display the context of the citation and describe whether the article provides supporting or contrasting evidence. scite is used by students and researchers from around the world and is funded in part by the National Science Foundation and the National Institute on Drug Abuse of the National Institutes of Health.
hi@scite.ai
10624 S. Eastern Ave., Ste. A-614
Henderson, NV 89052, USA
Copyright © 2024 scite LLC. All rights reserved.
Made with 💙 for researchers
Part of the Research Solutions Family.