Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure

Uchiyama, Kazuhisa; Ueno, Masaki; Ozawa, Satoru; Hayami, Shinya; Kawai, Manabu; Tani, Masaji; Mizumoto, Kazuhiro; Haba, Masanori; Hatano, Yoshio; Yamaue, Hiroki

doi:10.1007/s00423-008-0297-3

Cited by 35 publications

(29 citation statements)

References 19 publications

(43 reference statements)

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“…With lowering the pressure in the inferior vena cava, the hepatic venous pressure and then the hepatic sinusoidal pressure will decline. The blood loss during liver resection is proportional to the pressure gradient of the vascular walls and the diameter of the injured vessels [24,25]. In this series, a central venous pressure above 8 cm H 2 O resulted in a higher rate of blood transfusions during the first half of the study; during the second half of the study, the central venous pressure was lowered to 2 to 5 cm H 2 O.…”

Section: Discussionmentioning

confidence: 96%

Lessons learned from 100 initial cases of laparoscopic liver surgery

et al. 2011

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PurposeLaparoscopic liver resection (LLR) is now widely accepted and is being increasingly performed. The present study describes our experience with LLR at a single center over an eight-year period.MethodsThis retrospective study enrolled 100 patients between October 2002 and February 2010. Forty-six benign lesions and 54 malignant lesions were included. The LLR performed included 58 pure laparoscopy procedures, 18 hand-assisted laparoscopy procedures and 24 hybrid technique procedures.ResultsThe mean age of the patients was 57 years; among these patients, 31 were over 65 years of age. The mean operation time was 220 minutes. The overall morbidity was 11% and the mortality was zero. Among the 20 patients with simple hepatic cysts, 50% unexpectedly recurred. Among the 41 patients with hepatocellular carcinoma, 21 patients (51%) underwent preoperative radiofrequency ablation therapy or transarterial chemoembolization. During parenchymal-transection, 11 received blood transfusion. The width of the resection margins was under 0.5 cm in 11 cases (27%); 0.5 to 1 cm in 22 cases (54%) and over 1 cm in eight cases (12%). There was no port site seeding, but argon beam coagulation-induced tumor dissemination was observed in two cases. The overall two-year survival rate was 75%.ConclusionThis study suggests that the applications for LLR can be gradually expanded when assuring that the safety and curability of LLR are equivalent to that of open liver resection.

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Section: Discussionmentioning

confidence: 96%

Lessons learned from 100 initial cases of laparoscopic liver surgery

et al. 2011

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“…End-tidal carbon dioxide must be carefully monitored. When low CVP cannot be achieved, clamping of the infrahepatic IVC has been utilized [17,18]. …”

Section: Vascular Clamping Techniques: Inflow Occlusionmentioning

confidence: 99%

Vascular clamping in liver surgery: physiology, indications and techniques

Chouillard

Gumbs

Cherqui³

2010

Ann Surg Innov Res

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This article reviews the historical evolution of hepatic vascular clamping and their indications. The anatomic basis for partial and complete vascular clamping will be discussed, as will the rationales of continuous and intermittent vascular clamping.Specific techniques discussed and described include inflow clamping (Pringle maneuver, extra-hepatic selective clamping and intraglissonian clamping) and outflow clamping (total vascular exclusion, hepatic vascular exclusion with preservation of caval flow). The fundamental role of a low Central Venous Pressure during open and laparoscopic hepatectomy is described, as is the difference in their intra-operative measurements. The biological basis for ischemic preconditioning will be elucidated. Although the potential dangers of vascular clamping and the development of modern coagulation devices question the need for systemic clamping; the pre-operative factors and unforseen intra-operative events that mandate the use of hepatic vascular clamping will be highlighted.

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“…The second trial 59 showed a significant decrease in intra‐operative blood loss but without any impact on morbidity or mortality. Half clamping of the infra‐hepatic vena cava with a tourniquet, in association with portal triad clamping, has also been reported to be associated with a lower central venous pressure and a significant decrease in intra‐operative blood loss 60 . Although never performed in the present series, this manoeuver may be associated with hemivascular control of the right liver in a right hepatectomy, as it might decrease supra‐hepatic backflow even in the absence of portal triad clamping and, therefore, might decrease the probability to require salvage portal triad clamping during transection.…”

Section: Discussionmentioning

confidence: 99%

Right hepatectomy with extra-hepatic vascular division prior to transection: intention-to-treat analysis of a standardized policy

Boleslawski

Decanter

Truant

et al. 2012

HPB

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Background: Right hepatectomy (RH) is the most common type of major hepatectomy and can be achieved without portal triad clamping (PTC) in non‐cirrhotic liver. The present study reviews our standardized policy of performing RH without systematic PTC. Methods: One hundred and eighty‐one consecutive RH were performed in non‐cirrhotic patients, with division of the right afferent and efferent blood vessels prior to transection, without systematically using PTC. Prospectively collected data were analysed, focusing on the following endpoints: need for salvage PTC, ischaemic time, blood loss and post‐operative outcome. Results: Extra‐hepatic division of the right hepatic vessels was feasible in all patients, but was ineffective in 48 patients (26.5%) who required salvage PTC during transection. In those patients, the median ischaemic time was 20 min. The median blood loss was 500 ml (50–3000). Six patients (3.3%) experienced post‐operative liver failure. Overall morbidity, severe morbidity and mortality were 42%, 12.1% and 1.6%, respectively, with peri‐operative transfusion rate (16.6%) being the only factor associated with morbidity. Discussion: By performing RH with extra‐hepatic vascular division prior to transection, PTC can be safely avoided in the majority of patients.

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Half clamping of the infrahepatic inferior vena cava reduces bleeding during a hepatectomy by decreasing the central venous pressure

Abstract: Using the half clamping technique of the IVC, intra-operative CVP was maintained below 3 mmHg without any side effects, and the low CVP significantly reduced the bleeding from hepatic veins during a major hepatectomy.

Cited by 35 publications

References 19 publications

Lessons learned from 100 initial cases of laparoscopic liver surgery

Lessons learned from 100 initial cases of laparoscopic liver surgery

Vascular clamping in liver surgery: physiology, indications and techniques

Right hepatectomy with extra-hepatic vascular division prior to transection: intention-to-treat analysis of a standardized policy

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