How Should Transection of the Liver Be Performed?

Lesurtel, Mickaël; Selzner, Markus; Petrowsky, Henrik; McCormack, Lucas; Clavien, Pierre‐Alain

doi:10.1097/01.sla.0000189121.35617.d7

Cited by 268 publications

(73 citation statements)

References 27 publications

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“…The tendency to withhold from clamping may partly be the result of advances in parenchymal transection [40, 41], including the use of precoagulation devices [42, 43]. In fact, the frequent use of precoagulation correlated with less frequent use of clamping.…”

Section: Discussionmentioning

confidence: 99%

European Survey on the Application of Vascular Clamping in Liver Surgery

et al. 2007

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Background: This study evaluated the frequency, the indications and techniques of vascular clamping during liver resection and during thermal destruction therapies, as currently used by hepatic surgeons throughout Europe. Methods: A web-based questionnaire was distributed among 621 physicians, including all members of the European Hepato-Pancreato-Biliary Association and the European Surgical Association. Results: The overall response rate was 50%. During liver resection, vascular clamping is never applied by 10%, on indication by 71%, and routinely by 19%. Routine clamping is particularly performed by high-volume and senior surgeons and appears to be associated with longer ischaemia times. Intermittent inflow occlusion is the clamping method of choice for more than 65% of surgeons and total ischaemia times are usually limited to 15–30 min. During thermal ablation, vascular clamping is never used by 57%, on indication by 37%, and routinely by 7%; it is particularly applied for large tumours and for tumours close to large vessels, and ischaemia times are shorter. Conclusions: Vascular clamping during liver resection is frequently used; during thermal ablation it is preserved for larger tumours or tumours in the vicinity of large vessels. Complete inflow occlusion is the most frequently used technique, with a distinct preference for intermittent clamping.

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Section: Discussionmentioning

confidence: 99%

European Survey on the Application of Vascular Clamping in Liver Surgery

et al. 2007

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“…This less risky procedure is performed by ligating and separating the left hepatic artery in the neighborhood of the tumor, skeletonizing the left portal vein from the cancerous bile duct to some extent and then isolating the liver. With recent progress in operative techniques and devices, however, surgeons can now isolate the liver while blocking the blood flow and resect the liver with reduced bleeding [10,11]. Meanwhile, improvements in techniques for preoperative diagnoses enable the accurate preoperative evaluation of cancer infiltration in arteries and portal veins that have to be preserved after extended hepatectomy.…”

Section: Discussionmentioning

confidence: 99%

Extended Left Hepatic Lobectomy for Hepatic Hilar Bile Duct Cancer: A Novel Surgical Procedure in Which the Right Hepatic Duct Is Transected before the Hepatoduodenal Ligament Is Skeletonized

Miyazawa

Aikawa²,

Okada³

et al. 2009

Dig Surg

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As a general principle, the procedure of isolating a cancer region from surrounding tissues (skeletonization) is not taken until the last stage of a cancer operation. This principle is often disregarded in surgery for cancers of the hepatic hilar duct, however, as it may be mandatory to skeletonize the region before resecting the liver. Our group invented ‘extended left hepatic lobectomy’, a new surgical procedure for hepatic hilar bile duct cancer, in which we isolate the liver and transect the right hepatic duct before skeletonizing the cancer region in the hepatoduodenal ligament.

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“…Several mechanical devices, such as CUSA, Bipolar electrocautery, Water-Jet, Microwave Coagulator and Tissue Link, etc., have independently been applied during liver parenchymal transection in various institutions. However, there is still no clear evidence showing which of the devices is significantly better than the others [19,23,24,25,26]. …”

Section: Operative Proceduresmentioning

confidence: 99%

“…Anatomical resection has been considered beneficial for complete segmental resection of the cancer burden and the non-valid hepatic parenchyma. While during transection of the hepatic parenchyma both Pringle’s maneuver and hemi-vascular clamp have commonly been utilized to reduce intraoperative blood loss, no obvious differences in liver damage, blood loss and operative time have been found between the two vascular control methods [19,20,21,22]. Several mechanical devices, such as CUSA, Bipolar electrocautery, Water-Jet, Microwave Coagulator and Tissue Link, etc., have independently been applied during liver parenchymal transection in various institutions.…”

Section: Operative Proceduresmentioning

confidence: 99%

Surgical Treatment for Liver Cancer

Miyazaki¹,

Kimura²,

Shimizu³

et al. 2007

Dig Surg

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Surgical treatment of hepatocellular carcinoma (HCC) has developed remarkable for several reasons. The surgical mortality rates of patients with HCC after hepatectomy have decreased due to appropriate criteria for surgery, refined surgical techniques and improvement in the pre- and postoperative management. In preoperative management, refinements in liver function tests and strategies for esophageal varices, and the induction of preoperative portal vein embolization have contributed favorably to the outcome after hepatectomy for HCC. Furthermore, hepatectomy has been technically refined by various vascular control methods and liver transection devices based on the realization that surgical anatomical information also plays a major role in improving surgical outcome. Also concomitant splenectomy with hepatectomy might extend the criteria for surgery in HCC patients with hypersplenism. Therefore, hepatectomy is a safe therapeutic approach that could bring about a favorable outcome in patients with HCC. Nowadays transplantation is one of the therapeutic options for HCC patients, even in Japan. Herein the surgical treatment of HCC in Japan is reviewed and current issues in the surgical treatment of HCC are discussed.

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How Should Transection of the Liver Be Performed?

Abstract: The clamp crushing technique was the most efficient device in terms of resection time, blood loss, and blood transfusion frequency compared with CUSA, Hydrojet, and dissecting sealer, and proved to be also the most cost-efficient device.

Cited by 268 publications

References 27 publications

European Survey on the Application of Vascular Clamping in Liver Surgery

European Survey on the Application of Vascular Clamping in Liver Surgery

Extended Left Hepatic Lobectomy for Hepatic Hilar Bile Duct Cancer: A Novel Surgical Procedure in Which the Right Hepatic Duct Is Transected before the Hepatoduodenal Ligament Is Skeletonized

Surgical Treatment for Liver Cancer

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