Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial

Ratti, Francesca; Cipriani, Federica; Reineke, Raffaella; Catena, Marco; Paganelli, Michele; Comotti, Laura; Beretta, Luigi; Aldrighetti, Luca

doi:10.1016/j.hpb.2015.09.005

Cited by 39 publications

(28 citation statements)

References 33 publications

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“…Lower intra-operative blood loss is reported in patients with a central venous pressure (CVP) lower than 5cmH2O (74) . The efficacy of stroke volume variation as an alternative to CVP monitoring has been demonstrated (75) . See R22.1, 22.2, 22.3…”

Section: What Are the Haemostatic Techniques During Laparoscopic Livementioning

confidence: 99%

The Southampton Consensus Guidelines for Laparoscopic Liver Surgery

Aldrighetti²,

et al. 2018

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The European Guidelines Meeting for Laparoscopic Liver Surgery has produced a set of clinical practice guidelines that have been independently validated for the safe development and progression of laparoscopic liver surgery. The Southampton Guidelines have amalgamated the available evidence and a wealth of experts' knowledge taking in consideration the relevant stakeholders' opinions and complying with the international methodology standards.

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Section: What Are the Haemostatic Techniques During Laparoscopic Livementioning

confidence: 99%

The Southampton Consensus Guidelines for Laparoscopic Liver Surgery

Aldrighetti²,

et al. 2018

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“…However, there is a great difference between septic patients and surgical patients regarding the duration of ventilation or surgical hemodynamic changes. Although in liver surgery this monitoring has been used in patients during liver transplantation [16,17], there are few references in the literature about liver transection controlled by stroke volume variation (SVV) and GEDV values [18]. Our aim was to investigate whether GEDV values can successfully control the measurement of fluid volume and, therefore, blood loss during liver transection and cardiac function.…”

Section: Discussionmentioning

confidence: 99%

Global end-diastolic volume could be more appropiate to reduce intraoperative bleeding than central venous pressure during major liver transection

Redondo

Padilla

Villazala

et al. 2017

Anaesthesiol Intensive Ther

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Background: Central venous pressure often fails to identify the true value of cardiac preload. Our purpose is to investigate whether Global End-Diastolic Volume (GEDV) values can control hemodynamic parameters for the measurement of fluid volume, cardiac preload and blood loss during liver transection. Methods: This was a prospective clinical study that included patients undergoing liver resection. All patients were monitored by means of PiCCO technology and 222 hemodynamic measurements were performed in 74 patients. Fluid restriction was used. Transpulmonary thermodilutions were performed at different times of surgery, namely: 1. at the beginning of surgery; 2. before hepatectomy and after selective vascular exclusion (Time 1); 3. approximately half way through the liver transection (Time 2); and 4. after liver resection (Time 3). Results: One hundred and twenty-nine of the 222 GEDV values were decreased (prevalence of hypovolemia of 58.1%). However, twenty two of the 222 CVP values were decreased (prevalence of 10.8%). Sensitivity of CVP with regard to volume depletion (GEDV > 650 mL m -2 ) on the times (1, 2 and 3) were ) and 21.43 (95% CI: 7.83-35.03), respectively. There was no correlation between CVP and GEDV. Conclusions: GEDV values may be more appropriate for monitoring cardiac preload during liver transection.

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“…[21,22] Cardiac preload has been traditionally monitored by central venous pressure, while recently, haemodynamic changes during surgery have been successfully assessed using minimally-invasive devices like Flotrac/Vigileo that is proved to be safe and reliable. [23] Since in cirrhotics baseline systemic vascular resistance is lower and less sensitive to hemodynamic changes, these patients have altered capability to respond to portal clamping so that intraoperative administration of vasopressors (norepinephrine and dopamine) might be required. Crystalloid administration was generally suspended the second day after surgery unless specifically required by clinical conditions of the patient.…”

Section: Discussionmentioning

confidence: 99%

Liver resection for hepatocellular carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach

Ratti¹,

Cipriani²,

Reineke³

et al. 2016

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Aim: The study was designed to assess the implications of enhanced recovery after surgery (ERAS) approach in patients submitted to open liver resection for hepatocellular carcinoma (HCC) comparing their short term outcome with patients treated by laparoscopic approach, in a case-matched design. Methods: The open-group (n = 60) was matched in a ratio of 1:1 with patients undergoing laparoscopic liver resection for HCC (Lap-group, n = 60), with a matching achieved on a basis of propensity scores including 6 covariates representing patients characteristics and severity of the disease. Primary outcome analysis was performed in terms of ERAS-specific items and postoperative morbidity and mortality. Results: Overall morbidity and mortality were comparable between groups. Incidence of ascites was slightly higher in the open-compared with the Lap-group (respectively 11.7% and 13.3%), without statistical significance. The need for introduction or increase of chronic diuretic therapy was significantly higher in the open-compared with the Lap-group (16.7% vs. 11.7%, P = 0.046). Furthermore, ascites more frequently required percutaneous drainage in the open-compared with the Lap-group (5% vs. 1.7% respectively, P = 0.041). Conclusion: In patients who can't benefit from minimally-invasive approach because of disease characteristics, ERAS management seems to be associated with an improved postoperative functional recovery and postoperative outcomes, comparable to those of the minimally invasive approach.

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Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial

Abstract: SVV monitoring in laparoscopic liver surgery improves intraoperative outcome, thus enhancing the benefits of the minimally-invasive approach and fast-track protocols.

Cited by 39 publications

References 33 publications

The Southampton Consensus Guidelines for Laparoscopic Liver Surgery

The Southampton Consensus Guidelines for Laparoscopic Liver Surgery

Global end-diastolic volume could be more appropiate to reduce intraoperative bleeding than central venous pressure during major liver transection

Liver resection for hepatocellular carcinoma within a fast-track management: a propensity-score matched analysis between open and laparoscopic approach

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