Laparoscopic-assisted ERCP

Abstract

chloride, Y-shaped bypass tubes were created with venous cannulas on each end. Heparinized saline filled the tubing and 30 U/kg of systemic heparin administered. The left internal jugular (IJ) vein was cannulated with the single arm of the Y. The portal vein (PV) was cannulated with one of the double arms, then divided. Clamps were removed to establish PV-IJ flow. Infra-hepatic inferior vena cava (IVC) was then cannulated, divided and flow established. Cannulas were secured with Rumel tourniquets and additionally secured to the tubing. Suprahepatic IVC was clamped and liver was removed. The suprahepatic IVC anastomosis was completed, then the PV and infrahepatic IVC anastomoses. Bypass time, flow, and one-hour post-reperfusion pH were recorded. Results: Eleven liver transplants were performed from eleven donor pigs. Mean weight of the donor and recipient animals was 23.5 kg +/-4.1 and 29.2 kg +/-6.4, respectively. There were two peri-operative mortalities: one pig died due to portal bypass cannula dislocation and the other due to inadequate ventilation. Of the 9 animals successfully transplanted with the use of passive veno-venous bypass, all survived until sacrifice. The mean time on bypass was 52 minutes +/-15.5. The mean flow (L/min) at 10, 20, and 30 minutes on bypass was 0.55 +/-0.06, 0.54 +/-0.06, and 0.33 +/-0.25. The mean pH at 1-hour post-reperfusion was 7.4 +/-0.17. The cost per set up was approximately 112 USD. Conclusion: This series of experimental orthotopic liver transplantation in pigs shows that the use of passive venovenous bypass with heparin-bonded polyvinyl chloride tubing to maintain hemodynamic stability during the recipient hepatectomy, is a less expensive alternative compared to bypass with a centrifugal pump.