Total versus selective hepatic vascular exclusion in major liver resections

Smyrniotis, Vassilios; Kostopanagiotou, Georgia; Gamaletsos, Evangelos; Vassiliou, John; Voros, Dionysios; Fotopoulos, A.; Contis, John

doi:10.1016/s0002-9610(01)00864-9

Cited by 74 publications

(74 citation statements)

References 21 publications

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“…Hemostasis was achieved by suturing all vascular orifices on the cut surface with 3-0 and 4-0 prolene. After completion of the liver resection, outflow was released first, followed by liver inflow [5,6] . Following reperfusion, hemostasis was completed using additional stitches.…”

Section: Methodsmentioning

confidence: 99%

“…SHVE entails disconnection of the liver from the retrohepatic IVC and inflow occlusion combined with extrahepatic control of hepatic veins. This technique offers bloodless liver transection without the abovementioned disadvantages of PM and THVE [5,6] . Dissection and clamping of the hepatic veins during the application of SHVE may predispose the major hepatic veins to thrombi formation through the induction of venous stasis and endothelial injury coupled with coagulation disturbances.…”

Section: Introductionmentioning

confidence: 99%

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Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Arkadopoulos¹,

Stafyla²,

Marinis³

et al. 2009

WJG

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AIM:To test whether clamping during liver surgery predisposes to hepatic vein thrombosis. METHODS:We performed a retrospective analysis of 210 patients who underwent liver resection with simultaneous inflow and outflow occlusion. Intraoperatively, flow in the hepatic veins was assessed by Doppler ultrasonography during the reperfusion phase. Postoperatively, patency of the hepatic veins was assessed by contrast-enhanced CT angiography, when necessary after 3-6 mo follow up. RESULTS:Tw e l ve p a t i e n t s ( 5 .7 % ) d e ve l o p e d intraoperative liver remnant swelling. However, i n t ra o p e ra t i ve u l t ra s o n o g ra p hy d i d n o t re ve a l evidence of hepatic vein thrombosis. In three of these patients a kinking of the common trunk of the middle and left hepatic veins hindering outflow was recognized and was managed successfully by suturing the liver remnant to the diaphragm. Twenty three patients (10.9%) who developed signs of mild outflow obstruction postoperatively, had no evidence of thrombi in the hepatic veins or flow disturbances on ultrasonography and contrast-enhanced CT angiography, while hospitalized. Long term assessment of the patency of the hepatic veins over a 3-6 mo follow-up period did not reveal thrombi formation or clinical manifestations of outflow obstruction. CONCLUSION:Extrahepatic dissection and clamping of the hepatic veins does not predispose to clinically important thrombosis.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Arkadopoulos¹,

Stafyla²,

Marinis³

et al. 2009

WJG

View full text Add to dashboard Cite

show abstract

“…Instead of clamping the caval vein inferiorly and superiorly to the liver, the liver veins are clamped selectively (97). Thus, the flow in the inferior caval vein is not disrupted, and the risk of hemodynamic instability is reduced (98). With regard to reducing blood loss, SHVE is equally effective as THVE and is more effective than PM (98,99).…”

Section: Figure 6 Pringle´s Maneuver a Cotton Band Or Vascular Clammentioning

confidence: 99%

“…Thus, the flow in the inferior caval vein is not disrupted, and the risk of hemodynamic instability is reduced (98). With regard to reducing blood loss, SHVE is equally effective as THVE and is more effective than PM (98,99). This method resembles a technique widely used for hemi-hepatectomies in which both the vascular inflow and the involved liver vein are divided before parenchymal transection (see previous chapter);…”

Section: Figure 6 Pringle´s Maneuver a Cotton Band Or Vascular Clammentioning

confidence: 99%

Methods to Reduce Liver Ischemia/Reperfusion Injury

Björnsson¹

2014

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“…The THVE method was developed to control bleeding during hepatic parenchymal transection [5,6] ; however, it is technically complicated and may cause profound liver damage and circulatory instability, and as a result inflow occlusion via Pringle's maneuver is more frequently used to control bleeding during usual hepatectomy, rather than THVE [7] . While THVE can effectively limit blood loss during hepatic parenchymal transection, especially that from hepatic veins [8,9] , its related rates of morbidity and mortality after hepatectomy for tumors involving IVC have been quite high [10,11] . Novel strategies to reduce the risk of damage and complications of THVE will benefit clinical practice and patient outcome.…”

Section: Introductionmentioning

confidence: 99%

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

Ko¹,

Kirihataya²,

Yayoi³

et al. 2016

WJH

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AIM:To evaluate the efficacy of technical modifications of total hepatic vascular exclusion (THVE) for hepatectomy involving inferior vena cava (IVC). METHODS:Of 301 patients who underwent hepatectomy during the immediate previous 5-year period, 8 (2.7%) required THVE or modified methods of IVC cross-clamping for resection of liver tumors with massive involvement of the IVC. Seven of the patients had diagnosis of colorectal liver metastases and 1 had diagnosis of hepatocellular carcinoma. All tumors involved the IVC, and THVE was unavoidable for combined resection of the IVC in all 8 of the patients. Technical modifications of THVE were applied to minimize the extent and duration of vascular occlusion, thereby reducing the risk of damage. RESULTS:Broad dissection of the space behind the IVC coupled with lifting up of the liver from the retrocaval space was effective for controlling bleeding around the IVC before and during THVE. The procedures facilitate modification of the positioning of the cranial IVC cross-clamp. Switching the cranial IVC cross-clamp from supra-to retrohepatic IVC or to the confluence of hepatic vein decreased duration of the THVE while restoring hepatic blood flow or systemic circulation via the IVC. Oblique cranial IVC cross-clamping avoided ischemia of the remnant hemi-liver. With these technical Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection Retrospective Study ORIGINAL ARTICLEmodifications, the mean duration of THVE was 13.4 ± 8.4 min, which was extremely shorter than that previously reported in the literature. Recovery of liver function was smooth and uneventful for all 8 patients. There was no case of mortality, re-operation, or severe complication (i.e. , Clavien-Dindo grade of Ⅲ or more). CONCLUSION:The retrocaval liver lifting maneuver and modifications of cranial cross-clamping were useful for minimizing duration of THVE.

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Total versus selective hepatic vascular exclusion in major liver resections

Cited by 74 publications

References 21 publications

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Does clamping during liver surgery predispose to thrombosis of the hepatic veins? Analysis of 210 cases

Methods to Reduce Liver Ischemia/Reperfusion Injury

Retrocaval liver lifting maneuver and modifications of total hepatic vascular exclusion for liver tumor resection

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