[Sharp transsection of the parenchyma in liver resection]

Extended clinical application of total vascular isolation (TVI) in resection liver surgery made a more radical and invasive liver interventions possible as well as the application of new so far non-standard technique. The sharp transsection of liver parenchyma in vascular isolation represents a technique that could provide some advantages as compared with classical technique of finger fracture. AIMS OF THE WORK: To verify the safety of the sharp liver transsection and total vascular isolation in non-anatomical liver resection.

The experiments were performed in minipigs (N = 9). The surgical intervention was performed under aseptic conditions in general endotracheal anesthesia. After TVI the authors performed non-anatomical resection of the right liver lobe in a sharp way by the scalpel. Individual structures, i.e. branches of protobiliary triad and branches of hepatic vein were treated by stitches. In the course of operation the authors evaluated the diameter and the number of the treated structures in the resection surface, duration of the operation and duration of TVI. The blood loss during the operation, changes in blood count and hepatic enzymes were evaluated.

The surgical intervention lasted 88.7 min (55-139 min) on the average, vascular isolation of the liver lasted 24 min (19-33 min) on the average. The mean blood loss was 193.7 ml (40-400 ml). The decrease in Hb values was 8.25 mg/l (6-11 g/l) on the average. In one resection surface the authors treated 9 (6-11) tubular structures on the average, as soon as the clamp was removed, a branch of hepatic artery had to be subsequently treated three times and a branch of portobiliary triad once.

The combination of total vascular isolation and sharp transsection of liver parenchyma enable a safe management of branches of portobiliary triad smaller than 1 mm in the case of vessels as well as biliary pathways. The management of small hepatic veins, smaller than 1 mm and the branches of hepatic artery pose greater problems which are, however, related to the anatomical difference of the model.