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Application of the En Bloc Concept Combined with Anatomic Resection in Laparoscopic Hepatectomy
Published on: March 10, 2023
The main indications and techniques for vascular exclusion of the liver
Eleazar Chaib1, William Abrão Saad, Ikurou Fujimura
1Liver and Portal Hypertension Surgery Unit, University of São Paulo School of Medicine, São Paulo, SP, Brazil. cientifico@uol.com.br
Insights
Vascular clamping during liver resection minimizes bleeding. Surgeons should master various techniques like the Pringle maneuver for optimal patient outcomes.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Vascular Surgery
Background:
- Vascular clamping is crucial in liver resection to reduce blood loss and complications.
- Effective bleeding control is paramount for successful hepatectomy.
Purpose of the Study:
- To detail surgical techniques for liver vascular exclusion.
- To outline the indications for each vascular exclusion method.
Main Methods:
- Describes hepatic pedicle clamping (Pringle maneuver).
- Details intermittent hepatic pedicle clamping.
- Explains intermittent liver vascular exclusion without vena cava clamping.
- Covers hepatic vascular exclusion with vena cava clamping.
- Discusses metabolic and hemodynamic consequences and technical failures.
Main Results:
- Presents multiple vascular clamping techniques for liver resection.
- Analyzes the associated physiological effects and potential complications.
- Highlights the variability in surgical approaches.
Conclusions:
- The selection of vascular clamping technique is surgeon-dependent.
- A flexible approach, utilizing various clamping methods, is essential for patient safety.
- Surgeons must be proficient in all clamping strategies for hepatectomy.
Background:
The purpose of vascular clamping during the course of liver resection is to reduce bleeding and subsequent complications.
Aim:
To show both step-by-step surgical techniques for vascular exclusion of the liver and their indications.
Methods:
It is described the following techniques: clamping of the hepatic pedicle, "Pringle" maneuver; intermittent clamping of the hepatic pedicle; intermittent vascular exclusion of the liver, without vena cava clamping, and hepatic vascular exclusion with vena cava clamping. Also metabolic and homodynamic consequences as well as the technical failure of the application of each of them are discussed.
Conclusions:
The choice of technique to use for clamping during hepatectomy depends on the surgeon's judgment. Dogmatic or systematic attitude, is prejudiciable for the patient and liver surgeon must be able to use all kinds of clamping.
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