Hepatic resection with in situ hypothermic perfusion is superior to other resection techniques

Through the years, liver resection and bleeding control techniques have progressively evolved. However, for liver tumors located unfavorably, the standard techniques are not suitable due to either failure to control the bleeding or to liver ischemia induced by prolonged interruption of perfusion. In this regard, total vascular exclusion (TVE) with in situ hypothermic perfusion is advantageous as it protects the parenchyma, achieves better vascular control and enables difficult vascular reconstructions or reimplantations. The advantages of this procedure described as early as 1960s by Fortner were also confirmed by our team in a subsequent report. We showed that TVE with in situ hypothermic perfusion is superior to TVE alone if used for more than 60 min in complex resections with or without vascular reconstruction. Other techniques (ex situ liver resection developed by Pichlmayr and ante situm liver resection by Hannoun) have been described; however, they have not been widely accepted due to a high rate of complications. In this article, we report our operative technique as well as discuss some important operative points.