Segmental liver resection using ultrasound-guided selective portal venous occlusion
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D Castaing1, O J Garden, H Bismuth
1Unite de Chirurgie Hepatobiliaire, Hopital Paul Brousse, Villejuif, France.
Abstract:
Anatomical segmental resection of small hepatic lesions using operative ultrasonography is improved by selective intrahepatic portal venous occlusion. The technique was successfully performed in 15 of the 18 patients in whom it was attempted. The lesions resected included 7 hepatocellular carcinomas in cirrhotic patients, 5 hepatic metastases, 2 benign tumors and 1 gallbladder carcinoma. The mean duration of local vascular exclusion was 47 minutes (range, 22 to 80 minutes) and mean blood transfusion requirement was 1.3 units (range, 0 to 7 units). Five patients sustained postoperative complications and these included chest infection (2 patients), ascites (2 patients), pleural effusion (1 patient) and hemorrhage (1 patient) from the site of hepatic resection. There were no postoperative deaths. One patient required further resection of a recurrent colonic metastasis and two patients have died of disseminated disease. This technique has allowed limited anatomical resection of lesions that would have otherwise required extensive classical hepatic resections or would have not been amenable to resection.
Insights
Selective intrahepatic portal venous occlusion improves anatomical resection of small liver lesions. This minimally invasive technique allows for precise removal of tumors, including hepatocellular carcinoma and metastases, with good outcomes.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Interventional Radiology
Background:
- Anatomical segmental resection of liver lesions is challenging.
- Minimally invasive techniques are needed to improve outcomes.
- Operative ultrasonography is crucial for precise lesion identification.
Purpose of the Study:
- To evaluate the efficacy of selective intrahepatic portal venous occlusion combined with operative ultrasonography for anatomical resection of small hepatic lesions.
- To assess the safety and feasibility of this technique in a clinical setting.
Main Methods:
- Selective intrahepatic portal venous occlusion was employed in patients undergoing anatomical resection of hepatic lesions.
- Operative ultrasonography was used for precise localization and guidance during resection.
- Data on procedure duration, blood transfusion requirements, and postoperative complications were collected.
Main Results:
- The technique was successfully performed in 15 of 18 attempted cases.
- Lesions included hepatocellular carcinoma, hepatic metastases, benign tumors, and gallbladder carcinoma.
- Mean vascular exclusion time was 47 minutes; mean transfusion was 1.3 units.
- Postoperative complications occurred in 5 patients, with no deaths.
Conclusions:
- Selective intrahepatic portal venous occlusion is a safe and effective adjunct to operative ultrasonography for anatomical liver resection.
- This technique facilitates the resection of lesions previously considered unresectable or requiring extensive surgery.
- It offers a minimally invasive approach for managing small hepatic lesions.