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Personalized stepwise vascular control during complex hepatectomy involving hepatocaval confluence
Lei Dou1,2, Zong-Ping Yu3, Hui-Yuan Yang1
1Department of Surgery, Tongji Hospital, Tongji Medical college, Huazhong University of Science and Technology, Wuhan, China.
ANZ Journal of Surgery
|December 11, 2017
Summary
This study presents a new stepwise vascular control method for liver surgery involving the hepatocaval confluence. The technique effectively reduces bleeding and ischemia time during complex hepatectomy procedures.
Area of Science:
- Hepatobiliary Surgery
- Vascular Control Techniques
- Surgical Oncology
Background:
- Massive bleeding from hepatic veins and retro-hepatic inferior vena cava poses a high risk during hepatectomy.
- Complex liver resections involving the hepatocaval confluence require advanced vascular control strategies.
Purpose of the Study:
- To introduce and evaluate an innovative stepwise vascular control technique.
- To mitigate the risks of massive bleeding during hepatectomy involving the hepatocaval confluence.
Main Methods:
- A stepwise vascular occlusion technique was applied to 80 patients undergoing complex liver resection.
- Occlusion involved sequential preparation of the portal triad (PT), infra-hepatic inferior vena cava (IIVC), and supra-hepatic inferior vena cava (SIVC).
- Clinical data were collected and analyzed, with comparisons to parallel studies.
Main Results:
- The mean blood loss was 504.1 ± 234.5 mL, with 16 patients receiving transfusions.
- Hemodynamic parameters remained stable, and no life-threatening complications or deaths occurred.
- The technique demonstrated decreased blood loss and reduced warm ischemia time compared to other methods.
Conclusions:
- The described stepwise vascular control technique is efficacious and feasible.
- This method provides effective control of intraoperative bleeding in complex hepatectomy involving the hepatocaval confluence.
