Combining On-Table Embolization with Immediate Resection to Safely Excise Giant Hepatic Hemangiomas

Area of Science:

• Hepatobiliary Surgery
• Interventional Radiology
• Oncology

Background:

• Management of symptomatic giant hepatic hemangiomas (>10 cm) is challenging and varies.
• Traditional approaches like resection carry high hemorrhage risks, while preoperative embolization has significant limitations and complications.
• Existing methods necessitate multiple procedures and prolonged hospital stays.

Purpose of the Study:

• To present a novel hybrid technique for simultaneous embolization and resection of giant hepatic hemangiomas.
• To demonstrate the safety and efficacy of performing these procedures in a single session within a hybrid operating room.
• To improve outcomes and reduce risks associated with managing massive liver hemangiomas.

Main Methods:

• Utilized a hybrid operating room with on-table angiogram capabilities for immediate assessment and intervention.
• Performed simultaneous inflow embolization and hepatic resection under a single anesthesia.
• Focused on decreasing tumor size and controlling vascular inflow/outflow to enhance resection safety.

Main Results:

• The combined approach facilitated safer resection by reducing tumor size and improving vascular control.
• This single-procedure strategy minimized intraoperative blood loss and associated risks.
• The technique proved efficient, avoiding intervening hospital admissions and optimizing resource utilization.

Conclusions:

• The hybrid on-table embolization and immediate resection technique is a safe and feasible approach for massive hepatic hemangiomas.
• This method overcomes limitations of traditional preoperative embolization and reduces the risks associated with hepatic resection.
• It offers an efficient and effective solution for managing complex liver hemangiomas.