A simplified bloodless procedure for extensive hepatectomy. Experimental study in the pig

Area of Science:

• Surgical Innovation
• Hepatobiliary Surgery
• Animal Models

Background:

• Hepatectomy, or liver resection, is a critical procedure for treating liver diseases.
• Minimizing blood loss and ischemia time during hepatectomy is crucial for patient outcomes.
• Developing effective and less invasive surgical techniques remains a priority in liver surgery.

Purpose of the Study:

• To describe an original, bloodless hepatectomy procedure in a porcine model.
• To evaluate the feasibility and efficacy of complete vascular liver isolation for extensive liver resection.
• To assess the utility of a gelatin-resorcin-formaldehyde adhesive for hemostasis and ischemia reduction.

Main Methods:

• A novel surgical procedure involving complete vascular liver isolation and aorta clamping (up to 25 minutes) was performed in pigs.
• Extensive hepatectomy (60-75% of the liver) was achieved without dissection of the portal triad.
• A gelatin-resorcin-formaldehyde adhesive was employed to ensure hemostasis and shorten liver ischemia duration.

Main Results:

• The procedure allowed for 60-75% bloodless hepatectomy in the porcine model.
• The technique successfully avoided portal triad dissection, simplifying the procedure.
• Excellent hemostasis was achieved, and liver ischemia time was significantly shortened.
• Good hemodynamic tolerance was observed post-procedure.

Conclusions:

• This original procedure offers a viable method for extensive bloodless hepatectomy in pigs.
• The technique, utilizing vascular isolation and a specific adhesive, effectively manages bleeding and ischemia.
• The observed rapid liver regeneration suggests potential for clinical translation in managing liver resections.