Major hepatic resection under total vascular exclusion with extracorporeal venovenous bypass

Techniques and principles pioneered during the development of hepatic transplantation have now been applied to hepatic resectional surgery. Primary and metastatic hepatic neoplasms that are centrally located or in proximity to the vena cava or major branches have been resected successfully by total hepatic vascular exclusion. Herein, the authors report the use of extracorporeal venovenous bypass from the infrahepatic vena cava to the axillary vein to provide adequate central venous filling during total vascular exclusion. The use of this technology, pioneered in transplantation, has extended the indication for hepatic resection to patients previously considered unresectable.