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Liver resection using total vascular exclusion

P M Evans1, D P Vogt, J T Mayes

  • 1Department of General Surgery, Cleveland Clinic Foundation, Ohio 44195, USA.

Surgery
|October 22, 1998
PubMed
Summary
This summary is machine-generated.

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Total vascular exclusion (TVE) is a safe liver resection technique, even for older patients. Optimal clamp times under 45 minutes minimize blood loss and complications, ensuring low mortality and morbidity.

Area of Science:

  • Hepatobiliary Surgery
  • Surgical Oncology
  • Vascular Surgery

Background:

  • Total vascular exclusion (TVE) is a liver resection method involving control of suprahepatic and infrahepatic vena cava and portal inflow during parenchymal transection.
  • This study reports on 61 liver resections performed on 60 patients utilizing the TVE technique.

Purpose of the Study:

  • To evaluate the safety and efficacy of total vascular exclusion (TVE) in liver resection.
  • To analyze patient demographics, operative parameters, and outcomes associated with TVE.

Main Methods:

  • A retrospective review of 61 liver resection procedures using TVE between 1990 and 1997.
  • Analysis of patient data including age, gender, diagnosis, operative time, clamp time, transfusion requirements, postoperative labs, length of stay, mortality, and morbidity.

Related Experiment Videos

  • Exclusion of patients with cirrhosis from the study cohort.

    • Main Results:

    • TVE was hemodynamically stable in all patients, including those over 70 years old.
    • Mean operative time was 330 minutes, and mean clamp time was 39 minutes, with 68% of procedures having clamp times under 45 minutes.
    • The perioperative mortality rate was 1.6% (1 death), and the morbidity rate was 36%, with liver dysfunction linked to clamp times exceeding 60 minutes, especially with abnormal or small liver remnants.

    Conclusions:

    • Total vascular exclusion (TVE) is a hemodynamically safe procedure for liver resection, suitable for elderly patients.
    • Minimal blood loss and low mortality/morbidity rates are associated with TVE.
    • Optimal clamp times should be kept below 45 minutes to prevent postoperative liver dysfunction, particularly in cases with compromised liver parenchyma.