Before-after study of a restricted fluid infusion strategy for management of donor hepatectomy for living-donor liver transplantation

Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy

BACKGROUND

Infrahepatic inferior vena cava (IVC) clamping is considered to be an effective method to reduce central venous pressure (CVP) and intraoperative bleeding in liver resection. However, its efficacy and safety during laparoscopic hepatectomy (LH) remain unclear. We perform this retrospective study to evaluate its efficacy and safety during LH.

METHODS

Consecutive patients scheduled for LH from September 2014 to August 2019 were retrospectively reviewed. The intraoperative parameters and postoperative outcomes were analyzed.

RESULTS

All patients in the infrahepatic IVC clamping group were able to tolerate partial clamping of IVC. The CVP was significantly decreased after infrahepatic IVC clamping without hemodynamic instability (8.7 ± 1.4 cmH₂O vs. 2.1 ± 1.3 cmH₂O, P = 0.000). Infrahepatic IVC clamping did not significantly reduce total blood loss (287.3 ± 112.5 mL vs. 301.4 ± 127.6 mL, P = 0.133) and blood loss during parenchymal transection (273.2 ± 107.9 mL vs. 296.5 ± 118.1 mL, P = 0.618) compared with the non-clamping group. In subgroup analysis, total blood loss and blood loss during parenchymal transection were significantly reduced in patients with moderate to severe cirrhosis in the clamping group (363.6 ± 71.2 mL vs. 473.4 ± 95.6 mL, P = 0.021), (358.7 ± 70.9 mL vs. 466.9 ± 94.5 mL, P = 0.016), respectively. The complications and hospital stay were comparable.

CONCLUSIONS

In conclusion, these data suggest that infrahepatic IVC clamping may be safe and effective.

Intraoperative circulatory management using the FloTrac™ system in laparoscopic liver resection

INTRODUCTION

Several studies have shown that maintenance of the central venous pressure at a low level during liver surgery is effective for intraoperative management. However, others have suggested that stroke volume variation (SVV) may be a better predictor of fluid responsiveness than central venous pressure. The purpose of this study is to conduct a new type of circulatory management using the FloTrac(TM) system in laparoscopic liver resection and to evaluate specific fluctuations in SVV.

METHODS

Of the laparoscopic liver resections that we performed between March 2012 and December 2013, we used the FloTrac system for intraoperative circulatory management in 21 cases. We analyzed the data, mainly the average value of SVV.

RESULTS

The average SVV value during liver transection was 5.2%-24.6% (mean, 17.0%), and 18 cases (86%) exceeded the conventional cut-off value (13%). The average SVV value was 4.3%-18.2% (mean, 9.7%) when pneumoperitoneum was not in effect, whereas it was 7.3% greater on average during liver transection (mean, 17.0%). No perioperative complications developed.

CONCLUSION

The average SVV value during laparoscopic liver transection (mean, 17.0%) exceeded the conventional cut-off value, but in this study, no perioperative complications developed, which enabled safe management. We might be able to manage appropriate fluid control using FloTrac system in patients with laparoscopic liver resection. Therefore, it is necessary to set the target SVV and conduct prospective trials to verify the safety margin for intraoperative management in the future.