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Sakamoto K, Iwamoto Y, Ogawa K, Tamura K, Ito C, Iwata M, Sakamoto A, Shine M, Nishi Y, Uraoka M, Nagaoka T, Honjo M, Funamizu N, Takada Y. Impact of the inferior vena cava morphology on fluid dynamics of the hepatic veins. Surg Today 2024; 54:205-209. [PMID: 37516666 DOI: 10.1007/s00595-023-02733-6] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/21/2023] [Accepted: 07/16/2023] [Indexed: 07/31/2023]
Abstract
We reported previously that a large vertical interval between the hepatic segment of the inferior vena cava (IVC) and right atrium (RA), referred to as the IVC-RA gap, was associated with more intraoperative bleeding during hemi-hepatectomy. We conducted a computational fluid dynamics (CFD) study to clarify the impact of fluid dynamics resulting from morphologic variations around the liver. The subjects were 10 patients/donors with a large IVC-RA gap and 10 patients/donors with a small IVC-RA gap. Three-dimensional reconstructions of the IVC and hepatic vessels were created from CT images for the CFD study. Median pressure in the middle hepatic vein was significantly higher in the large-gap group than in the small-gap group (P = 0.008). Differences in hepatic vein pressure caused by morphologic variation in the IVC might be one of the mechanisms of intraoperative bleeding from the hepatic veins.
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Affiliation(s)
- Katsunori Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan.
| | - Yukiharu Iwamoto
- Department of Mechanical Engineering, Ehime University Graduate School of Science and Engineering, 3 Bunkyo-Cho, Matsuyama, Ehime, 790-8577, Japan
| | - Kohei Ogawa
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Kei Tamura
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Chihiro Ito
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Miku Iwata
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Akimasa Sakamoto
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mikiya Shine
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yusuke Nishi
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Mio Uraoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Tomoyuki Nagaoka
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Masahiko Honjo
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Naotake Funamizu
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
| | - Yasutsugu Takada
- Department of Hepato-Biliary-Pancreatic and Breast Surgery, Ehime University Graduate School of Medicine, 454 Kou, Shitsukawa, Toon, Ehime, 791-0295, Japan
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Nanashima A, Hiyoshi M, Imamura N, Hamada T, Tsuchimochi Y, Shimizu I, Ota Y, Furukawa K, Tsuneyoshi I. Measuring intraoperative anesthetic parameters during hepatectomy with inferior vena cava clamping. Langenbecks Arch Surg 2023; 408:455. [PMID: 38049533 DOI: 10.1007/s00423-023-03172-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 11/04/2023] [Indexed: 12/06/2023]
Abstract
PURPOSE Uncontrollable bleeding remained problematic in anatomical hepatectomy exposing hepatic veins. Based on the inferior vena cava (IVC) anatomy, we attempted to analyze the hemodynamic and surgical effects of the combined IVC-partial clamp (PC) accompanied with the Trendelenburg position (TP). METHODS We prospectively assessed 26 consecutive patients who underwent anatomical hepatectomies exposing HV trunks between 2020 and 2023. Patients were divided into three groups: use of IVC-PC (group 1), no use of IVC-PC (group 2), and use of IVC-PC accompanied with TP (group 3). In 10 of 26 patients (38%), hepatic venous pressure was examined using transhepatic catheter insertion. RESULTS IVC-PC was performed in 15 patients (58%). Operating time and procedures did not significantly differ between groups. A direct hemostatic effect on hepatic veins was evaluated in 60% and 70% of patients in groups 1 and 3, respectively. Group 1 showed significantly more unstable vital status and vasopressor use (p < 0.01). Blood or fluid transfusion and urinary output were similar between groups. Group 2 had a significantly lower baseline central venous pressure (CVP), while group 3 showed a significant increase in CVP in TP. CVP under IVC-PC seemed lower than under TP; however, not significantly. Hepatic venous pressure did not significantly differ between groups. Systolic arterial blood pressure significantly decreased via IVC-PC in group 1 and to a similar extent in group 3. Heart rate significantly increased during IVC-PC (p < 0.05). CONCLUSION IVC-PC combined with the TP may be an alternative procedure to control intrahepatic venous bleeding during anatomical hepatectomy exposing hepatic venous trunks.
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Affiliation(s)
- Atsushi Nanashima
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan.
| | - Masahide Hiyoshi
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
| | - Naoya Imamura
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
| | - Takeomi Hamada
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
| | - Yuuki Tsuchimochi
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
| | - Ikko Shimizu
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
| | - Yusuke Ota
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
| | - Koji Furukawa
- Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
| | - Isao Tsuneyoshi
- Department of Anesthesiology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan
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Nanashima A, Hiyoshi M, Imamura N, Yano K, Hamada T, Kitamura E, Kawano F. Liver hanging maneuver is suitable in major hepatectomy for liver malignancies over 5 cm. Turk J Surg 2022; 38:215-220. [PMID: 36846068 PMCID: PMC9948658 DOI: 10.47717/turkjsurg.2022.5731] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2022] [Accepted: 07/31/2022] [Indexed: 12/24/2022]
Abstract
Objectives Hepatic transection through an anterior approach is required to successfully complete anatomical hepatectomy for large liver malignancies. The liver hanging maneuver (LHM) is an alternative procedure for transection on an adequate cut plane and may reduce intraoperative bleeding and transection times. Material and Methods We examined the medical records of 24 patients with large liver malignancies (>5 cm) who had undergone anatomical hepatic resection with LHM (n= 9) or without LHM (n= 15) between 2015 and 2020. Patient demographics, preoperative hepatic function, surgical records, and post-hepatectomy outcomes were retrospectively compared between the LHM and non-LHM groups. Results The prevalence of tumors >10 cm was significantly higher in the LHM group than in the non-LHM group (p <0.05). Furthermore, LHM was significantly performed to right and extended right hepatectomies in the background normal liver (p <0.05). Although transection times did not significantly differ between the two groups, the amount of intraoperative blood loss was slightly lower in the LHM group than in the non-LHM group (1.566 mL vs. 2.017 mL), and blood transfusion was not needed for patients in the LHM group. Post-hepatectomy liver failure and bile leakage were not observed in LHM. However, the length of hospitalization was slightly shorter in the LHM group than in the non-LHM group. Conclusion LHM is useful for transecting an adequately cut plane in hepatectomy for liver tumors over 5 cm-in-size located on the right side and achieves better outcomes.
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Affiliation(s)
- Atsushi Nanashima
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Masahide Hiyoshi
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Naoya Imamura
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Koichi Yano
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Takeomi Hamada
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Eiji Kitamura
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
| | - Fumiya Kawano
- Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
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Junrungsee S, Lapisatepun W, Chotirosniramit A. Reply to the letter "Queries regarding the optimal indication of infrahepatic inferior vena cava clamping, and proposal of examining the hepatic venous pressures or accompanied Trendelenburg position to improve this procedure". JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:e17-e18. [PMID: 34581502 DOI: 10.1002/jhbp.1046] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/27/2021] [Accepted: 08/27/2021] [Indexed: 11/09/2022]
Affiliation(s)
- Sunhawit Junrungsee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Worakitti Lapisatepun
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
| | - Anon Chotirosniramit
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Faculty of Medicine, Chiang Mai University, Chiang Mai, Thailand
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Nanashima A. Queries regarding the optimal indication of infrahepatic inferior vena cava clamping and proposal for examining the hepatic venous pressures or accompanied Trendelenburg position to improve this procedure. JOURNAL OF HEPATO-BILIARY-PANCREATIC SCIENCES 2021; 29:e15-e16. [PMID: 34523253 DOI: 10.1002/jhbp.1042] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/25/2021] [Accepted: 08/27/2021] [Indexed: 11/06/2022]
Affiliation(s)
- Atsushi Nanashima
- Division of Hepato-biliary-pancreas Surgery, Department of Surgery, University of Miyazaki Faculty of Medicine, Miyazaki, Japan
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