Robotic pancreatoduodenectomy for large solid pseudopapillary tumor of the pancreas using precise and systematic vascular control technique

Massive hemorrhage remains an important clinical problem in extracapsular resection of giant liver hemangiomas (GLHs), especially for those involving the proximal hepatic veins and/or inferior vena cava. Between July 2004 and March 2012, 87 patients with a complex GLH scheduled for surgical treatment were included in this study. All patients were underwent vascular preparation (Step 1), advanced hepatic artery clamping (Step 2), and stepwise vascular occlusion (Step 3). Intraoperative blood loss, blood transfusion volume, degree of ischemia–reperfusion injury, and postoperative complications were recorded. No patients required urgent vascular preparation to manage intraoperative bleeding. In total, 87, 64, and 21 patients had portal triad (PT), infra-hepatic inferior vena cava (IVC), and suprahepatic IVC preparation; and 17, 43, and 11 patients had PT, PTand suprahepatic IVC, and all three (PT, infra-, and suprahepatic IVC) occlusions. The PT, infrahepatic IVC, and SIVC occlusion times were 12.1 ± 3.7 minutes, 7.9 ± 2.4 minutes, and 3.2 ± 1.4 minutes, respectively. Mean blood loss was 291.9 ± 124.5 mL, and only four patients received blood transfusions. No patients had life-threatening complications or died (Clavien-Dindo Grade 4, 5). Compared with paralleled studies, this technique has an advantage to decrease the blood loss in less liver ischemia time. For complex GLH resections, the described step-by-step vascular control technique was efficacious and feasible for controlling intraoperative bleeding.

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To clamp or not to clamp?

University of Western Ontario Medical Journal ◽

10.5206/uwomj.v88i2.7217 ◽

2020 ◽

Author(s):

Roderick Clark ◽

Stacy Fan ◽

Roshan Navaratnam ◽

Nahid Punjani ◽

Nicholas Power

Keyword(s):

Blood Loss ◽

Surgical Techniques ◽

Control Technique ◽

Vascular Control ◽

Primary Analysis ◽

Excessive Bleeding ◽

Iliac Arteries ◽

Estimated Blood Loss ◽

Internal Iliac ◽

Internal Iliac Arteries

Introduction: Radical prostatectomy (RP) is the gold-standard surgical treatment for men with clinically localized prostate cancer (PCa). Surgical techniques to minimize intra and post-operative complications are well established, but excessive bleeding during RP continues to be a concern. The objective of our study was to determine whether additional intraoperative temporary occlusion of the internal iliac arteries combined with a penile base tourniquet during open RP improves hemostasis. Methods: We conducted a retrospective chart review of 23 patients who underwent open RP between Jan 2014 to May 2016. Eight patients underwent open RP with additional clamping of the internal iliac arteries using bulldog vascular clamps combined with a penile base penrose drain tourniquet as temporary prostatic arterial and venous control during dorsal venous complex ligation and neurovascular bundle sparing. Our primary outcome was immediate and post-operative day 1 hemoglobin levels. Our main outcome was analyzed using Students t-test with equal variance. Results: We stratified participants by clamping type. Fifteen patients underwent no clamping and 8 patients had the combined temporary clamping. Primary analysis of estimated blood loss showed a reduction in average blood loss among individuals with vascular control technique versus usual technique (516 ml and 754 ml respectively, p= 0.021). There were no obvious intraoperative or postoperative complications noted that could have been attributable to the temporary vascular control techniques. Conclusion: Temporary vascular control with the addition of minor surgical techniques during open RP may improve an objective measure of blood loss immediately after surgery.

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1306: Techniques of Vascular Control and their Effects on Vessel Length

The Journal of Urology ◽

10.1016/s0022-5347(18)38531-8 ◽

2004 ◽

Vol 171 (4S) ◽

pp. 344-344

Author(s):

Jonathan E. Bernie ◽

Chandru P. Sundaram,

Keyword(s):

Vascular Control ◽

Vessel Length

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Reduction of major amputations in the diabetic ischaemic foot: A strategy to "take control" with conservative care as well as revascularisation

VASA ◽

10.1024/0301-1526.30.s58.6 ◽

2001 ◽

Vol 30 (Supplement 58) ◽

pp. 6-14 ◽

Cited By ~ 13

Author(s):

Edmonds ◽

Foster

Keyword(s):

Natural History ◽

Treatment Plan ◽

Staging System ◽

Vascular Control ◽

New Approach ◽

Conservative Care ◽

Arterial Bypass ◽

Therapeutic Footwear ◽

Frequent Problem

The diabetic ischaemic foot has become an increasingly frequent problem over the last decade. However, we report a new approach consisting of a basic classification, a simple staging system of the natural history and a treatment plan for each stage, within a multi-disciplinary framework. This approach of "taking control" consists of two parts: 1. long-term conservative care including debridement of ulcers (to obtain wound control), eradication of sepsis (micribiological control), and provision of therapeutic footwear (mechanical control), and 2. revascularisation by angioplasty and arterial bypass (vascular control). This approach has led to a 50% reduction in the rate of major amputations in patients attending with ischaemic ulceration and absent foot pulses from 1989 to 1999 (from 4.6% to 2.3% per year). Patients who underwent angioplasty increased from 6% to 13%. Arterial bypass similarly increased from 3% to 7% of cases. However, even with an increased rate of revascularisation, 80% of patients responded to conservative care alone. This,we conclude, is an essential part of the management of all patients with ischaemic feet.

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