The Aim of Technology During Liver Resection — A Strategy to Minimize Blood Loss During Liver Surgery

Objective: The aim of this study is to examine whether intraoperative fluid management with stroke volume variation (SVV) can achieve safe intravenous fluid restriction and contribute to decreasing intraoperative blood loss in liver surgery. Background: In liver surgery, maintaining the central venous pressure (CVP) at a low level is effective in decreasing intraoperative blood loss. Recently, several studies have suggested that SVV obtained using the FloTrac system demonstrated a better fluid responsiveness than CVP. Methods: We enrolled 30 patients undergoing liver resection since May 2015 in this prospective observational study, and we set the SVV target during liver transection at 13%–20% (SVV group). Forty-three cases of liver resection that we performed between January 2014 and March 2015 without using CVP or SVV were used as the Control group. We compared the 2 groups by using intraoperative blood loss as the primary endpoint. Results: There was no significant difference in patient characteristics between the 2 groups. The mean SVV during liver transection in the SVV group was 15.6 ± 4.4%. The infusion volume until completion of liver transection in the Control group was 9.4 mL/kg/h, whereas that of the SVV group was 3.3 mL/kg/h, a significantly lower volume (P < 0.001). The median intraoperative blood loss was significantly decreased in the SVV group compared with the Control group (391 versus 1068 mL; P < 0.001). The intraoperative transfusion rate was also significantly decreased in the SVV group. Conclusion: We demonstrated that intraoperative management with SVV can achieve safe intravenous fluid restriction and is useful for decrease intraoperative blood loss in liver surgery.

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Systematic Review Comparing the Effectiveness of Robotic verse Laparoscopic Liver Surgery in Colorectal Liver Metastasis (CRLM)

Surgeries ◽

10.3390/surgeries2040035 ◽

2021 ◽

Vol 2 (4) ◽

pp. 357-370

Author(s):

Nabeel Merali ◽

Hajra Ashraf ◽

Tarak Chouari ◽

Badriya Al Araimi ◽

Rajiv Lahiri ◽

...

Keyword(s):

Liver Resection ◽

Liver Metastasis ◽

Blood Loss ◽

Colorectal Liver Metastasis ◽

Liver Surgery ◽

Operative Time ◽

Tumour Size ◽

P Value ◽

Estimated Blood Loss ◽

Average Operative Time

Introduction: Colorectal cancer (CRC) is the third most common cancer in the world. The liver is the most common site of metastasis with 15 to 25% of patients presenting with synchronous colorectal liver metastasis (CRLM). This study is aimed at evaluating the long- and short-term outcomes of laparoscopic and robotic CRLM surgery, and directly comparing their respective effectiveness. Methodology: A literature search was performed and all studies that reported on operative characteristics, oncological outcomes for CRLM, morbidity or mortality and cost-effectiveness on robotic or laparoscopic surgery were included. The study design was in keeping with the PRISMA guidelines. Results: From the initial 606 manuscripts identified, 19 studies were included in the final qualitative analysis. A total of 1340 patients with 1194 LLR (Laparoscopic Liver Resection) and 146 RLR (Robotic Liver Resection) cases were analysed. Within the LLR group, the average tumour size excised was 32.1 mm compared to the RLR group of 33.8 mm. The average operative time in the LLR was 193 min, CI of 95% (147.4 min to 238.6 min) compared to RLR 257 min, CI of 95% (201.5 min to 313.8 min) with a p-value < 0.0001. Estimated blood loss was lower in the RLR group (210 mL) compared with the LLR group (246 mL). Conclusion: Despite the higher operative cost, RLRs do not result in statistically better treatment outcomes, with the exception of lower estimated blood loss and excision of larger CRLMs. Operative time and total complication rate are significantly more favourable with LLRs. Our study has shown that robotic liver surgery is safe and feasible in well-selected patients.

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Hepatic resection in children: highlighted and revisited steps

Egyptian Pediatric Association Gazette ◽

10.1186/s43054-019-0008-4 ◽

2019 ◽

Vol 67 (1) ◽

Author(s):

Hesham Mohammed Abdelkader ◽

Mohamed Abdel-Latif ◽

Mohamed Abdelsattar ◽

Ahmed Abdelhaseeb Youssef

Keyword(s):

Blood Loss ◽

Liver Tumors ◽

University Hospital ◽

Remnant Liver ◽

Vascular Control ◽

Biliary Leak ◽

Intraoperative Bleeding ◽

Male Predominance ◽

Different Types ◽

Minimize Blood Loss

Abstract Background Hepatectomy in children deserves exhaustive preoperative and intraoperative tools to define the anatomy, minimize blood loss, and confirm adequacy of liver tissue left. The aim of this study is to report our experience in surgical management of liver tumors. Results All liver resections performed in Ain-Shams University Hospital, by the same team, between July 2013 and June 2018 were retrospectively reviewed. Data related to basic demographics, indication for resection, methods of parenchymal resection, blood loss, hospital stay, morbidity, and mortality was collected. The study included 27 patients who underwent different types of hepatectomies. There was a male predominance. Age ranged from 6 months to 13 years. Weight ranged from 5.7 to 33.7 kg. Total operative time ranged from 68 to 322 min, while resection time ranged from 34 to 144 min. Blood loss ranged from 53 to 259 ml. Surgical morbidities included five patients with minor biliary leak, three patients had surgical site infection, and one patient had torsion of the remnant liver necessitating repositioning. Recurrence of the mass was faced in three patients with hepatoblastoma. There were two mortalities; one occurred as a sequela of massive intraoperative bleeding and the other took place due to postoperative hepatic insufficiency. Conclusion For a safe hepatectomy, thorough familiarity of the hepatic segmental anatomy together with the various techniques for parenchymal resection and vascular control is fundamental. Complications such as biliary leak and torsion of remnant can be easily avoided by simple measures.

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Operative Time, Age, and Serum Albumin Predict Surgical Morbidity After Laparoscopic Liver Surgery

Surgical Innovation ◽

10.1177/1553350621991223 ◽

2021 ◽

pp. 155335062199122

Author(s):

Daniel Heise ◽

Jan Bednarsch ◽

Andreas Kroh ◽

Sandra Schipper ◽

Roman Eickhoff ◽

...

Keyword(s):

Liver Resection ◽

Liver Surgery ◽

Postoperative Morbidity ◽

Operative Time ◽

Multivariable Analysis ◽

Operation Time ◽

Laparoscopic Liver Surgery ◽

Surgical Morbidity ◽

Perioperative Morbidity ◽

Preoperative Albumin

Background. Laparoscopic liver resection (LLR) has emerged as a considerable alternative to conventional liver surgery. However, the increasing complexity of liver resection raises the incidence of postoperative complications. The aim of this study was to identify risk factors for postoperative morbidity in a monocentric cohort of patients undergoing LLR. Methods. All consecutive patients who underwent LLR between 2015 and 2019 at our institution were analyzed for associations between complications with demographics and clinical and operative characteristics by multivariable logistic regression analyses. Results. Our cohort comprised 156 patients who underwent LLR with a mean age of 60.0 ± 14.4 years. General complications and major perioperative morbidity were observed in 19.9% and 9.6% of the patients, respectively. Multivariable analysis identified age>65 years (HR = 2.56; P = .028) and operation time>180 minutes (HR = 4.44; P = .001) as significant predictors of general complications (Clavien ≥1), while albumin<4.3 g/dl (HR = 3.66; P = .033) and also operative time (HR = 23.72; P = .003) were identified as predictors of major postoperative morbidity (Clavien ≥3). Conclusion. Surgical morbidity is based on patient- (age and preoperative albumin) and procedure-related (operative time) characteristics. Careful patient selection is key to improve postoperative outcomes after LLR.

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Pediatric Use of a Novel Thrombectomy System Designed to Minimize Blood Loss

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2021.04.042 ◽

2021 ◽

Author(s):

Rod Shinozaki ◽

David Balzer ◽

Stephen J. Nageotte

Keyword(s):

Blood Loss ◽

Minimize Blood Loss ◽

Pediatric Use

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Restrictive Pulmonary Dysfunction May Increase Blood Loss During Liver Resection

The American Surgeon ◽

10.1177/00031348211060425 ◽

2021 ◽

pp. 000313482110604

Author(s):

Takahiro Yoshikawa ◽

Daisuke Hokuto ◽

Satoshi Yasuda ◽

Naoki Kamitani ◽

Yasuko Matsuo ◽

...

Keyword(s):

Risk Factor ◽

Liver Resection ◽

Blood Loss ◽

Perioperative Outcomes ◽

Complication Rates ◽

Pulmonary Dysfunction ◽

Intraoperative Blood Loss ◽

Control Groups ◽

Anatomical Liver Resection ◽

And Control

Background Restrictive pulmonary dysfunction (RPD) is a risk factor for perioperative complications during gastrointestinal surgery. We hypothesized that high airway pressure due to RPD results in increased intraoperative blood loss during liver surgery. Thus, we investigated the effects of RPD on perioperative outcomes for liver resection. Methods This study included 496 patients who underwent curative liver resection at our hospital between April 2009 and April 2020. Perioperative outcomes for the RPD and control groups were compared. Restrictive pulmonary dysfunction was defined as % vital capacity <80%. Results Forty-one patients (8.3%) had RPD. No significant differences were observed in intraoperative blood losses (440 mL vs 320 mL, P = .340), overall complication rates (29.3% vs 31.2%, P = .797), or pulmonary complication rates (4.9% vs 9.0%, P = .286) between the RPD and control groups. In the 256 patients who underwent anatomical liver resection, 18 patients (7.0%) had RPD. The intraoperative blood loss was significantly higher in the RPD group (925 mL vs 456 mL, P = .013), but no differences in the overall complication rates (44.4% vs 37.3%, P = .528) or pulmonary complication rates (11.1% vs 10.5%, P = .589) between the two groups were detected. A multivariate analysis showed that RPD was an independent risk factor for intraoperative blood loss ≥500 mL during anatomical liver resection (odds ratio 4.132; 95% confidence interval 1.135-15.045; P = .031). Discussion Restrictive pulmonary dysfunction may be a risk factor for intraoperative blood loss during anatomical liver resection, which requires exposure of the main hepatic vein.

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Evolution and trends in the adoption of laparoscopic liver resection in Singapore: Analysis of 300 cases

Annals of the Academy of Medicine, Singapore ◽

10.47102/annals-acadmedsg.2021213 ◽

2021 ◽

Vol 50 (10) ◽

pp. 742-750

Author(s):

Brian K Goh ◽

Zhongkai Wang ◽

Ye-Xin Koh ◽

Kai-Inn Lim

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Abdominal Surgery ◽

Laparoscopic Liver Resection ◽

Conversion Rate ◽

Perioperative Outcomes ◽

Transfusion Rate ◽

Open Conversion ◽

Previous Abdominal Surgery ◽

Surgeon Experience

ABSTRACT Introduction: The introduction of laparoscopic surgery has changed abdominal surgery. We evaluated the evolution and changing trends associated with adoption of laparoscopic liver resection (LLR) and the experience of a surgeon without prior LLR experience. Methods: A retrospective review of 310 patients who underwent LLR performed by a single surgeon from 2011 to 2020 was conducted. Exclusion criteria were patients who underwent laparoscopic liver surgeries such as excision biopsy, local ablation, drainage of abscesses and deroofing of liver cysts. There were 300 cases and the cohort was divided into 5 groups of 60 patients. Results: There were 288 patients who underwent a totally minimally invasive approach, including 28 robotic-assisted procedures. Open conversion occurred for 13 (4.3%) patients; the conversion rate decreased significantly from 10% in the initial period to 3.3% subsequently. There were 83 (27.7%) major resections and 131 (43.7%) resections were performed for tumours in the difficult posterosuperior location. There were 152 (50.7%) patients with previous abdominal surgery, including 52 (17.3%) repeat liver resections for recurrent tumours, and 60 patients had other concomitant operations. According to the Iwate criteria, 135 (44.7%) were graded as high/expert difficulty. Major morbidity (>grade 3a) occurred in 12 (4.0%) patients and there was no 30-day mortality. Comparison across the 5 patient groups demonstrated a significant trend towards older patients, higher American Society of Anesthesiologists (ASA) score, increasing frequency of LLR with previous abdominal surgery, increasing frequency of portal hypertension and huge tumours, decreasing blood loss and decreasing transfusion rate across the study period. Surgeon experience (≤60 cases) and Institut Mutualiste Montsouris (IMM) high grade resections were independent predictors of open conversion. Open conversion was associated with worse perioperative outcomes such as increased blood loss, transfusion rate, morbidity and length of stay. Conclusion: LLR can be safely adopted for resections of all difficulty grades, including major resections and for tumours located in the difficult posterosuperior segments, with a low open conversion rate. Keywords: Laparoscopic hepatectomy, laparoscopic liver resection, robotic hepatectomy, robotic liver resection, Singapore

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Minimal Blood Loss Radio Frequency Assisted Liver Resection Technique

Advances in Experimental Medicine and Biology - Liver and Pancreatic Diseases Management ◽

10.1007/0-387-29512-7_9 ◽

2006 ◽

pp. 75-88 ◽

Cited By ~ 5

Author(s):

Miroslav Milicevic ◽

Predrag Bulajic

Keyword(s):

Liver Resection ◽

Blood Loss ◽

Radio Frequency ◽

Liver Resection Technique

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