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Measuring intraoperative anesthetic parameters during hepatectomy with inferior vena cava clamping

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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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Data availability

The data that support the findings of this study are available in public.

References

  1. Moris D, Tsilimigras DI, Kostakis ID et al (2018) Anatomic versus non-anatomic resection for hepatocellular carcinoma: a systematic review and meta-analysis. Eur J Surg Oncol 44:927–938

    Article  PubMed  Google Scholar 

  2. Walcott-Sapp S, Billingsley KG (2018) Preoperative optimization for major hepatic resection. Langenbecks Arch Surg 403:23–35

    Article  PubMed  Google Scholar 

  3. Kokudo N, Takemura N, Ito K, Mihara F (2020) The history of liver surgery: achievements over the past 50 years. Ann Gastroenterol Surg 4:109–117

    Article  PubMed  PubMed Central  Google Scholar 

  4. Nanashima A, Sumida Y, Abo T et al (2008) Principle of perioperative management for hepatic resection and education for young surgeons. Hepatogastroenterol 55:587–591

    Google Scholar 

  5. Rahbari NN, Garden OJ, Padbury R et al (2011) Posthepatectomy liver failure: a definition and grading by the International Study Group of Liver Surgery (ISGLS). Surgery 149:713–724

    Article  PubMed  Google Scholar 

  6. Latchana N, Hirpara DH, Hallet J, Karanicolas PJ (2019) Red blood cell transfusion in liver resection. Langenbecks Arch Surg 404:1–9

    Article  PubMed  Google Scholar 

  7. Houben P, Hinz U, Knebel P, Diener MK, Mehrabi A, Schemmer P (2019) Randomized controlled trial on Pringle Maneuver to reduce blood loss during stapler hepatectomy-PriMal StHep. BMC Surg 19:60

    Article  PubMed  PubMed Central  Google Scholar 

  8. Melendez JA, Arslan V, Fischer ME et al (1998) Perioperative outcomes of major hepatic resections under low central venous pressure anesthesia: blood loss, blood transfusion, and the risk of postoperative renal dysfunction. J Am Coll Surg 187:620–625

    Article  CAS  PubMed  Google Scholar 

  9. Jones RM, Moulton CE, Hardy KJ (1998) Central venous pressure and its effect on blood loss during liver resection. Br J Surg 85:1058–1060

    Article  CAS  PubMed  Google Scholar 

  10. Li Z, Sun YM, Wu FX, Yang LQ, Lu ZJ, Yu WF (2014) Controlled low central venous pressure reduces blood loss and transfusion requirements in hepatectomy. World J Gastroenterol 20(1):303–309

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  11. Hughes MJ, Ventham NT, Harrison EM, Wigmore SJ (2015) Central venous pressure and liver resection: a systematic review and meta-analysis. HPB (Oxford) 17(10):863–871

    Article  PubMed  Google Scholar 

  12. Nanashima A, Tanoue Y, Sakae T et al (2021) Relationship between hepatic venous anatomy and hepatic venous blood loss during hepatectomy. Surg Today 51(12):1953–1968

    Article  PubMed  Google Scholar 

  13. Okuno A, Kimura F, Nakagawa K et al (2010) Effects of partial hepatic venous congestion on hepatic hemodynamics and histology. Hepatogastroenterol 57:127–133

    Google Scholar 

  14. Otsubo T, Takasaki K, Yamamoto M et al (2004) Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery 135(1):67–73

    Article  PubMed  Google Scholar 

  15. Ueno M, Kawai M, Hayami S et al (2017) Partial clamping of the infrahepatic inferior vena cava for blood loss reduction during anatomic liver resection: a prospective, randomized, controlled trial. Surgery 161:1502–1513

    Article  PubMed  Google Scholar 

  16. Rahbari NN, Koch M, Mehrabi A et al (2009) Portal triad clamping versus vascular exclusion for vascular control during hepatic resection: a systematic review and meta-analysis. J Gastrointest Surg 13(3):558–568

    Article  PubMed  Google Scholar 

  17. Xiao LK, Huang P, Wu K et al (2021) Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy. Surg Endosc 35:2773–2780

    Article  CAS  PubMed  Google Scholar 

  18. Imamura T, Yamamoto Y, Sugiura T et al (2019) Infrahepatic inferior vena cava semi-clamping can reduce blood loss during hepatic resection but still requires monitoring to avoid acute kidney injury. World J Surg 43:2038–2047

    Article  PubMed  Google Scholar 

  19. Rahbari NN, Koch M, Zimmermann JB et al (2011) Infrahepatic inferior vena cava clamping for reduction of central venous pressure and blood loss during hepatic resection: a randomized controlled trial. Ann Surg 253:1102–1110

    Article  PubMed  Google Scholar 

  20. Junrungsee S, Suwannikom K, Tiyaprasertkul W et al (2021) Efficacy and safety of infrahepatic inferior vena cava clamping under controlled central venous pressure for reducing blood loss during hepatectomy: a randomized controlled trial. J Hepatobiliary Pancreat Sci 28:604–616

    Article  PubMed  Google Scholar 

  21. Jaffurs W Jr, Spicer SS, Carroll RG, Allison EJ Jr, Whitley TW, Mayo HL (1989) Transcutaneous oxygen tension measurements during hemorrhagic hypoperfusion using Trendelenburg and the pneumatic antishock garment. Resuscitation 17:119–129

    Article  PubMed  Google Scholar 

  22. Nanashima A, Tobinaga S, Abo T, Nonaka T, Sawai T, Nagayasu T (2010) Usefulness of the combination procedure of crash clamping and vessel sealing for hepatic resection. J Surg Oncol 102:179–183

    Article  PubMed  Google Scholar 

  23. Takasaki T, Kobayashi S, Suzuki S et al (1980) Predetermining postoperative hepatic function for hepatectomies. Int Surg 65:309–313

    CAS  PubMed  Google Scholar 

  24. Kubota K, Makuuchi M, Kusaka K et al (1997) Measurement of liver volume and hepatic functional reserve as a guide to decision-making in resection surgery for hepatic tumors. Hepatology 26:1176–1181

    CAS  PubMed  Google Scholar 

  25. Yamaguchi H, Nanashima A, Hatano K et al (1998) Safety of repeated total hepatic inflow occlusion during liver resection. (in Japanese with English title and abstract) Kanzo 39:812–819. https://doi.org/10.2957/kanzo.39.812

    Article  Google Scholar 

  26. Brooke-Smith M, Figueras J, Ullah S, Rees M et al (2015) Prospective evaluation of the International Study Group for Liver Surgery definition of bile leak after a liver resection and the role of routine operative drainage: an international multicentre study. HPB(Oxford) 17:46–51

    PubMed  Google Scholar 

  27. Hughes MJ, Ventham NT, Harrison EM, Wigmore SJ (2015) Central venous pressure and liver resection: a systematic review and meta-analysis. HPB (Oxford) 17:863–871

    Article  PubMed  Google Scholar 

  28. Yoneda G, Katagiri S, Yamamoto M (2015) Reverse Trendelenburg position is a safer technique for lowering central venous pressure without decreasing blood pressure than clamping of the inferior vena cava below the liver. J Hepatobiliary Pancreat Sci 22:463–436

    Article  PubMed  Google Scholar 

  29. Gan EC, Habib AR, Rajwani A, Javer AR (2014) Five-degree, 10-degree, and 20-degree reverse Trendelenburg position during functional endoscopic sinus surgery: a double-blind randomized controlled trial. Int Forum Allergy Rhinol 4:61–68

    Article  PubMed  Google Scholar 

  30. Soonawalla ZF, Stratopoulos C, Stoneham M, Wilkinson D, Britton BJ, Friend PJ (2008) Role of the reverse-Trendelenberg patient position in maintaining low-CVP anaesthesia during liver resections. Langenbecks Arch Surg 393:195–198

    Article  PubMed  Google Scholar 

  31. De Backer D, Vincent JL (2018) Should we measure the central venous pressure to guide fluid management? Ten answers to 10 questions. Crit Care 22:43

    Article  PubMed  PubMed Central  Google Scholar 

  32. Behem CR, Grassler MF, Trepte CJC (2018) Central venous pressure in liver surgery: a primary therapeutic goal or a hemodynamic tessera? Anaesthesist 67:780–789

    Article  CAS  PubMed  Google Scholar 

  33. Lau WY, Lai EC, Lau SH (2010) Methods of vascular control technique during liver resection: a comprehensive review. Hepatobiliary Pancreat Dis Int 9:473–481

    PubMed  Google Scholar 

  34. van Gulik TM, de Graaf W, Dinant S, Busch OR, Gouma DJ (2007) Vascular occlusion techniques during liver resection. Dig Surg 24:274–281

    Article  PubMed  Google Scholar 

  35. Makuuchi M, Yamamoto J, Takayama T et al (1991) Extrahepatic division of the right hepatic vein in hepatectomy. Hepatogastroenterol 38:176–179

    CAS  Google Scholar 

  36. Lakhal K, Ehrmann S, Runge I et al (2010) Central venous pressure measurements improve the accuracy of leg raising-induced change in pulse pressure to predict fluid responsiveness. Intensive Care Med 36:940–948

    Article  PubMed  Google Scholar 

  37. Satterly SA, Salgar S, Hoffer Z et al (2015) Hydrogen sulfide improves resuscitation via non-hibernatory mechanisms in a porcine shock model. J Surg Res 199:197–210

    Article  CAS  PubMed  Google Scholar 

  38. Sakamoto K, Iwamoto Y, Ogawa K et al (2023) Impact of the inferior vena cava morphology on fluid dynamics of the hepatic veins. Surg Today. https://doi.org/10.1007/s00595-023-02733-6

    Article  PubMed  PubMed Central  Google Scholar 

  39. Zhu P, Lau WY, Chen YF et al (2012) Randomized clinical trial comparing infrahepatic inferior vena cava clamping with low central venous pressure in complex liver resections involving the Pringle manoeuvre. Br J Surg 99:781–788

    Article  CAS  PubMed  Google Scholar 

  40. Sakamoto K, Ogawa K, Matsui T et al (2020) Vertical interval between hepatic segment of inferior vena cava and right atrium predicts intraoperative blood loss during hemi-hepatectomy. J Hepatobiliary Pancreat Sci 27:90–100

    Article  PubMed  Google Scholar 

  41. Tranchart H, O’Rourke N, Van Dam R et al (2015) Bleeding control during laparoscopic liver resection: a review of literature. J Hepatobiliary Pancreat Sci 22:371–378

    Article  PubMed  Google Scholar 

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Acknowledgements

The authors would like to thank Elsevier’s editing service for the English language review. Revised sentences were edited by another English editing service, FORTE Science Communications (No. R2304389 October 19th).

Funding

This study was supported by an institutional Grant-in-Aid for Clinical Research from Miyazaki University Hospital in 2022 (without reference number). English was edited by the Elsevier language service.

Author information

Authors and Affiliations

  1. Division of Hepato-Biliary-Pancreas Surgery, Department of Surgery, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan

    Atsushi Nanashima, Masahide Hiyoshi, Naoya Imamura, Takeomi Hamada, Yuuki Tsuchimochi, Ikko Shimizu, Yusuke Ota & Koji Furukawa

  2. Department of Anesthesiology, Faculty of Medicine, University of Miyazaki, Kiyotake, Miyazaki, 5200, Japan

    Isao Tsuneyoshi

Authors
  1. Atsushi Nanashima
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  2. Masahide Hiyoshi
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  3. Naoya Imamura
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  4. Takeomi Hamada
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  5. Yuuki Tsuchimochi
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  6. Ikko Shimizu
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  7. Yusuke Ota
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  8. Koji Furukawa
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  9. Isao Tsuneyoshi
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Contributions

All listed authors attended the prospective study project. Principle writing, study design making, paper writing, and all responsibility of study: AN; measurement, data collection, and patient management: MH, NI, TH, YT, IS, YO; support the circulatory management as a director of cardiovascular surgery: KF; instruction and anesthetic management as a director of anesthesia: IT.

Corresponding author

Correspondence to Atsushi Nanashima.

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Nanashima, A., Hiyoshi, M., Imamura, N. et al. Measuring intraoperative anesthetic parameters during hepatectomy with inferior vena cava clamping. Langenbecks Arch Surg 408, 455 (2023). https://doi.org/10.1007/s00423-023-03172-0

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