Skip to main content

Advertisement

SpringerLink
Log in

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

  • Published:
Surgical Endoscopy Aims and scope Submit manuscript

Abstract

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.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Xiao L, Li JW, Zheng SG (2016) Laparoscopic anatomical segmentectomy of liver segments VII and VIII with the hepatic veins exposed from the head side (with videos). J Surg Oncol 114:752–756

    Article  Google Scholar 

  2. Yu DC, Wu XY, Sun XT, Ding YT (2018) Glissonian approach combined with major hepatic vein first for laparoscopic anatomic hepatectomy. Hepatobiliary Pancreat Dis Int 17:316–322

    Article  Google Scholar 

  3. Xiang S, Zhang YX, Chai SS, Zhang WG (2019) Laparoscopic anatomic spiegel lobectomy with the extrahepatic glissonean approach. Surg Laparosc Endosc Percutaneous Tech 29:e57–e59

    Article  Google Scholar 

  4. Nakajima Y, Shimamura T, Kamiyama T, Matsushita M, Sato N, Todo S (2002) Control of intraoperative bleeding during liver resection: analysis of a questionnaire sent to 231 Japanese hospitals. Surg Today 32:48–52

    Article  Google Scholar 

  5. Zhu P, Lau WY, Chen YF, Zhang BX, Huang ZY, Zhang ZW, Zhang W, Dou L, Chen XP (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  Google Scholar 

  6. Wang WD, Liang LJ, Huang XQ, Yin XY (2006) Low central venous pressure reduces blood loss in hepatectomy. World J Gastroenterol 12:935–939

    Article  Google Scholar 

  7. Lin CX, Guo Y, Lau WY, Zhang GY, Huang YT, He WZ, Lai EC (2013) Optimal central venous pressure during partial hepatectomy for hepatocellular carcinoma. Hepatobiliary Pancreat Dis Int 12:520–524

    Article  Google Scholar 

  8. Fujita Y, Takeuchi A, Sugiura T, Hattori T, Sasano N, Mizuochi Y, Sobue K (2009) Before-after study of a restricted fluid infusion strategy for management of donor hepatectomy for living-donor liver transplantation. J Anesth 23:67–74

    Article  Google Scholar 

  9. Ryu HG, Nahm FS, Sohn HM, Jeong EJ, Jung CW (2010) Low central venous pressure with milrinone during living donor hepatectomy. Am J Transplant 10:877–882

    Article  Google Scholar 

  10. Rahbari NN, Koch M, Zimmermann JB, Elbers H, Bruckner T, Contin P, Reissfelder C, Schmidt T, Weigand MA, Martin E, Buchler MW, Weitz J (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  Google Scholar 

  11. Sear JW (2005) Kidney dysfunction in the postoperative period. Br J Anaesth 95:20–32

    Article  CAS  Google Scholar 

  12. Zhou YM, Sui CJ, Zhang XF, Li B, Yang JM (2016) Anterior approach combined with infrahepatic inferior vena cava clamping right hepatic resection for large hepatocellular carcinoma: a prospective randomized controlled trial. Medicine 95:e4159

    Article  Google Scholar 

  13. Ueno M, Kawai M, Hayami S, Hirono S, Okada KI, Uchiyama K, Yamaue H (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  Google Scholar 

  14. Kato M, Kubota K, Kita J, Shimoda M, Rokkaku K, Sawada T (2008) Effect of infra-hepatic inferior vena cava clamping on bleeding during hepatic dissection: a prospective, randomized, controlled study. World J Surg 32:1082–1087

    Article  Google Scholar 

  15. Chen XP, Zhang ZW, Zhang BX, Chen YF, Huang ZY, Zhang WG, He SQ, Qiu FZ (2006) Modified technique of hepatic vascular exclusion: effect on blood loss during complex mesohepatectomy in hepatocellular carcinoma patients with cirrhosis. Langenbeck’s Arch Surg 391:209–215

    Article  Google Scholar 

  16. Fancellu A, Petrucciani N, Melis M, Porcu A, Feo CF, Zorcolo L, Nigri G (2018) Usefulness of infra-hepatic inferior vena cava clamping during liver resection: a meta-analysis of randomized controlled trials. J Gastrointest Surg 22:941–951

    Article  Google Scholar 

  17. Dindo D, Demartines N, Clavien PA (2004) Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg 240:205–213

    Article  Google Scholar 

  18. Cheek SM, Sucandy I, Tsung A, Marsh JW, Geller DA (2016) Evidence supporting laparoscopic major hepatectomy. J Hepatobiliary Pancreat Sci 23:257–259

    Article  Google Scholar 

  19. Huanwei C, Feiwen D (2016) Pure laparoscopic right hemihepatectomy via anterior approach. Surg Endosc 30:5621

    Article  Google Scholar 

  20. Smyrniotis V, Kostopanagiotou G, Theodoraki K, Tsantoulas D, Contis JC (2004) The role of central venous pressure and type of vascular control in blood loss during major liver resections. Am J Surg 187:398–402

    Article  Google Scholar 

  21. Zhou Y, Zhang Z, Wan T (2018) Effect of infrahepatic inferior vena cava clamping on bleeding during hepatic resection: a meta-analysis. Asian J Surg 41:523–529

    Article  Google Scholar 

  22. Otsubo T, Takasaki K, Yamamoto M, Katsuragawa H, Katagiri S, Yoshitoshi K, Hamano M, Ariizumi S, Kotera Y (2004) Bleeding during hepatectomy can be reduced by clamping the inferior vena cava below the liver. Surgery 135:67–73

    Article  Google Scholar 

  23. Zhang W, Wang J, Li C, Zhang Z, Dirie NI, Dong H, Xiang S, Zhang W, Zhang Z, Zhang B, Chen X (2017) Infrahepatic inferior vena cava clamping with Pringle maneuvers for laparoscopic extracapsular enucleation of giant liver hemangiomas. Surg Endosc 31:3628–3636

    Article  Google Scholar 

  24. Eyraud D, Richard O, Borie DC, Schaup B, Carayon A, Vezinet C, Movschin M, Vaillant JC, Coriat P, Hannoun L (2002) Hemodynamic and hormonal responses to the sudden interruption of caval flow: insights from a prospective study of hepatic vascular exclusion during major liver resections. Anesth Analg 95:1173–1178

    Article  CAS  Google Scholar 

  25. Imamura T, Yamamoto Y, Sugiura T, Okamura Y, Ito T, Ashida R, Ohgi K, Uesaka K (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  Google Scholar 

Download references

Funding

This study was supported by the Medical Research Project of Chongqing Municipal Health and Family Planning Commission (2017MSXM050) and Chongqing Yuzhong District Science and Technology Commission (20160130).

Author information

Authors and Affiliations

  1. Department of Hepatobiliary Surgery, Institute of Hepatopancreatobiliary Surgery, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013, China

    Lin-Kang Xiao, Kun Wu, Ji-Feng Xiang, Xiang Fu, Ming-You Zheng, Xiao-Xue Song & Wei Xie

  2. Department of Anesthesia, Chongqing General Hospital, University of Chinese Academy of Sciences, Chongqing, 400013, People’s Republic of China

    Pan Huang

Authors
  1. Lin-Kang Xiao
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Pan Huang
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Kun Wu
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Ji-Feng Xiang
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Xiang Fu
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ming-You Zheng
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Xiao-Xue Song
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Wei Xie
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Wei Xie.

Ethics declarations

Disclosure

Drs. Xiao, Huang, Wu, Xiang, Fu, Zheng, Song and Xie have no conflicts of interest or financial ties to disclose in relation to this manuscript.

Additional information

Publisher's Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Xiao, LK., Huang, P., Wu, K. et al. Effect of infrahepatic inferior vena cava partial clamping on central venous pressure and intraoperative blood loss during laparoscopic hepatectomy. Surg Endosc 35, 2773–2780 (2021). https://doi.org/10.1007/s00464-020-07709-y

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00464-020-07709-y

Keywords

Search

Navigation