Liver Resection and Total Vascular Exclusion

  • Andrea LauterioEmail author
  • Riccardo De Carlis
  • Stefano Di Sandro
  • Luciano De Carlis
Part of the Updates in Surgery book series (UPDATESSURG)


Despite the evolution of the surgical technique, minimizing blood loss during parenchymal transection still remains the major challenge of complex and extended hepatectomies. Total vascular exclusion (TVE) successfully applied in hepatic dissection during liver transplantation is now an accepted and commonly used technique in conventional liver surgery. A better understanding of the concepts related to liver transplantation such as ischemia-reperfusion injury and cold preservation of the liver graft has led to the development of technical improvements such as the combination of hypothermic liver perfusion and standard vascular exclusion. This chapter reviews the surgical and clinical advances in liver surgery using TVE, focusing on the technical progress that will allow further extension and application of these complex surgical procedures.


Liver transplantation Total vascular exclusion Liver resection Hypothermic perfusion In situ Ante situm 

Supplementary material

Video 3.1

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  1. 1.
    Heaney JP, Stanton WK, Halbert DS, et al. An improved technic for vascular isolation of the liver: experimental study and case reports. Ann Surg. 1966;163:237–41.CrossRefGoogle Scholar
  2. 2.
    Foster JH, Berman MM. Solid liver tumors. Major Probl Clin Surg. 1977;22:1–342.PubMedGoogle Scholar
  3. 3.
    Huguet C, Nordlinger B, Galopin JJ, et al. Normothermic hepatic vascular exclusion for extensive hepatectomy. Surg Gynecol Obstet. 1978;147:689–93.PubMedGoogle Scholar
  4. 4.
    Bismuth H, Castaing D, Garden OJ. Major hepatic resection under total vascular exclusion. Ann Surg. 1989;210:13–9.CrossRefGoogle Scholar
  5. 5.
    Huguet C, Vacher B, Delva E, et al. Hepatectomy for tumor under vascular exclusion. Development of the ideas in the last decade. Apropos of experience with 41 cases. Chirurgie. 1983;109:146–51. [Article in French]PubMedGoogle Scholar
  6. 6.
    Huguet C, Addario-Chieco P, Gavelli A, et al. Technique of hepatic vascular exclusion for extensive liver resection. Am J Surg. 1992;163:602–5.CrossRefGoogle Scholar
  7. 7.
    Azoulay D, Eshkenazy R, Andreani P, et al. In situ hypothermic perfusion of the liver versus standard total vascular exclusion for complex liver resection. Ann Surg. 2005;241:277–85.CrossRefGoogle Scholar
  8. 8.
    Shaw BW, Martin DJ, Marquez JM, et al. Venous bypass in clinical liver transplantation. Ann Surg. 1984;200:524–34.CrossRefGoogle Scholar
  9. 9.
    Azoulay D, Lim C, Salloum C, et al. Complex liver resection using standard total vascular exclusion, venovenous bypass, and in situ hypothermic portal perfusion. Ann Surg. 2015;262:93–104.CrossRefGoogle Scholar
  10. 10.
    Emond JC, Kelley SD, Heffron TG, et al. Surgical and anesthetic management of patients undergoing major hepatectomy using total vascular exclusion. Liver Transpl Surg. 1996;2:91–8.CrossRefGoogle Scholar
  11. 11.
    Habib N, Zografos G, Dalla Serra G, et al. Liver resection with total vascular exclusion for malignant tumours. Br J Surg. 1994;81:1181–4.CrossRefGoogle Scholar
  12. 12.
    Fortner JG, Shiu MH, Kinne DW, et al. Major hepatic resection using vascular isolation and hypothermic perfusion. Ann Surg. 1974;180:644–52.CrossRefGoogle Scholar
  13. 13.
    Elias D, Lasser P, Debaene B, et al. Intermittent vascular exclusion of the liver (without vena cava clamping) during major hepatectomy. Br J Surg. 1995;82:1535–9.CrossRefGoogle Scholar
  14. 14.
    Cherqui D, Malassagne B, Colau PI, et al. Hepatic vascular exclusion with preservation of the caval flow for liver resections. Ann Surg. 1999;230:24–30.CrossRefGoogle Scholar
  15. 15.
    Sommacale D, Rhaiem R, Piardi T, et al. Liver resection using total vascular exclusion of the liver preserving the caval flow, in situ hypothermic portal perfusion and temporary porta-caval shunt: a new technique for central tumors. Hepatobiliary Surg Nutr. 2017;6:207–9.CrossRefGoogle Scholar
  16. 16.
    Pichlmayr R, Weimann A, Oldhafer KJ, et al. Role of liver transplantation in the treatment of unresectable liver cancer. World J Surg. 1995;19:807–13.CrossRefGoogle Scholar
  17. 17.
    Yamamoto Y. Ante-situm hepatic resection for tumors involving the confluence of hepatic veins and IVC. J Hepatobiliary Pancreat Sci. 2013;20:313–23.CrossRefGoogle Scholar
  18. 18.
    de Santibañes E, Cristiano A, de Santibañes M, et al. Ante-situm resection: a novel approach to avoid extracorporeal circulation using a transient portacaval shunt. HPB (Oxford). 2015;17:94–6.CrossRefGoogle Scholar

Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  • Andrea Lauterio
    • 1
    Email author
  • Riccardo De Carlis
    • 1
    • 2
  • Stefano Di Sandro
    • 1
  • Luciano De Carlis
    • 1
    • 3
  1. 1.Department of General Surgery and TransplantationNiguarda HospitalMilanItaly
  2. 2.Department of Surgical SciencesUniversity of PaviaPaviaItaly
  3. 3.School of Medicine and SurgeryUniversity of Milano-BicoccaMilanItaly

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