Extrahepatic control of the middle hepatic vein with inflow control by pedicle clamping in major liver surgery.
Surgical techniques commonly used for controlling bleeding during major liver surgery are hepatic inflow occlusion (Pringle maneuver) or total hepatic vascular exclusion (THVE), which are effective procedures of diminishing intraoperative blood loss. However, it is difficult to control retrograde bleeding from the hepatic veins using Pringle maneuver and some patients do not tolerate hemodynamic changes caused by THVE. We isolated the left and middle hepatic veins separately using Arantius' ligament approach to these hepatic veins, and extrahepatic control of the relevant to the liver segment to be resected hepatic veins with inflow control by Glissonian pedicle clamping was successfully performed.
Cho
Akihiro
A
Department of Surgery, Seirei Sakura Citizen Hospital, Japan. acho@chiba-cc.jp
Arita
Seiji
S
Koike
Naoto
N
Isaka
Naohide
N
Kusume
Kenichi
K
Okazumi
Shinichi
S
Ochiai
Takenori
T
D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D006528:Carcinoma, Hepatocellular / Q000098:blood supply / Q000601:surgery*; D006503:Hepatic Veins / Q000601:surgery*; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000097:blood / Q000601:surgery*; D008297:Male; D009378:Neoplasms, Multiple Primary / Q000098:blood supply / Q000601:surgery*; D013525:Surgical Instruments; D016896:Treatment Outcome