title: European survey on the application of vascular clamping in liver surgery.
abstract: BACKGROUND
  This study evaluated the frequency, the indications and techniques of vascular clamping during liver resection and during thermal destruction therapies, as currently used by hepatic surgeons throughout Europe.
  
  
  METHODS
  A web-based questionnaire was distributed among 621 physicians, including all members of the European Hepato-Pancreato-Biliary Association and the European Surgical Association.
  
  
  RESULTS
  The overall response rate was 50%. During liver resection, vascular clamping is never applied by 10%, on indication by 71%, and routinely by 19%. Routine clamping is particularly performed by high-volume and senior surgeons and appears to be associated with longer ischaemia times. Intermittent inflow occlusion is the clamping method of choice for more than 65% of surgeons and total ischaemia times are usually limited to 15-30 min. During thermal ablation, vascular clamping is never used by 57%, on indication by 37%, and routinely by 7%; it is particularly applied for large tumours and for tumours close to large vessels, and ischaemia times are shorter.
  
  
  CONCLUSIONS
  Vascular clamping during liver resection is frequently used; during thermal ablation it is preserved for larger tumours or tumours in the vicinity of large vessels. Complete inflow occlusion is the most frequently used technique, with a distinct preference for intermittent clamping.
authors.affiliation: Department of Surgery, University Medical Center, Utrecht, The Netherlands.
authors.forename: J D W
authors.initials: JD
authors.lastname: van der Bilt
authors.forename: D P
authors.initials: DP
authors.lastname: Livestro
authors.forename: A
authors.initials: A
authors.lastname: Borren
authors.forename: R
authors.initials: R
authors.lastname: van Hillegersberg
authors.forename: I H M
authors.initials: IH
authors.lastname: Borel Rinkes
mesh_terms: D016063:Blood Loss, Surgical / Q000517:prevention & control; D017115:Catheter Ablation; D003250:Constriction; D005060:Europe; D019538:Health Care Surveys; D006498:Hepatectomy / Q000379:methods*; D008113:Liver Neoplasms / Q000601:surgery; D010818:Practice Patterns, Physicians'