Feasibility of bloodless liver resection using Lumagel, a reverse thermoplastic polymer, to produce temporary, targeted hepatic blood flow interruption.
BACKGROUND
Lumagel, a reverse thermosensitive polymer (RTP), provides targeted flow interruption to the kidney by reversibly plugging segmental branches of the renal artery, allowing blood-free partial nephrectomy. Extending this technology to the liver requires the development of techniques for temporary occlusion of the hepatic artery and selected portal vein branches.


METHODS
A three-phased, 15 swine study was performed to determine feasibility, techniques and survival implications of using Lumagel for occlusion of inflow vessels to targeted portions of the liver. Lumagel was delivered using angiographic techniques to sites determined by pre-operative 3-D vascular reconstructions of arterial and venous branches. During resection, the targeted liver mass was resected without vascular clamping. Three survival swine were sacrificed at 3 weeks; the remainder at 6 weeks for pathological studies.


RESULTS
Six animals (100%) survived, with normal growth, blood tests and no adverse events. Three left lateral lobe resections encountered no bleeding during resection; one right median resection bled; two control animals bled significantly. Pre-terminal angiography and autopsy showed no local pathology and no remote organ damage.


CONCLUSIONS
Targeted flow interruption to the left lateral lobe of the swine liver is feasible and allows resection without bleeding, toxicity or pathological sequelae. Targeting the remaining liver will require more elaborate plug deposition owing to the extensive collateral venous network.
Department of Transplantation and Hepatobiliary Surgery, Lahey Clinic Medical Center, 41 Mall Road, Burlington, MA 01805, USA. james.j.pomposelli@lahey.org
James J
JJ
Pomposelli
Mohamed
M
Akoad
Sebastian
S
Flacke
James J
JJ
Benn
Mauricio
M
Solano
Aarti
A
Kalra
Peter N
PN
Madras
D015901:Angiography, Digital Subtraction; D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D004621:Embolization, Therapeutic / Q000379:methods*; D005240:Feasibility Studies; D006498:Hepatectomy; D006499:Hepatic Artery / Q000000981:diagnostic imaging; D007472:Iohexol / Q000008:administration & dosage*; D008099:Liver / Q000098:blood supply* / Q000601:surgery*; D008102:Liver Circulation; D023421:Models, Animal; D010690:Phlebography / Q000379:methods; D020442:Poloxamer / Q000008:administration & dosage*; D011169:Portal Vein / Q000000981:diagnostic imaging; D013552:Swine; D013997:Time Factors
C569797:Lumagel; D020442:Poloxamer; D007472:Iohexol