title: A prospective randomized controlled trial to compare two methods of selective hepatic vascular exclusion in partial hepatectomy.
abstract: OBJECTIVE
  Selective hepatic vascular exclusion (SHVE) has not been widely used because of difficulty in extrahepatic isolation of hepatic veins. This study aims to compare the results of SHVE using tourniquets or Satinsky clamps on major hepatic veins in partial hepatectomy for liver tumors involving the roots of hepatic veins.
  
  
  METHODS
  Between June 2008 and March 2012, a randomized controlled trial was performed on patients undergoing liver resection to compare selective hepatic vascular exclusion using tourniquets or Satinsky clamps in partial hepatectomy. In the tourniquet group, the hepatic veins were completely isolated and occluded with tourniquets. In the Satinsky clamp group, the hepatic veins were dissected on the anterior and side walls only and they were clamped directly by Satinsky clamps.
  
  
  RESULTS
  The time for dissecting hepatic veins was significantly shorter in the Satinsky clamp group (7.5 ± 6.6 min vs 21.3 ± 7.4 min) than the tourniquet group. In the tourniquet group, 5 hepatic veins could not be completely isolated and encircled. In 4 additional patients the hepatic vein was slightly torn during dissection. These 9 patients received successful occlusion using Satinsky clamps. In the Satinsky group, all occlusion of the hepatic vein was successful. There was a significant difference in the success rate in hepatic vein occlusion using the Satinsky and the tourniquet groups 60/60 vs 51/60, P = 0.0018.
  
  
  CONCLUSIONS
  Both techniques of hepatic vein occlusion were safe and efficacious. As the use of Satinsky clamps is safer, easier and took less time, it is recommended.
authors.affiliation: Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, China.
authors.forename: Y
authors.initials: Y
authors.lastname: Yang
authors.forename: E C H
authors.initials: EC
authors.lastname: Lai
authors.forename: S Y
authors.initials: SY
authors.lastname: Fu
authors.forename: F M
authors.initials: FM
authors.lastname: Gu
authors.forename: P P
authors.initials: PP
authors.lastname: Li
authors.forename: W Y
authors.initials: WY
authors.lastname: Lau
authors.forename: W P
authors.initials: WP
authors.lastname: Zhou
authors.forename: M C
authors.initials: MC
authors.lastname: Wu
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods*; D006503:Hepatic Veins / Q000473:pathology* / Q000601:surgery*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply* / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D013525:Surgical Instruments / Q000706:statistics & numerical data; D014111:Tourniquets / Q000706:statistics & numerical data; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures / Q000009:adverse effects / Q000295:instrumentation* / Q000379:methods