title: Intraoperative circulatory management using the FloTrac™ system in laparoscopic liver resection.
abstract: BACKGROUND
  Several studies have shown that maintenance of the central venous pressure at a low level during liver surgery is effective for intraoperative management. However, others have suggested that stroke volume variation (SVV) may be a better predictor of fluid responsiveness than central venous pressure. The purpose of this study is to conduct a new type of circulatory management using the FloTrac(TM) system in laparoscopic liver resection and to evaluate specific fluctuations in SVV.
  
  
  METHODS
  Of the laparoscopic liver resections that we performed between March 2012 and December 2013, we used the FloTrac system for intraoperative circulatory management in 21 cases. We analyzed the data, mainly the average value of SVV.
  
  
  RESULTS
  The average SVV value during liver transection was 5.2%-24.6% (mean, 17.0%), and 18 cases (86%) exceeded the conventional cut-off value (13%). The average SVV value was 4.3%-18.2% (mean, 9.7%) when pneumoperitoneum was not in effect, whereas it was 7.3% greater on average during liver transection (mean, 17.0%). No perioperative complications developed.
  
  
  CONCLUSIONS
  The average SVV value during laparoscopic liver transection (mean, 17.0%) exceeded the conventional cut-off value, but in this study, no perioperative complications developed, which enabled safe management. We might be able to manage appropriate fluid control using FloTrac system in patients with laparoscopic liver resection. Therefore, it is necessary to set the target SVV and conduct prospective trials to verify the safety margin for intraoperative management in the future.
authors.affiliation: Division of Hepatobiliary and Pancreatic Surgery, National Cancer Center Hospital East, Chiba, Japan; Juntendo University Graduate School of Medicine, Tokyo, Japan.
authors.forename: Kazuhiko
authors.initials: K
authors.lastname: Kitaguchi
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Hiroyuki
authors.initials: H
authors.lastname: Yamamoto
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Ryuichi
authors.initials: R
authors.lastname: Hayashi
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006498:Hepatectomy / Q000379:methods; D006801:Humans; D010535:Laparoscopy; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000295:instrumentation* / Q000379:methods; D017063:Outcome Assessment, Health Care; D013318:Stroke Volume; D014882:Water-Electrolyte Balance
keywords: Central venous pressure; laparoscopic liver resection; stroke volume variation