title: Intraoperative simulation of remnant liver function during anatomic liver resection with indocyanine green clearance (LiMON) measurements.
abstract: OBJECTIVE
  Post-hepatectomy liver failure (PHLF) is the major cause of death following liver resection. The aim of this study was to evaluate the feasibility of an intraoperative simulation of post-resection liver function.
  
  
  METHODS
  Intraoperative liver function was measured by indocyanine green (ICG) clearance using the LiMON technology. In 20 patients undergoing anatomic liver resection, ICG plasma disappearance rate (PDR (%/min) and ICG retention at 15 min (R15 ) (%) were measured immediately after the induction of anaesthesia (t0 ), after selective arterial and portovenous inflow trial clamping (TC) of the resected liver segments (t1 ), after the completion of resection (t2 ) and before the closure of the abdominal cavity (t3 ).
  
  
  RESULTS
  The median baseline (t0 ) PDR was 16.5%/min. Trial clamping of the inflow (t1 ) resulted in a significant reduction in PDR to 10.5%/min. Results under TC were similar to those obtained after resection (t2 ) (median PDR: 10.5%/min). Linear regression modelling showed that post-resection liver volume could be accurately predicted by TC of liver inflow (P < 0.0001), but not by determining the resected liver volume. Simulated post-resection liver function under TC correlated well with PHLF and length of hospital stay.
  
  
  CONCLUSIONS
  Intraoperative ICG clearance measurements allow real-time monitoring of intraoperative liver function during surgery. Trial clamping of arterial and portovenous inflow accurately predicts immediate post-resection liver function. The intraoperative measurement of liver function and simulation of post-resection liver function may help to avoid PHLF.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Michael N
authors.initials: MN
authors.lastname: Thomas
authors.affiliation: Department of Anaesthesiology, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Ernst
authors.initials: E
authors.lastname: Weninger
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Martin
authors.initials: M
authors.lastname: Angele
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Florian
authors.initials: F
authors.lastname: Bösch
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Sebastian
authors.initials: S
authors.lastname: Pratschke
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Joachim
authors.initials: J
authors.lastname: Andrassy
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Rentsch
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Manfred
authors.initials: M
authors.lastname: Stangl
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of General, Visceral, Transplantation, Vascular and Thoracic Surgery, Ludwig-Maximilian University of Munich, Munich, Germany.
authors.forename: Markus
authors.initials: M
authors.lastname: Guba
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004396:Coloring Agents / Q000008:administration & dosage / Q000493:pharmacokinetics*; D005240:Feasibility Studies; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects; D006801:Humans; D007208:Indocyanine Green / Q000008:administration & dosage / Q000493:pharmacokinetics*; D007902:Length of Stay; D016014:Linear Models; D008099:Liver / Q000098:blood supply / Q000378:metabolism / Q000503:physiopathology / Q000601:surgery*; D008102:Liver Circulation; D017093:Liver Failure / Q000209:etiology / Q000503:physiopathology / Q000517:prevention & control; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000473:pathology / Q000601:surgery*; D008115:Liver Regeneration; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D010865:Pilot Projects; D011237:Predictive Value of Tests; D011446:Prospective Studies; D015203:Reproducibility of Results; D016896:Treatment Outcome; D055815:Young Adult
chemical_list: D004396:Coloring Agents; D007208:Indocyanine Green