title: Intraoperative monitoring of stroke volume variation versus central venous pressure in laparoscopic liver surgery: a randomized prospective comparative trial.
abstract: BACKGROUND
  Central venous pressure (CVP) is used as a marker of cardiac preload to control intraoperative blood loss in open hepatectomies, while its reliability in laparoscopy is less certain. The aim of this randomized prospective trial was to evaluate the outcome of laparoscopic resections performed with stroke volume variation (SVV) or CVP monitoring.
  
  
  METHODS
  All candidates for laparoscopic liver resection were assigned randomly to SVV or to CVP groups. Outcome was evaluated included conversion rate, cause of conversion, intraoperative blood loss, need for transfusions, length of surgery and postoperative results.
  
  
  RESULTS
  Ninety consecutive patients were enrolled: both SVV and CVP groups included 45 patients each and were comparable in terms of patient and disease characteristics. A reduced rate of conversion was recorded in the SVV compared to the CVP group (6.7% and 17.8% respectively, p = 0.02). Blood loss was lower in the SVV group (150 mL), compared to the CVP group (300 mL, p = 0.04). Morbidity, mortality, length of stay and functional recovery were comparable. On multivariate analysis, lesion location, extent of hepatectomy and type of cardiac preload monitoring were associated significantly to risk of conversion.
  
  
  CONCLUSIONS
  SVV monitoring in laparoscopic liver surgery improves intraoperative outcome, thus enhancing the benefits of the minimally-invasive approach and fast-track protocols.
authors.affiliation: Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milano, Italy. Electronic address: ratti.francesca@hsr.it.
authors.forename: Francesca
authors.initials: F
authors.lastname: Ratti
authors.affiliation: Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milano, Italy.
authors.forename: Federica
authors.initials: F
authors.lastname: Cipriani
authors.affiliation: Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milano, Italy.
authors.forename: Raffaella
authors.initials: R
authors.lastname: Reineke
authors.affiliation: Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milano, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Catena
authors.affiliation: Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milano, Italy.
authors.forename: Michele
authors.initials: M
authors.lastname: Paganelli
authors.affiliation: Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milano, Italy.
authors.forename: Laura
authors.initials: L
authors.lastname: Comotti
authors.affiliation: Department of Anaesthesiology and Intensive Care, IRCCS San Raffaele Hospital, Milano, Italy.
authors.forename: Luigi
authors.initials: L
authors.lastname: Beretta
authors.affiliation: Division of Hepatobiliary Surgery, IRCCS San Raffaele Hospital, Milano, Italy.
authors.forename: Luca
authors.initials: L
authors.lastname: Aldrighetti
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control; D001803:Blood Transfusion; D002496:Central Venous Pressure; D016009:Chi-Square Distribution; D061887:Conversion to Open Surgery; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007558:Italy; D010535:Laparoscopy / Q000009:adverse effects; D008297:Male; D008875:Middle Aged; D016343:Monitoring, Intraoperative / Q000379:methods*; D015999:Multivariate Analysis; D061646:Operative Time; D011183:Postoperative Complications / Q000209:etiology; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D015203:Reproducibility of Results; D012307:Risk Factors; D013318:Stroke Volume; D013997:Time Factors; D016896:Treatment Outcome