title: Simplified technique for 75% and 90% hepatic resection with hemodynamic monitoring in a large white swine model.
abstract: Accurate measuring of the hepatic hemodynamic parameters in humans is inconvenient. Swine has been a favorite surgical model for the study of liver conditions due to many similarities with human livers. However, pigs cannot tolerate pedicle clamping and to reduce bleeding during resection a simplified technique is required. The aim of this study is to present a simplified technique for different percentages of hepatic resection in a porcine model.
  
  
  
  Twenty-two consecutive large white pigs were operated with 75% and 90% liver resection. Computarized tomography liver volumetry is performed before and after surgery. In both types of surgery, hemodynamic monitoring was performed using a specialized apparatus.
  
  
  
  Resections were performed in both groups successfully. The residual volume in the planned 75% was 235 ± 77 mL and 118 ± 119 mL in the planned 90% resection. For 75% resection, the portal flow was reduced after resection by 8.13 ± 28%, which might be part of systemic circulatory depression. However, the portal pressure increased by 20.1 ± 51%. The hepatic artery flow decreased by 63.86 ± 26.3% as well as the pressure by 5 ± 28%. The central venous pressure at the start of surgery was 3.34 ± 1.9 mm Hg and 2.8 ± 2.2 mm Hg at the end of surgery. The portacaval pressure gradient was 4.4 ± 2.9 mm Hg at the beginning of surgery and was 5.9 ± 2.8 mm Hg at the end of surgery. For 90% resection, the portal flow decreased by 33.6 ± 12.6% and the pressure increased by 104 ± 58%. The hepatic artery flow decreased by 88 ± 7%, and the pressure decreased by 5 ± 14.8%. The central venous pressure was 3.5 ± 1.7 mm Hg before resection and 3 ± 2.5 mm Hg after resection. The portacaval pressure gradient was 3.8 ± 1.1 mm Hg before resection and 8 ± 3.7 mm Hg after resection. The mean anesthesia time was 6.6 ± 1.05 h and 6.9 ± 0.5 h for 75% and 90% resection, respectively. The mean operative time was 4.6 ± 0.9 h and 5 ± 0.7 h for 75% and 90% resections, respectively. The mean time for hepatectomy was 1.23 ± 0.76 h and 2.4 ± 0.1 h for 75% and 90% resection, respectively. The mean time consumed in the measurements was 2.28 ± 1.4 h and 1.1 ± 0.3 h for 75% and 90% resections, respectively. The mean volume of aspirated fluid and blood in the 75% resection was 1062 ± 512 mL, while it was 1050 ± 354 mL in 90% resections.
  
  
  
  The hereby described technique is simple and easily applicable for major liver resection in a porcine model. Portal flow decreases after 90% resection more than in 75% due to the relative reduction of remnant hepatic mass. There was a larger increase in portal pressure following 90% compared to 75% resection. The hepatic artery flow decreases more in 90% than in 75% resections.
authors.affiliation: Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; Inserm Unité 1193, Villejuif, France.
authors.forename: Petru
authors.initials: P
authors.lastname: Bucur
authors.affiliation: Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; Inserm Unité 1193, Villejuif, France.
authors.forename: Mohamed
authors.initials: M
authors.lastname: Bekheit
authors.affiliation: Inria, Paris, France; Laboratoire Jacques-Louis Lions, UPMC Univ. of Paris 6, Sorbonne University, Paris, France.
authors.forename: Chloe
authors.initials: C
authors.lastname: Audebert
authors.affiliation: Inria, Paris, France; Laboratoire Jacques-Louis Lions, UPMC Univ. of Paris 6, Sorbonne University, Paris, France.
authors.forename: Irene
authors.initials: I
authors.lastname: Vignon-Clementel
authors.affiliation: Centre Hépato-Biliaire, Hôpital Paul Brousse, AP-HP, Villejuif, France; Inserm Unité 1193, Villejuif, France. Electronic address: eric.vibert@pbr.aphp.fr.
authors.forename: Eric
authors.initials: E
authors.lastname: Vibert
mesh_terms: D000818:Animals; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D008102:Liver Circulation; D008991:Monitoring, Physiologic; D061646:Operative Time; D013552:Swine
keywords: Hemodynamic monitoring; Liver resection; Major; Pigs; Technique