Application of controlled low central venous pressure during hepatectomy: A systematic review and meta-analysis

Indocyanine green fluorescence-guided laparoscopic hepatectomy versus conventional laparoscopic hepatectomy for hepatocellular carcinoma: A single-center propensity score matching study

“…Intraoperative blocking of the hepatic hilum can reduce intraoperative bleeding and clarify the operative field ( 29 , 30 ). Other laparoscopic techniques, including appropriate pneumoperitoneum pressure and low central venous pressure, can also reduce intraoperative bleeding ( 31 , 32 ).…”

Advances in the surgical treatment of liver cancer

“…Multiple RCTs have indicated that keeping the central venous pressure low during parenchymal dissection can reduce bleeding. Liu et al (13) analyzed 18 RCTs involving 1,285 patients. That systematic review noted a 312-mL reduction in blood loss, a 59% reduction in patients requiring blood transfusions, and a significantly lower alanine transaminase level in the first 5 days after surgery in the low central venous pressure group than in the control group.…”

Observational studies: a perpetual quest for a signal among the noise

“…En outre, la quantification pre ´cise de la perte de sang lors d'une chirurgie majeure demeure difficile a `re ´aliser et repre ´sente un re ´sultat de substitution. Enfin, l'utilisation de la PVC comme marqueur de l'e ´tat vole ´mique a e ´te ´abondamment remise en question [17][18][19] bien que, pour des raisons touchant a `la congestion splanchnique et du greffon, elle demeure populaire en chirurgie he ´patique et en transplantation he ´patique. 19,20 Les me ´thodes utilise ´es pour obtenir une re ´duction de la PVC varient e ´galement d'une institution a l'autre et comprennent non seulement la phle ´botomie, mais e ´galement l'administration de ve ´nodilatateurs, le clampage infe ´rieur de la veine cave, les blocs neuromusculaires, un positionnement de Trendelenburg inverse ´, la restriction hydrique ou une combinaison de ces techniques.…”

“…In addition, accurate quantification of blood loss during major surgery has been elusive and represents a surrogate outcome. Finally, using CVP as a marker of volume status has been widely questioned, [17][18][19] although it remains popular in liver surgery and liver transplantation for reasons regarding splanchnic and graft congestion. 19,20 Methods to achieve CVP reduction also vary between institutions and include the use of not only phlebotomy but also venodilator administration, inferior vena cava clamping, neuromuscular blockade, reverse Trendelenburg positioning, fluid restriction, or a combination of these techniques.…”