European Survey on the Application of Vascular Clamping in Liver Surgery

Abstract

Background: This study evaluated the frequency, the indications and techniques of vascular clamping during liver resection and during thermal destruction therapies, as currently used by hepatic surgeons throughout Europe. Methods: A web-based questionnaire was distributed among 621 physicians, including all members of the European Hepato-Pancreato-Biliary Association and the European Surgical Association. Results: The overall response rate was 50%. During liver resection, vascular clamping is never applied by 10%, on indication by 71%, and routinely by 19%. Routine clamping is particularly performed by high-volume and senior surgeons and appears to be associated with longer ischaemia times. Intermittent inflow occlusion is the clamping method of choice for more than 65% of surgeons and total ischaemia times are usually limited to 15–30 min. During thermal ablation, vascular clamping is never used by 57%, on indication by 37%, and routinely by 7%; it is particularly applied for large tumours and for tumours close to large vessels, and ischaemia times are shorter. Conclusions: Vascular clamping during liver resection is frequently used; during thermal ablation it is preserved for larger tumours or tumours in the vicinity of large vessels. Complete inflow occlusion is the most frequently used technique, with a distinct preference for intermittent clamping.

Bleeding in Liver Surgery: Prevention and Treatment

“…Selective vascular occlusion techniques have an important role in controlling blood loss in this stage of the operation, as was recently discussed elsewhere. [17][18][19][20] Van der Belt and colleagues 20 studied the application of vascular occlusion methods by sending a questionnaire to 621 surgeons in Europe. Although the overall response rate was low (50%), this study provided good insight into current practice.…”

“…22 Nevertheless, it is the most frequently applied method of vascular occlusion in Europe. 20 In addition to vascular inflow occlusion techniques, several new methods and devices for transsection of the liver parenchyma have been developed (see Box 1). The Cavitron Ultrasonic Surgical Aspirator (CUSA) is the most frequently used device, followed by precoagulation devices.…”

“…The Cavitron Ultrasonic Surgical Aspirator (CUSA) is the most frequently used device, followed by precoagulation devices. 20,21 Although most of these devices may contribute to a reduction of blood loss during the transsection phase, some of them perform slowly and some groups have reported disappointing results. 22,23 In a prospective randomized clinical trial, Lesurtel and colleagues 24 compared four techniques of liver transsection in 100 noncirrhotic patients undergoing major liver resections.…”

Protective effects of quercetin on hepatic ischemia reperfusion injury

“…To avoid this problem, several vascular occlusion techniques have been used. In a retrospective study by Nakajima Y et al (11), they investigated surgical techniques used to control bleeding in liver resection; and van der Bilt et al (12) investigated vascular clamp techniques in liver surgery. The frequency of vascular occlusion techniques were shown in these studies.…”

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“…Но наиболее простым, доступным и эффективным мето-дом профилактики массивного кровотечения является временное выключение печени из кровообращения путем пережатия печеночно-двенадцатиперстной связки (ПДС), известное как маневр Прингла. Этот прием рутинно используют в среднем около 19% хирургов, по показаниям -71%, не используют в 10% случаев соответственно [3]. Техника сосудистой изоляции в различных ее вариантах обеспечи-вает возможность агрессивного и безопасного подхода к большинству очаговых образований печени, однако неизбежно приводит к ише-мическому и реперфузионному повреждению сохраняющейся паренхимы c потенциальным развитием печеночной недостаточности [4,5].…”