Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial

Pan, Yangxun; Wang, Juncheng; Lu, Xin-Jiang; Chen, Jinbin; He, Wei; Chen, Jian-Cong; Wang, Xiaohui; Fu, Yizhen; Xu, Li; Zhang, Yaojun; Chen, Minshan; Lai, Renchun; Zhou, Zhongguo

doi:10.1016/j.surg.2020.02.004

Cited by 18 publications

(22 citation statements)

References 32 publications

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“…A total of 841 patients who underwent hepatectomy in 10 trials [ 8 , 16 – 20 , 28 , 29 , 32 , 34 ] were included in the comparative analysis between low CVP ( n = 420) and control ( n = 421) groups. Among these 10 studies, four [ 17 , 19 , 32 , 34 ] utilised clamping of the intrahepatic inferior vena cava (IVC) to achieve a controlled low CVP, while the remaining studies [ 8 , 16 , 18 , 20 , 28 , 29 ] used other approaches, such as limiting the infusion volume, adopting the Trendelenburg position, and using vasodilators. The CVP was < 5 mmHg in the low CVP group (Ueno et al even limited the CVP to < 3 mmHg) and > 5 mmHg in the control group [ 8 , 16 – 20 , 28 , 29 , 32 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

“…Among these 10 studies, four [ 17 , 19 , 32 , 34 ] utilised clamping of the intrahepatic inferior vena cava (IVC) to achieve a controlled low CVP, while the remaining studies [ 8 , 16 , 18 , 20 , 28 , 29 ] used other approaches, such as limiting the infusion volume, adopting the Trendelenburg position, and using vasodilators. The CVP was < 5 mmHg in the low CVP group (Ueno et al even limited the CVP to < 3 mmHg) and > 5 mmHg in the control group [ 8 , 16 – 20 , 28 , 29 , 32 , 34 ].…”

Section: Resultsmentioning

confidence: 99%

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Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis

et al. 2023

BMC Anesthesiol

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Background Perioperative bleeding and allogeneic blood transfusion are generally thought to affect the outcomes of patients. This meta-analysis aimed to determine the benefits and risks of several cardiovascular interventions in patients undergoing hepatectomy. Methods In this systematic review and meta-analysis, randomised controlled trials (RCTs) were searched in the Cochrane Library, Medline, Embase, and Web of Science to February 02, 2023. RCTs focused on cardiovascular interventions aimed at reducing blood loss or blood transfusion requirements during hepatectomy were included. The primary outcomes were perioperative blood loss amount, number of patients requiring allogeneic blood transfusion and overall occurrence of postoperative complications. The secondary outcomes were operating time, perioperative mortality rate, postoperative liver and kidney function and length of hospital stay. Results Seventeen RCTs were included in the analysis. A total of 841 patients who underwent hepatectomy in 10 trials were included in the comparative analysis between low central venous pressure (CVP) and control groups. The forest plots showed a low operative bleeding volume [(mean difference (MD): -409.75 mL, 95% confidence intervals (CI) -616.56 to -202.94, P < 0.001], reduced blood transfusion rate [risk ratio (RR): 0.47, 95% CI 0.34 to 0.65, P < 0.001], shortened operating time (MD: -13.42 min, 95% CI -22.59 to -4.26, P = 0.004), and fewer postoperative complications (RR: 0.76, 95% CI 0.58 to 0.99, P = 0.04) in the low CVP group than in the control group. Five and two trials compared the following interventions, respectively: ‘acute normovolaemic haemodilution (ANH) vs control’ and ‘autologous blood donation vs control’. ANH and autologous blood donation could not reduce the blood loss amount but greatly decreased the number of patients requiring allogeneic blood transfusion. No benefits were found in the rate of mortality and length of postoperative hospital stay in any of the comparisons. Conclusion Lowering the CVP seems to be effective and safe in adult patients undergoing hepatectomy. ANH and autologous blood donation should be used as a part of blood management for suitable patients in certain circumstances. Trial registration PROSPERO, CRD42022314061.

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Section: Resultsmentioning

confidence: 99%

Section: Resultsmentioning

confidence: 99%

Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis

et al. 2023

BMC Anesthesiol

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“…As minimally invasive surgery is an emerging field in liver surgery, the results of the present study might not be transferable to laparoscopic resections because pneumoperitoneum and patient positioning may result in unreliable CVP values [ 34 , 35 ]. Although a recent randomized trial demonstrated that lowering of CVP values in laparoscopic hepatectomy was associated with lower blood loss, IVC clamping was omitted in this trial and the safety and impact in minimally invasive surgery remains unclear [ 36 ]. Fourth, we did not include studies with the restricted use of, e.g., anterior-approach hepatectomy for large primary liver malignancies.…”

Section: Discussionmentioning

confidence: 99%

Infrahepatic Inferior Vena Cava Clamping does not Increase the Risk of Pulmonary Embolism Following Hepatic Resection

et al. 2021

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Background Infrahepatic inferior vena cava (IVC) clamping reduces central venous pressure. However, controversies remain regarding its impact on postoperative complications, particularly, the incidence of postoperative pulmonary embolism (PE). The aim of the study was to determine the impact of IVC clamping on the incidence of PE in patients undergoing hepatectomy. Methods A pooled analysis of five prospective trials on patients who underwent hepatic resection over a period of 10 years was performed. Patients with infrahepatic IVC clamping were compared to patients without infrahepatic IVC clamping. Outcomes were studied by univariate and multivariate analyses. Results Of 505 included patients, 141 patients had IVC clamping and 364 patients served as control group. The rate of postoperative PE was comparable between groups (3% vs. 3%; P = 0.762), as were postoperative morbidity (P = 0.932), bile leakage (P = 0.272), posthepatectomy hemorrhage (P = 0.095), and posthepatectomy liver failure (P = 0.605), respectively. No clinicopathological and intraoperative risk factors were found to predict the onset of PE. Subgroup analyses of patients with major hepatectomy and vascular resections confirmed no adverse perioperative outcomes to be associated with IVC clamping. Conclusions Infrahepatic IVC clamping does not increase the incidence of postoperative PE.

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“…Other research confirms decreased BL and TR when using terlipressin infusion to maintain low CVP [66]. The reverse Trendelenburg position, used commonly in LLS, also helps to reduce intraoperative BL (Photos 9 and 10) [67]. Pneumoperitoneum, with Photo 8.…”

Section: Anesthesiamentioning

confidence: 91%

Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review.

Serednicki¹,

Hołówko²,

Major³

et al. 2023

Videosurgery and Other Miniinvasive Techniques

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Laparoscopic liver resection has become a standard practice in many surgical wards in elective liver surgery, due to its positive impact on reducing hospital stay and postoperative complications, including lower blood loss and transfusion rate. However, achieving proper hemostasis in liver surgery, due to its vast blood supply, still remains a main concern to surgeons. Therefore, numerous techniques were and are still being developed to further reduce blood loss and transfusion rate. The aim of this literature review was to summarize the best available methods for achieving the minimal blood loss and transfusion rate in laparoscopic liver surgery, according to the newest data.

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Intention to control low central venous pressure reduced blood loss during laparoscopic hepatectomy: A double-blind randomized clinical trial

Cited by 18 publications

References 32 publications

Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis

Application of cardiovascular interventions to decrease blood loss during hepatectomy: a systematic review and meta-analysis

Infrahepatic Inferior Vena Cava Clamping does not Increase the Risk of Pulmonary Embolism Following Hepatic Resection

Minimizing blood loss and transfusion rate in laparoscopic liver surgery: a review.

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