Experience in normothermic and hypothermic total hepatic vascular exclusion for liver surgery

This paper reports the technique of using total hepatic vascular isolation under normothermic or hypothermic perfusion for bloodless hepatic resection, to deal with large liver tumour or severe liver trauma involving the liver hilum, the main hepatic veins and the retrohepatic vena cava. The original Heaney's and Fortner's methods were modified so that the techniques would be simpler and more practicable to perform than the otherwise hazardous liver resections. Over a four year period, major hepatic surgeries were successfully performed on 21 occasions, with normothermic or hypothermic total vascular exclusion techniques, in our department, for patients with malignant or benign liver tumour or trauma. Of the 21 cases, 18 used the normothermic selective total vascular exclusion (five cases of extended right lobectomy; three cases of extended left lobectomy; five cases of right lobectomy; three cases of central segmentectomy; and two cases of repair of the ruptures of the hepatic veins and the retrohepatic vena cava); and three cases with total vascular isolation on the in situ cold perfused liver (one case of trisegmentectomy; one case of right trisegmentectomy; and one case of extended left lobectomy). We believe that the technique of normothermic vascular exclusion may be indicated to deal with lesions close to the hepatic veins and the retrohepatic vena cava. However, for more complicated hepatic surgery, hypothermic perfusion technique should be considered to prolong the safe ischemic time of the liver. Preliminary experience in the clinical application of this technique is reported.