The technique of the normothermic and hypothermic total hepatic vascular exclusion for resection of the liver tumors

The technique for bloodless hepatic resection using the total hepatic vascular isolation under the normothermic or hypothermic perfusion was reported to deal with the large liver tumor involving in the liver hilum, the main hepatic veins or the retrohepatic vena cava. The original Heaney's and Fortner's methods were modified so that the technique could be simpler and more practicable to perform otherwise hazardous liver resection. During the past 4 year, major hepatic resection with the normothermic or hypothermic total vascular exclusion technique was successfully performed on 19 patients with liver tumors in our department. Among the 19 cases, 16 underwent hepatic resection with the normothermic selective total vascular exclusion (extended right lobectomy in 5 cases, extended left lobectomy in 3 cases; right lobectomy in 5 cases; central segmentectomy in 3 cases) and 3 with the total vascular isolation and in situ cold perfusion (extended left lobectomy in 2 case, extended right lobectong in 1 case). We believe that the technique of normothermic vascular exclusion may be indicated to deal with the lesion close to the hepatic veins and the retrohepatic vena cava. However, for more complicated hepatic resection, the hypothermic perfusion technique should be considered to prolong the safety of ischemic time of the liver. The preliminary experience in the clinical application using the above technique is reported.