TY - JOUR
T1 - Simplified technique for 75% and 90% hepatic resection with hemodynamic monitoring in a large white swine model
AU - Bucur, Petru
AU - Bekheit, Mohamed
AU - Audebert, Chloe
AU - Vignon-Clementel, Irene
AU - Vibert, Eric
N1 - Funding: this study was funded mainly by the “Agence de la Biomedecine” through its program of Research (AOR 2009). Eric Vibert, Petru O. Bucur, and Mohamed Bekheit acknowledge funding by project ANR-13-TECS-0006 (IFlow).
PY - 2017/3
Y1 - 2017/3
N2 - Background Accurate measuring of the hepatic hemodynamic parameters in humans is inconvenient. Swine has been a favorite surgical model for the study of liver conditions due to many similarities with human livers. However, pigs cannot tolerate pedicle clamping and to reduce bleeding during resection a simplified technique is required. The aim of this study is to present a simplified technique for different percentages of hepatic resection in a porcine model. Methods Twenty-two consecutive large white pigs were operated with 75% and 90% liver resection. Computarized tomography liver volumetry is performed before and after surgery. In both types of surgery, hemodynamic monitoring was performed using a specialized apparatus. Results Resections were performed in both groups successfully. The residual volume in the planned 75% was 235 ± 77 mL and 118 ± 119 mL in the planned 90% resection. For 75% resection, the portal flow was reduced after resection by 8.13 ± 28%, which might be part of systemic circulatory depression. However, the portal pressure increased by 20.1 ± 51%. The hepatic artery flow decreased by 63.86 ± 26.3% as well as the pressure by 5 ± 28%. The central venous pressure at the start of surgery was 3.34 ± 1.9 mm Hg and 2.8 ± 2.2 mm Hg at the end of surgery. The portacaval pressure gradient was 4.4 ± 2.9 mm Hg at the beginning of surgery and was 5.9 ± 2.8 mm Hg at the end of surgery. For 90% resection, the portal flow decreased by 33.6 ± 12.6% and the pressure increased by 104 ± 58%. The hepatic artery flow decreased by 88 ± 7%, and the pressure decreased by 5 ± 14.8%. The central venous pressure was 3.5 ± 1.7 mm Hg before resection and 3 ± 2.5 mm Hg after resection. The portacaval pressure gradient was 3.8 ± 1.1 mm Hg before resection and 8 ± 3.7 mm Hg after resection. The mean anesthesia time was 6.6 ± 1.05 h and 6.9 ± 0.5 h for 75% and 90% resection, respectively. The mean operative time was 4.6 ± 0.9 h and 5 ± 0.7 h for 75% and 90% resections, respectively. The mean time for hepatectomy was 1.23 ± 0.76 h and 2.4 ± 0.1 h for 75% and 90% resection, respectively. The mean time consumed in the measurements was 2.28 ± 1.4 h and 1.1 ± 0.3 h for 75% and 90% resections, respectively. The mean volume of aspirated fluid and blood in the 75% resection was 1062 ± 512 mL, while it was 1050 ± 354 mL in 90% resections. Conclusions The hereby described technique is simple and easily applicable for major liver resection in a porcine model. Portal flow decreases after 90% resection more than in 75% due to the relative reduction of remnant hepatic mass. There was a larger increase in portal pressure following 90% compared to 75% resection. The hepatic artery flow decreases more in 90% than in 75% resections.
AB - Background Accurate measuring of the hepatic hemodynamic parameters in humans is inconvenient. Swine has been a favorite surgical model for the study of liver conditions due to many similarities with human livers. However, pigs cannot tolerate pedicle clamping and to reduce bleeding during resection a simplified technique is required. The aim of this study is to present a simplified technique for different percentages of hepatic resection in a porcine model. Methods Twenty-two consecutive large white pigs were operated with 75% and 90% liver resection. Computarized tomography liver volumetry is performed before and after surgery. In both types of surgery, hemodynamic monitoring was performed using a specialized apparatus. Results Resections were performed in both groups successfully. The residual volume in the planned 75% was 235 ± 77 mL and 118 ± 119 mL in the planned 90% resection. For 75% resection, the portal flow was reduced after resection by 8.13 ± 28%, which might be part of systemic circulatory depression. However, the portal pressure increased by 20.1 ± 51%. The hepatic artery flow decreased by 63.86 ± 26.3% as well as the pressure by 5 ± 28%. The central venous pressure at the start of surgery was 3.34 ± 1.9 mm Hg and 2.8 ± 2.2 mm Hg at the end of surgery. The portacaval pressure gradient was 4.4 ± 2.9 mm Hg at the beginning of surgery and was 5.9 ± 2.8 mm Hg at the end of surgery. For 90% resection, the portal flow decreased by 33.6 ± 12.6% and the pressure increased by 104 ± 58%. The hepatic artery flow decreased by 88 ± 7%, and the pressure decreased by 5 ± 14.8%. The central venous pressure was 3.5 ± 1.7 mm Hg before resection and 3 ± 2.5 mm Hg after resection. The portacaval pressure gradient was 3.8 ± 1.1 mm Hg before resection and 8 ± 3.7 mm Hg after resection. The mean anesthesia time was 6.6 ± 1.05 h and 6.9 ± 0.5 h for 75% and 90% resection, respectively. The mean operative time was 4.6 ± 0.9 h and 5 ± 0.7 h for 75% and 90% resections, respectively. The mean time for hepatectomy was 1.23 ± 0.76 h and 2.4 ± 0.1 h for 75% and 90% resection, respectively. The mean time consumed in the measurements was 2.28 ± 1.4 h and 1.1 ± 0.3 h for 75% and 90% resections, respectively. The mean volume of aspirated fluid and blood in the 75% resection was 1062 ± 512 mL, while it was 1050 ± 354 mL in 90% resections. Conclusions The hereby described technique is simple and easily applicable for major liver resection in a porcine model. Portal flow decreases after 90% resection more than in 75% due to the relative reduction of remnant hepatic mass. There was a larger increase in portal pressure following 90% compared to 75% resection. The hepatic artery flow decreases more in 90% than in 75% resections.
KW - Hemodynamic monitoring
KW - Liver resection
KW - Major
KW - Pigs
KW - Technique
UR - http://www.scopus.com/inward/record.url?scp=84993940285&partnerID=8YFLogxK
U2 - 10.1016/j.jss.2016.09.018
DO - 10.1016/j.jss.2016.09.018
M3 - Article
C2 - 28032548
AN - SCOPUS:84993940285
VL - 209
SP - 122
EP - 130
JO - Journal of Surgical Research
JF - Journal of Surgical Research
SN - 0022-4804
ER -