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A safe and fast technique for isolated hepatic perfusion
Author(s) -
Verzaro R.,
Zeh H.,
Bartlett D.
Publication year - 2008
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.21113
Subject(s) - medicine , nuclear medicine , center (category theory) , medical school , gerontology , library science , medical education , computer science , chemistry , crystallography
Herein we describe our modified technique of isolated hepatic perfusion that is simpler and faster compared to the initial ones reported in the literature. Previous techniques [7] of isolated hepatic perfusion included total vascular isolation of the liver with portal and systemic venous by pass. The venous by pass was performed either using a cut-down technique or by percutaneous cannulation of the femoral vein. Another important step of previous described techniques was the continuous intra-operative monitoring of complete vascular isolation of the liver by 131-I labeled serum albumin. The technique we describe herein does not include portal vein by pass but shunting of the blood is limited solely to the inferior vena cava. Complete vascular isolation of the liver is demonstrated by a steady volume of the reservoir during the entire procedure, without using labeled albumin. SURGICAL TECHNIQUE The patient is placed in the supine position and general anesthesia through orotracheal intubation is provided. The patient is invasively monitored by radial artery catheter and Swan-Ganz catheter in the pulmonary artery. An 18-French cannula is also placed in the right jugular vein (right if possible) for veno-venous by-pass (see below). The operation begins with a mini-laparotomy on the midline to asses the feasibility of the operation. Once peritoneal carcinomatosis or massive extra-hepatic neoplastic disease is ruled out, the midline incision is extended up to the xyphoid process and to a subcostal laparotomy. The quality of the liver is assessed, with special attention to the steato-hepatitis following chemotherapy. In case of severe steatosis the procedure is not indicated due to increased risk of liver failure after the perfusion. The liver is fully mobilized by division of the right and left triangular ligaments, the round ligament and all the retroperitoneal attachments. The vena cava is dissected off the retroperitoneum and attention is paid to ligate and divide all the collateral veins from the retro