Nodir Madrahimov, MD, Olaf Dirsch, MD, Christoph Broelsch, MD, PhD, and Uta Dahmen, MD, PhD
From the Department of General, Visceral and Transplantation Surgery, University Hospital Essen, Essen, Germany.
Abstract
Objective:
Based
on the 3-dimensional visualization of vascular supply and drainage, a
vessel-oriented resection technique was optimized. The new surgical
technique was used to determine the maximal reduction in liver mass
enabling a 50% 1-week survival rate.
on the 3-dimensional visualization of vascular supply and drainage, a
vessel-oriented resection technique was optimized. The new surgical
technique was used to determine the maximal reduction in liver mass
enabling a 50% 1-week survival rate.
Background Data:
Determination
of the minimal liver mass is necessary in clinical as well as in
experimental liver surgery. In rats, survival seems to depend on the
surgical technique applied. Extended hepatectomy with removal of 90% of
the liver mass was long regarded as a lethal model. Introduction of a
vessel-oriented approach enabled long-term survival in this model.
of the minimal liver mass is necessary in clinical as well as in
experimental liver surgery. In rats, survival seems to depend on the
surgical technique applied. Extended hepatectomy with removal of 90% of
the liver mass was long regarded as a lethal model. Introduction of a
vessel-oriented approach enabled long-term survival in this model.
Methods:
The
lobar and vascular anatomy of rat livers was visualized by plastination
of the whole organ, respectively, by corrosion casts of the portal
vein, hepatic artery and liver veins. The three-dimensional models were
used to extract the underlying anatomic structure. In 90% partial
hepatectomy, the liver parenchyma was clamped close to the base of the
respective liver lobes (left lateral, median and right, liver lobe).
Piercing sutures were placed through the liver parenchyma, so that the
stem of portal vein and the accompanying hepatic artery but also the
hepatic vein were included.
lobar and vascular anatomy of rat livers was visualized by plastination
of the whole organ, respectively, by corrosion casts of the portal
vein, hepatic artery and liver veins. The three-dimensional models were
used to extract the underlying anatomic structure. In 90% partial
hepatectomy, the liver parenchyma was clamped close to the base of the
respective liver lobes (left lateral, median and right, liver lobe).
Piercing sutures were placed through the liver parenchyma, so that the
stem of portal vein and the accompanying hepatic artery but also the
hepatic vein were included.
Results:
A
1-week survival rate of 100% was achieved after 90% hepatectomy.
Extending the procedure to 95% resection by additional removal of the
upper caudate lobe led to a 1-week survival rate of 66%; 97% partial
hepatectomy, accomplished by additional resection of the lower caudate
lobe only leaving the paracaval parts of the liver behind, resulted in
100% lethality within 4 days.
1-week survival rate of 100% was achieved after 90% hepatectomy.
Extending the procedure to 95% resection by additional removal of the
upper caudate lobe led to a 1-week survival rate of 66%; 97% partial
hepatectomy, accomplished by additional resection of the lower caudate
lobe only leaving the paracaval parts of the liver behind, resulted in
100% lethality within 4 days.
Conclusions:
Using
a anatomically based, vessel-oriented, parenchyma-preserving surgical
technique in 95% liver resections led to long-term survival. This
represents the maximal reduction of liver mass compatible with survival.
a anatomically based, vessel-oriented, parenchyma-preserving surgical
technique in 95% liver resections led to long-term survival. This
represents the maximal reduction of liver mass compatible with survival.
Full text available in Ann Surg. 2006 July; 244(1): 89–98.