Simplified technique for 75% and 90% hepatic resection with hemodynamic monitoring in large white swine model

Abstract : Background: Accurate measuring of the hepatic hemodynamic parameters in humans is inconvenient. Swine has been a favourite 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. Aim: 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. CT liver volumetry is performed before and after surgery. In both types of surgery, hemodynamic monitoring was performed using a specialised 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 mmHg and 2.8 ± 2.2 mmHg at the end of surgery. The portocaval pressure gradient was 4.4 ± 2.9 mmHg at the beginning of surgery and was 5.9 ± 2.8 mmHg 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 mmHg before resection and 3±2.5 mmHg after resection. The portocaval pressure gradient was 3.8±1.1 mmHg before resection and 8±3.7 mmHg after resection. The mean anaesthesia time was 6.6 ±1.05 hours and 6.9 ± 0.5 hours for 75% and 90% resection, respectively. The mean operative time was 4.6 ±0.9 hours and 5 ±0.7 hours for 75% and 90% resections, respectively. The mean time for hepatectomy was 1.23±0.76 hours and 2.4 ±0.1 hours for 75% and 90% resection, respectively. The mean time consumed in the measurements was 2.28±1.4 hours and 1.1 ±0.3 hours 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.
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Petru Bucur, Mohamed Bekheit, Chloe Audebert, Irene E. Vignon-Clementel, Eric Vibert. Simplified technique for 75% and 90% hepatic resection with hemodynamic monitoring in large white swine model. Journal of Surgical Research, Elsevier, 2017, 209, pp.122-130. ⟨10.1016/j.jss.2016.09.018⟩. ⟨hal-01405171⟩

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