[Total vascular exclusion of the liver in extensive hepatic exeresis. Value and limits]

Abstract

Three cases of right hepatic lobectomy performed under complete hepatic vascular exclusion with aortic clamping in normothermia are reported. Hemostasis of the row surface of the liver is obtained with application of a biological glue. Hepatic vascular exclusion (from 24 to 30mn) was harmless to the remnant liver and the kidneys. Blood loss was minimal. The hemodynamic tolerance was good all along the procedure, but there is a high risk of overloading and acute congestive heart failure immediately after removal of the clamps. The continuous monitoring of pulmonary artery pressures must be emphasized. This procedure may be advised for massive and hypervascular tumors of the right lobe of the liver.