Ординатура / Хирургия / Библиотека им академика М.И. Перельмана / Книга_3844_Библиотеки_им_академика_М_И_Перельмана

Longmire et al. was the person to report in 1961 the use of hypothermia induced by external body cooling during a hepatectomy for liver cancer [18]. The in situ hypothermic liver resection was employed by Heaney et al. in 1956 [1] and Fortner et al. in 1974 [20]. In their technique, the liver is perfused with preservation solution at 4 °C and packed with ice during the period of total vascular exclusion. This technique has been shown to prolong safely the vascular exclusion up to several hours [10]. Pichlmayr et al. reported the technique of ex situ liver resection (Fig. 6.2) [21]. The main steps of this technique include the installation of total vascular exclusion, venovenous bypass, and the removal of the whole liver. The latter is then perfused ex situ via portal and arterial route with preservation solution. The liver is maintained in cold solution packed with ice for optimal preservation during bench hepatectomy. The remaining liver is reimplanted as an auto-transplantation. To improve the access to the dorsal part of the liver without resorting to the division of the portal triad, Hannoun et al. developed the ante situm technique in which the hepatic veins are divided, allowing mobilization of the liver anteriorly (Fig. 6.3) [22]. The future remnant liver is perfused with the Belzer’s University of Wisconsin solution chilled at 4 °C (UW solution) via the portal vein or the hepatic artery [13]. The remaining hepatic veins are reimplanted into the vena cava. Then, Belghiti et al. [23] described a variation of the latter technique in which the vena cava is cut above and below the liver, enabling the resection to be done while the liver is being perfused to induce the hypothermia via the portal vein [24]. The vena cava is reconstructed after liver resection using synthetic [23, 25–30], autogenous [31–33], or pericardial grafts [34].