%0 Journal Article
%T Vascular clamping in liver surgery: physiology, indications and techniques
%A Elie K Chouillard
%A Andrew A Gumbs
%A Daniel Cherqui
%J Annals of Surgical Innovation and Research
%D 2010
%I BioMed Central
%R 10.1186/1750-1164-4-2
%X Specific techniques discussed and described include inflow clamping (Pringle maneuver, extra-hepatic selective clamping and intraglissonian clamping) and outflow clamping (total vascular exclusion, hepatic vascular exclusion with preservation of caval flow). The fundamental role of a low Central Venous Pressure during open and laparoscopic hepatectomy is described, as is the difference in their intra-operative measurements. The biological basis for ischemic preconditioning will be elucidated. Although the potential dangers of vascular clamping and the development of modern coagulation devices question the need for systemic clamping; the pre-operative factors and unforseen intra-operative events that mandate the use of hepatic vascular clamping will be highlighted.Efforts to reduce or eliminate operative bleeding, have been the primary focus throughout the history of liver surgery. For years the degree of hemorrhage has remained a major prognostic factor after liver resection. Vascular clamping is an efficient tool to minimize bleeding during parenchymal transection. This has been made possible by the liver's known tolerance to normothermic ischemia. Different types of clamping methods have been described including total (i.e. Pringle maneuver) and partial or selective (i.e. selective clamping of the part of the liver to be resected) (APPENDIX 1). In addition, clamping can be applied to the inflow only, or to both inflow and outflow (hepatic vascular exclusion). Clamping may also be either continuous or intermittent.The indication, as well as the type of clamping, depends mainly on the size and the location of the lesions to be resected, the quality of the liver parenchyma, the surgeon's preferences, and the unexpected operative events. Ideally, the type of clamping is decided preoperatively. Operative hemodynamic and fluid management differs according to the type of clamping. For example, in the absence of inferior vena cava clamping, fluid expansion must be limited
%U http://www.asir-journal.com/content/4/1/2