In situ cold perfusion

Extended right hepatectomy with in situ cold perfusion

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  • Case Scenario

    • Patient was a 46 year old man, diagnosed with a large hepatocellular carcinoma predominantly in the right lobe.
    • It enroached upon the right portal vein, right hepatic artery and the left and right hepatic ducts. In addition, it also enveloped the middle and right hepatic veins, and was involved the left hepatic vein.
  • Surgical Plan

    • The liver would be transected with a plane that divides the intrahepatic left hepatic vein.
    • Parenchymal transection would be performed until the intrahepatic left hepatic vein is reached.
    • A standard IV tubing would be inserted into the main portal vein, and the hepatic artery and portal vein would be clamped.
    • The vena cava would then be cross-clamped above and below the liver.
    • While the left hepatic vein is divided, ice cold HTK solution would be perfused through the IV tubing. Sterile ice would also be placed around the liver remnant.
    • The confluence of the middle/left hepatic vein would be divided at the cava, and then anastomosed to the divided left hepatic vein.
    • A Roux-en-Y hepatico-jejunostomy will be performed to reconstruct the biliary circulation.