Artikel
Intraoperative simulation of the remnant liver function during anatomical liver resections with ICG Clearance (LiMON) measurements
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Veröffentlicht: | 24. April 2015 |
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Gliederung
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Introduction: Posthepatectomy liver failure (PHLF) is the major cause of death following liver resection. The aim of this study is to evaluate the feasibility of an intraoperative simulation of post-resectional liver function (PRLF).
Material and methods: Intraoperative liver function was measured by ICG clearance using the LIMON™ technology. In 20 patients undergoing anatomic liver resections, ICG-plasma-disappearance rate (PDR [%/min]) and ICG-retention rate at 15 minutes (R15 / [%]) were measured immediately after induction of anaesthesia (t0), after selective arterial and portovenous inflow trial clamping (TC) of the resected liver segments (t1), after accomplishment of resection (t2) and before closing the abdominal cavity (t3).
Results: The median baseline (t0) PDR was 16.5 %/min. TC of the inflow (t1) resulted in a significant PDR reduction to 10.5 %/min. Results under TC were similar to those obtained after resection (t2) 10.5 %/min. Linear regression modeling showed that postresectional liver volume could be accurately predicted by TC of liver inflow (p<0.0001), but not by determination of the resected liver volume. Simulated post-resectional liver function under TC correlated well with PRLF and the length of hospital stay.
Conclusion: Intraoperative ICG-clearance measurements allow real-time monitoring of intraoperative liver function during surgery. TC of arterial and porto-venous inflow accurately predicts immediate post-resection liver function. Intraoperative measurement of liver function and simulation of post-resectional liver function may help to avoid PHLF.