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132. Kongress der Deutschen Gesellschaft für Chirurgie

Deutsche Gesellschaft für Chirurgie

28.04. - 01.05.2015, München

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Intraoperative simulation of the remnant liver function during anatomical liver resections with ICG Clearance (LiMON) measurements

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  • Michael Thomas - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Ernst Weninger - Klinikum Grosshadern, Klinik für Anästhesiologie der Universität München, München, Deutschland
  • Martin Angele - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Florian Bösch - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Sebastian Pratschke - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Joachim Andrassy - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Manfred Stangl - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Werner Hartwig - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Jens Werner - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland
  • Markus Guba - Klinikum Grosshadern, Klinik für Allgemeine-, Viszeral-, Transplantations-, Gefäß- und Thoraxchirurgie, München, Deutschland

Deutsche Gesellschaft für Chirurgie. 132. Kongress der Deutschen Gesellschaft für Chirurgie. München, 28.04.-01.05.2015. Düsseldorf: German Medical Science GMS Publishing House; 2015. Doc15dgch204

doi: 10.3205/15dgch204, urn:nbn:de:0183-15dgch2041

Published: April 24, 2015

© 2015 Thomas et al.
This is an Open Access article distributed under the terms of the Creative Commons Attribution 4.0 License. See license information at http://creativecommons.org/licenses/by/4.0/.

Outline

Text

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.