Feasibility of bloodless liver resection using Lumagel, a reverse thermoplastic polymer, to produce temporary, targeted hepatic blood flow interruption
| Autor: | James J. Benn, Peter N. Madras, James J. Pomposelli, Mohamed Akoad, Aarti Kalra, Mauricio Solano, Sebastian Flacke |
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| Rok vydání: | 2012 |
| Předmět: |
medicine.medical_specialty
Time Factors Swine Iohexol medicine.medical_treatment Blood Loss Surgical Portal vein Poloxamer liver Resection Hepatic Artery medicine.artery medicine Animals Hepatectomy resection Renal artery Kidney Hepatology Portal Vein business.industry Gastroenterology Angiography Digital Subtraction Phlebography Original Articles Blood flow Embolization Therapeutic Nephrectomy Surgery medicine.anatomical_structure Models Animal radiological intervention Feasibility Studies Radiology business Liver Circulation Artery |
| Zdroj: | HPB. 14(2):115-121 |
| ISSN: | 1365-182X |
| DOI: | 10.1111/j.1477-2574.2011.00412.x |
| Popis: | BackgroundLumagel, a reverse thermosensitive polymer (RTP), provides targeted flow interruption to the kidney by reversibly plugging segmental branches of the renal artery, allowing blood-free partial nephrectomy. Extending this technology to the liver requires the development of techniques for temporary occlusion of the hepatic artery and selected portal vein branches.MethodsA three-phased, 15 swine study was performed to determine feasibility, techniques and survival implications of using Lumagel for occlusion of inflow vessels to targeted portions of the liver. Lumagel was delivered using angiographic techniques to sites determined by pre-operative 3-D vascular reconstructions of arterial and venous branches. During resection, the targeted liver mass was resected without vascular clamping. Three survival swine were sacrificed at 3 weeks; the remainder at 6 weeks for pathological studies.ResultsSix animals (100%) survived, with normal growth, blood tests and no adverse events. Three left lateral lobe resections encountered no bleeding during resection; one right median resection bled; two control animals bled significantly. Pre-terminal angiography and autopsy showed no local pathology and no remote organ damage.ConclusionsTargeted flow interruption to the left lateral lobe of the swine liver is feasible and allows resection without bleeding, toxicity or pathological sequelae. Targeting the remaining liver will require more elaborate plug deposition owing to the extensive collateral venous network. |
| Databáze: | OpenAIRE |
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