J.Jpn. Surg. Soc.. 99(4): 223-228, 1998

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Feature topic

TOPICAL COOLING AS AN ADJUNCT FOR HEPATECTOMY WITH INFLOW OCCLUSION

Hypothermia of the liver was developed to alleviate the ischemic insult induced by prolonged hepatic inflow occlusion. The use of hypothermia in liver surgery dates back to an experiment in 1953, which showed that the safe normothermic ischemic time of 20 minutes could be prolonged to 60 minutes with generalized cooling.
Generalized cooling was first used clinically as an adjunct to hepatectomy with inflow occlusion in 1961. This method has not been widely used due to its adverse effect on systemic hemodynamics. Subsequently, methods of inducing hypothermia evolved to encompass in situ, isolated hypothermic perfusion under total vascular exclusion, and then to hemihepatic hypothermic perfusion without the need for total vascular exclusion but with topical surface cooling. These technically feasible modifications were newly devised by our group.
Our series of 39 hepatectomized patients, who underwent right-sided hepatectomy under hemihepatic inflow occlusion combined with topical surface cooling (October 1990 to April 1997), demonstrated that even in livers associated with chronic liver disease, if surface topical cooling was interposed, a consecutive hemihepatic inflow occlusion time of as long as 60±23 minutes was acceptable without cyclic recirculation. ln addition, no further ischemic insult occurred compared with a normothermic patient series with a significantly shorter occlusion time. Our data lead to the conclusion that the topical surface cooling method can be a useful and feasible adjunct to complicated hepatectomy in which inflow occlusion time is anticipated to prolong.

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