Right extended hepatectomy for alveolar echinococcosis, with portal reconstruction under total vascular exclusion and liver cooling

Abstract

Background: (VIDEO) We report the case of a 43-years old men suffering of a 10cm alveolar echinococcosis of the right liver, with left portal vein involvement. A right extended hepatectomy with portal reconstruction and hepaticojejunostomy is planned, under Total Vascular Exclusion (TVE) and Liver Cooling (LC). Methods: The first step is preparing for TVE: the liver is fully mobilized to expose and control the infra and suprahepatic inferior vena cava with a tape. The pedicle is prepared dissecting the portal vein independently from the artery and bile duct, in order to obtain a selective portal occlusion. Results: The second step is to prepare for Extra corporeal circulation (ECC): the inferior mesenteric vein is cannulated, the right femoral and left axillary veins are cannulated using a percutaneous echo guided approach. Finally the circuit is purged by saline, and connected to the pump. Conclusion: The third step starts with ECC: the pump flow is progressively increased, and simultaneously TVE is started, while in situ perfusion for the liver with refrigerated liver preservation solution is achieved by direct cannulation of the portal trunk. Moreover topical cooling is achieved either with crushed ice in plastic bags or cold water. The fourth step is the liver transection, followed by portal reconstruction. Liver is rewarmed, ECC is weaned and cannulas are removed. Finally, the hepatocojejunostomy is realized.