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Cooling Techniques and Ex Situ Liver Surgery

  • Umberto CilloEmail author
  • Enrico Gringeri
Chapter
Part of the Updates in Surgery book series (UPDATESSURG)

Abstract

Hypothermic preservation is a strategy to reduce ischemia-reperfusion injury in both liver transplantation and liver resection procedures and has been successfully used in liver transplantation setting since the early 1960s to prolong the viability of harvested liver grafts. Static cold storage is able to reduce cellular metabolism by 10- to 12-fold and to slow down energy demand. Hypothermic perfusion is used also during complex liver resection in order to protect the liver parenchyma from ischemia-reperfusion injury during total vascular exclusion.

Ex situ liver resection is a complex kind of surgery burdened by a high morbidity and mortality rate and feasible only for a strictly selected category of patients affected by primary and metastatic liver cancer considered unresectable by conventional surgery. Surgical expertise in liver transplant is required due to the several similarities with the transplant techniques.

Keywords

Liver transplantation Hypothermic perfusion Cold storage Liver harvesting Ischemia-reperfusion injury Liver preservation Total vascular exclusion Ex situ liver resection Extreme resection Machine perfusion 

Supplementary material

Video 4.1

(MP4 1886244 kb)

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Copyright information

© Springer Nature Switzerland AG 2020

Authors and Affiliations

  1. 1.Department of Surgery, Oncology and GastroenterologyUniversity of PaduaPaduaItaly
  2. 2.Hepatobiliary Surgery and Liver Transplant UnitPadua University HospitalPaduaItaly

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