Intraoperative simulation of remnant liver function during anatomic liver resection with indocyanine green clearance (LiMON) measurements

ObjectivePost-hepatectomy liver failure (PHLF) is the major cause of death following liver resection. The aim of this study was to evaluate the feasibility of an intraoperative simulation of post-resection liver function. MethodsIntraoperative liver function was measured by indocyanine green (ICG) clearance using the LiMON technology. In 20 patients undergoing anatomic liver resection, ICG plasma disappearance rate (PDR (%/min) and ICG retention at 15min (R-15) (%) were measured immediately after the induction of anaesthesia (t(0)), after selective arterial and portovenous inflow trial clamping (TC) of the resected liver segments (t(1)), after the completion of resection (t(2)) and before the closure of the abdominal cavity (t(3)). ResultsThe median baseline (t(0)) PDR was 16.5%/min. Trial clamping of the inflow (t(1)) resulted in a significant reduction in PDR to 10.5%/min. Results under TC were similar to those obtained after resection (t(2)) (median PDR: 10.5%/min). Linear regression modelling showed that post-resection liver volume could be accurately predicted by TC of liver inflow (P < 0.0001), but not by determining the resected liver volume. Simulated post-resection liver function under TC correlated well with PHLF and length of hospital stay. ConclusionsIntraoperative ICG clearance measurements allow real-time monitoring of intraoperative liver function during surgery. Trial clamping of arterial and portovenous inflow accurately predicts immediate post-resection liver function. The intraoperative measurement of liver function and simulation of post-resection liver function may help to avoid PHLF.