doi:10.19538/j.cjps.issn1005-2208.2025.09.16

Chinese Journal of Practical Surgery ›› 2025, Vol. 45 ›› Issue (09) : 1046-1049. DOI: 10.19538/j.cjps.issn1005-2208.2025.09.16

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Abstract

Minimizing intraoperative bleeding during liver resection is crucial for improving surgical safety and maintaining a clear operative field. Controlling central venous pressure (CVP) is a key measure. Traditional controlled low central venous pressure (CLCVP) techniques rely on anesthetic interventions, which are associated with management complexity and risks of organ injury. Inferior vena cava suspension and clamping (IVCSC) below the liver can physically reduce CVP, avoiding drug-related adverse effects, and is particularly suitable for high-risk patients such as those with cirrhosis or requiring extensive liver resection. However, its application in laparoscopic surgery is limited due to technical difficulties. To address this, Guangdong Provincial People’s Hospital has optimized the IVCSC procedure. Specific improvements include establishing an operative plane between the hepatic entrance of the inferior vena cava and the right renal vein while avoiding major vascular branches; creating a suspension channel at the right posterior side of the inferior vena cava; using sutures and a gold-finger dissector to complete suspension; performing clamping along the suture direction with atraumatic clips for safe occlusion; and conducting the entire procedure under direct vision with vigilance for potential bleeding vessels. Following optimization, IVCSC was successfully performed in 103 patients, with the mean operative time shortened to less than 10 minutes and no complications observed. This method can be widely applied in laparoscopic, open, and robotic liver resections, aiming to enhance safety and achieve standardization and proceduralization.

Key words

inferior vena cava suspension and clamping / laparoscopic liver resection / central venous pressure control / procedure optimization / bleeding prevention / surgical safety

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