Goal-directed LCVP Based on HP in Laparoscopic Hepatectomy

The Application of Goal-directed Low Central Venous Pressure Based on Hypovolemic Phlebotomy in Laparoscopic Hepatectomy

The goal of this clinical trial is to learn about goal-directed LCVP based on hypovolemic phlebotomy (HP) in laparoscopic hepatectomy. The main questions it aims to answer are:

1. The safety and feasibility of HP
2. To evaluate whether HP can reduce perioperative blood transfusion ratio Participants undergoing liver resection with HP was performed by the anesthesiologist. Blood was withdrawn approximately 30 min prior to the initiation of liver parenchymal transection from central venous. The aim was to maintain the CVP between 0 to 5 cmH2O. HP volume was 5-10 mL/kg of patient body weight, generally. Participants in control group undergoing liver resection without HP.

Inclusion Criteria:

• Clinical diagnosis of Hepatocellular Carcinoma
• Preference for laparoscopic hepatectomy and patient agreement

Exclusion Criteria:

• Age <18 years
• Pregnancy
• Refusal of blood product transfusion
• Active cardiac conditions (unstable coronary syndromes, decompensated heart failure, significant arrhythmias, severe valvular disease, history of congestive heart failure)
• History of significant cerebrovascular disease
• Restrictive or obstructive pulmonary disease
• Uncontrolled hypertension
• Renal dysfunction (glomerular filtration rate <60 mL/min),
• Hemoglobin <100 g/L
• Abnormal coagulation values (international normalized ratio >1.5 not on warfarin and/or platelet count <100 ×109/L)
• Evidence of hepatic metabolic disorder (bilirubin >35 mmol/L)
• Presence of active infection
• Preoperative autologous blood donation
• Patients were not allowed to receive erythropoietin at any time during the index hospitalization.