New liver surgery technique reduces the need for blood transfusions

While training as a surgeon at the Centre Hospitalier de l’Université de Montréal, Dr. Guillaume Martel was introduced to a fascinating new technique of removing blood before surgery called hypovolemic phlebotomy. The idea was to reduce blood pressure and the need for red blood cell transfusions following surgery, improving outcomes for patients and saving costs.

Removing bags-worth of blood might not sound ideal, but the technique, as applied to liver surgery, has passed major trials and been published in The Lancet Gastroenterology and Hepatology.

“We’ve proved that it’s officially working as I hoped it would,” says Dr. Martel, now a surgeon at The Ottawa Hospital’s Liver and Pancreas Unit.

“The surgery begins as usual, and then we will remove one or two bags of blood from the patient,” Dr. Martel explains. “That’s about 10% of the patient’s blood volume. The blood goes into a collection bag, is stored in a cooler, and then we will cut the liver. Once the liver is cut, we hook the blood back up and reinfuse it.”

The liver has many blood vessels, explains Dr. Martel. “In a hypovolemic state, the large veins in the liver are under such low pressure that when you cut them, they barely bleed. Whereas a patient who has normal blood volume, when you cut those veins, it can be like a geyser.”

Each year, there are approximately 10,000 liver surgeries in the United States and Canada. There are about 100 liver surgeries a year at The Ottawa Hospital, one of four locations where the trial was conducted. With hypovolemic phlebotomy, the need for blood transfusions is reduced by half.

What’s next for this novel approach to surgery? Getting the word out there, says Dr. Martel, who also teaches at the University of Ottawa’s Department of Surgery and hopes new students will learn his technique.

“The next important piece for me is knowledge translation and dissemination,” he says. “I would argue that hypovolemic phlebotomy is the best way forward to avoid blood transfusions during liver surgery, and I want people to know about it.”

At a glance

Issue

Liver surgery can result in the loss of a lot of blood, requiring blood transfusions, which are costly and require donors. Dr. Guillaume Martel saw another way of doing liver surgery without the use of blood transfusions.

Research

Dr. Martel’s research has proven that removing about 10% of the patient’s blood, resulting in lower pressure and volume, and then reinfusing the patient’s own blood back into the body, reduces the need for blood transfusions and makes the surgery easier.