Bloodless Surgery Techniques for Tumor Removal

New techniques offer a way to surgically remove an aggressive pancreatic tumor without any transfusions during the operation or at any time afterward. The techniques were developed at the New Jersey Institute for the Advancement of Bloodless Medicine & Surgery at Englewood Hospital and Medical Center (Englewood, USA) by Dr. Herbert Dardik, acting chief of the department of surgery.

The tumor patient refused to have a blood transfusion due to religious beliefs and had been turned away by several other hospitals because of this need and the potential for heavy blood loss. Since the tumor had grown beyond the pancreas into the adjacent vein, Dr. Dardik decided to remove the vein with the tumor as part of a radical Whipple procedure. Once the diseased vessel was removed, a Teflon graft was sewn in place to connect the intestinal blood circuit to the liver circuit.

In order to ensure continued flow of blood during the procedure and to prevent or minimize intestinal congestion, a temporary shunt consisting of a sterile segment of polyvinyl tubing was placed between the two veins that would be connected. This shunt was removed just before the last sutures were in place and blood flow was re-established. The focus of this technique is to prevent blood congestion in the intestines and deficient flow of blood to the liver. The use of a temporary shunt appears to eliminate these problems and supports surgeons in their efforts to perform radical venous resections and reconstructions with increasing simplicity, says Dr. Dardik.

In preparation for the operation, to address the possibility of potential blood loss, the patient was given erythropoietin for a period of several weeks prior to the operation. The operation was then performed using the technique of acute normovolemic hemodilution (ANH) in combination with a cell-saving device. In accordance with transfusion-free techniques, some blood was removed from the patient just before surgery. The blood was retained within a closed system and about 15% of red blood cells were reinfused.





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