Saving the precious resource of blood during major liver surgery
Between a quarter to a third of people having major liver surgery, often due to cancer, will need a blood transfusion. Now, imagine being able to reduce the need for this type of transfusion and the impact it would have on a global scale. This has been a vision for Dr. Guillaume Martel, a surgeon and scientist, who holds the donor-funded Arnie Vered Family Chair in Hepato-Pancreato-Biliary Research at The Ottawa Hospital and University of Ottawa.
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When Dr. Martel was training as a fellow in Montreal, he witnessed a technique for liver surgery that was new to him. It reduces the amount of blood loss during a liver operation, and the idea both fascinated and intrigued him. But when he did some digging, the young doctor realized there wasn't much background on the technique and there were no clinical trials — no concrete evidence to prove its value.
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When he arrived at The Ottawa Hospital, it became a personal mission to learn more about the technique, known as hypovolemic phlebotomy, where a controlled amount of blood is removed from the patient before liver surgery, then re-infused back into the patient afterward. Once he and his team, including anesthetist Dr. Chris Wherrett, perfected the technique, they decided to do their own research, in order to have concrete evidence showing the impact of this practice-changing medicine.
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Often donations from the community help get the early phase research projects off the ground, attracting large-scale funding through grants to launch in-depth investigations.
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Once Dr. Martel's team had tested the safety and feasibility of the technique in major liver surgery as part of a Phase 1 trial at the hospital, they launched the largest trial of its kind, thanks to funding from the Canadian Institutes of Health Research.
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Over five years, ending in 2023, 446 people were recruited at four Canadian hospitals, including The Ottawa Hospital, to participate. 'Once under anesthetic, patients were randomly selected to receive either hypovolemic phlebotomy, to decrease blood transfusions, or to receive usual care,' explains Dr. Martel.
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