Evidence map›Paper›PMID 40197483›Full record

Trial reportAnnals of surgery2025

Reduction of Central Venous Pressure in Elective Robotic and Laparoscopic Liver Resection: The PRESSURE Trial-A Randomized Clinical Study.

Patrick Téoule, Niccolo Dunker, Johanna Debatin, Dorothée Sturm, Svetlana Hetjens, Valentin Walter, Erik Rasbach, Christoph Reissfelder, Emrullah Birgin, Nuh N Rahbari

Abstract readRandomized Controlled Trial
PubMed Publisher
In one paragraph

Trial report in Annals of surgery, 2025. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Article
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  4. Review
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4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

10 authors.

Patrick TéouleDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Niccolo DunkerDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Johanna DebatinDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Dorothée SturmDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Svetlana HetjensDepartment of Medical Statistics and Biomathematics, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Valentin WalterDepartment of Anesthesiology and Critical Care Medicine, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Erik RasbachDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Christoph ReissfelderDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Emrullah BirginDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.
Nuh N RahbariDepartment of Surgery, Universitätsmedizin Mannheim, Medical Faculty Mannheim, Heidelberg University, Mannheim, Germany.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

objectiveTo compare perioperative outcomes in patients undergoing minimally invasive liver surgery (MILR) with or without central venous pressure (CVP) reduction (≤5 mm Hg).

backgroundReduction of CVP during parenchymal transection is widely accepted in open hepatectomy to reduce intraoperative blood loss, as a major predictor of postoperative outcomes. However, the effect of CVP reduction on blood loss in MILR remains unclear.

methodsThis study is a randomized controlled, double-blinded trial. Patients undergoing elective MILR between August 2020 and April 2023 were equally randomized to either no CVP reduction (No CVP reduction group) or CVP reduction by anesthesiological interventions (CVP reduction group). The remaining perioperative care was kept identical between groups. The primary endpoint was total intraoperative blood loss.

resultsIn total, 120 patients were randomized and 112 were analyzed. Baseline characteristics did not differ between groups. Total intraoperative blood loss in MILR was equivalent between groups [No CVP reduction: 280 mL (120-560) vs CVP reduction: 360 mL (150-640); P = 0.30], despite higher CVP values during resection in the No CVP reduction group (9.3 mm Hg ± 4.2 vs 3.2 mm Hg ± 2.2; P < 0.001). Similarly, there was no difference in blood loss during parenchymal transection between the No CVP reduction (220 mL; 80-400) and the CVP reduction group (240 mL; 110-560; P = 0.39). Postoperative 90-day mortality (No CVP reduction: n=3, 5% versus CVP reduction: n=2, 4%; P = 0.68) and total morbidity rates (No CVP reduction: n = 10, 18% vs CVP reduction: n = 11, 20%; P = 0.77) were comparable. Intraoperative hemodynamic instability was less frequent in the No CVP reduction group (n = 7, 12% vs CVP reduction group: n = 16, 30%; P = 0.03).

conclusionsMILR without CVP reduction during liver transection is safe and is not associated with increased intraoperative blood loss. Moreover, a no CVP reduction strategy might prevent potential adverse effects of fluid restriction in MILR, such as hemodynamic instability.

Indexed as

Blood Loss, SurgicalCentral Venous PressureElective Surgical ProceduresHepatectomyLaparoscopyRobotic Surgical ProceduresAgedDouble-Blind MethodFemaleHumansMaleMiddle AgedTreatment Outcomeanesthesiological CVP reductionblood looshepatectomypneumoperitoneumpostoperative outcome

Identifiers

PMID40197483

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.