Open Hepatic Transection Using Kelly Clamp

Abstract

Minimization of blood loss during hepatic resection still remains a major concern for liver surgeons. Thus, surgical techniques and devices have been developed to achieve control of blood loss, although the safety of hepatic resection itself has already been established. The method used for liver transection has been considered to be the most critical factor influencing intraoperative blood loss. We prefer to use the conventional Kelly clamp method, because this method is safe, quick, and inexpensive. In the Kelly clamp method, no special device is required except for forceps as used in usual surgery. Forceps of adequate size and shape to clamp a small amount of liver parenchyma is selected according to the stiffness of the liver and the situation of the resection. The keys to the Kelly clamp method are:

• 1. Crushing of a certain amount of liver parenchyma using a Péan forceps

• 2. Aspiration of the crushed tissues using an aspirator

• 3. Ligation and division of the remaining structures including vessels and bile ducts

The Kelly clamp method (clamp-crushing method) is a simple and certain method for hepatic parenchymal division, and mastering the method would lead to safer liver surgery.