Advertisement

World Journal of Surgery

, 34:101 | Cite as

Fusion Technique for Liver Transection with Kelly-Clysis and Harmonic Technology

  • P. JagannathEmail author
  • D. G. Chhabra
  • K. R. Sutariya
  • R. C. Shah
Article

Abstract

Background

Various devices are available for liver transection and comparative data on transection techniques are limited by the diversity of operative procedures. Clamp crushing (Kelly-clysis) with a Cavitron ultrasonic surgical aspirator (CUSA—Integra Radionics) is widely used for splitting the liver parenchyma. Hemostasis is achieved by bipolar coagulation, ligatures, or hemoclips. We introduce a fusion technique (Focus-clysis) for liver transection using a combination of Kelly-clysis and harmonic technology.

Materials and method

A fusion technique (FT) was performed using FOCUS, a Kelly clamp like instrument attached to a Harmonic generator. Hepatic resections (nine major, nine minor) were performed with the fusion technique in 18 non-cirrhotic patients. Variables evaluated were blood loss, transection time, biliary leak, postoperative liver function, morbidity, and cost-effectiveness. The results were compared with 18 hepatic resections (nine major, nine minor) that were performed with our earlier technique, i.e., CUSA with bipolar cautery, ligatures, and hemoclips.

Results

The mean blood loss was 416 ml in the FT group, compared to 833 ml in the CUSA group. Two patients in the FT group needed blood transfusion in the first 48 h, whereas eight patients in the CUSA group had transfusions. No major postoperative liver dysfunction was noted with the new technique, and postoperative morbidity was lower in the FT group. Liver transection with the fusion technique was faster.

Conclusion

The fusion technique (Focus-clysis) using Kelly-clysis and harmonic technology is promising, easy, and effective for liver transection. Our initial results show advantages over the routinely used CUSA/bipolar combination. The fusion technique could be a new option for liver transection, especially in non-cirrhotic patients.

Keywords

Inferior Vena Cava Fusion Technique Major Liver Resection Ultrasonic Dissector Bipolar Coagulation 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

Supplementary material

Supplementary material 1 (WMV 5.74 MB)

Supplementary material 2 (WMV 8.78 MB)

Supplementary material 3 (WMV 6.17 MB)

References

  1. 1.
    Minagawa M, Makuuchi M, Torzilli G et al (2000) Extension of the frontiers of surgical indications in treatment of liver metastases from colorectal cancer: long-term results. Ann Surg 231:487–499CrossRefPubMedGoogle Scholar
  2. 2.
    Belghiti J, Hiramatsu K, Benoist S et al (2000) Seven hundred forty-seven hepatectomies in the 1990s: an update to evaluate the actual risk of liver resection. J Am Coll Surg 191:38–46CrossRefPubMedGoogle Scholar
  3. 3.
    Fong Y, Fortner J, Sun RL et al (1999) Clinical score for predicting recurrence after hepatic resection for metastatic colorectal cancer: analysis of 1001 consecutive cases. Ann Surg 230:309–318CrossRefPubMedGoogle Scholar
  4. 4.
    Kooby DA, Stockman J, Ben-Porat L et al (2003) Influence of transfusions on perioperative and long-term outcome in patients following hepatic resection for colorectal metastases. Ann Surg 237:860–869 (discussion 869–870)CrossRefPubMedGoogle Scholar
  5. 5.
    Yamamoto Y, Ikai I, Kume M et al (1999) New simple technique for hepatic parenchymal resection using a Cavitron Ultrasonic Surgical Aspirator with bipolar cautery equipped with a channel for water dripping. World J Surg 23:1032–1037CrossRefPubMedGoogle Scholar
  6. 6.
    Fan ST, Lai EC, Lo CM et al (1996) Hepatectomy with an ultrasonic dissector for hepatocellular carcinoma. Br J Surg 83:117–120CrossRefPubMedGoogle Scholar
  7. 7.
    Nakayama H, Masuda H, Shibata M et al (2003) Incidence of bile leakage after three types of hepatic parenchymal transection. Hepatogastroenterology 50:1517–1520PubMedGoogle Scholar
  8. 8.
    Taniai N, Onda M, Tajiri T et al (2002) Hepatic parenchymal resection using ultrasonic surgical aspirator with electrosurgical coagulation. Hepatogastroenterology 49:1649–1651PubMedGoogle Scholar
  9. 9.
    Rau HG, Wichmann MW, Schinkel S et al (2001) Surgcal techniques in hepatic resections: ultrasonic aspirator versus Jet-cutter. A prospective randomized clinical trial. Zentralbl Chir 126:586–590CrossRefPubMedGoogle Scholar
  10. 10.
    Takayama T, Makuuchi M, Kubota K et al (2001) Randomized comparison of ultrasonic vs clamp transection of liver. Arch Surg 136:922–928CrossRefPubMedGoogle Scholar
  11. 11.
    Lesuretl M, Selzner M, Petrowsky H et al (2005) How should transection of liver be performed? A prospective randomized study in 100 consecutive patients: comparing four different transection strategies. Ann Surg 242:814–822CrossRefGoogle Scholar
  12. 12.
    Huguet C, Gavelli A, Chieco PA et al (1992) Liver ischemia for hepatic resection: where is the limit? Surgery 111:251–259PubMedGoogle Scholar
  13. 13.
    Huguet C, Gavelli A, Bona S (1994) Hepatic resection with ischemia of the liver exceeding one hour. J Am Coll Surg 178:454–458PubMedGoogle Scholar
  14. 14.
    Kimura F, Miyazaki M, Suwa T et al (2002) Evaluation of total hepatic vascular exclusion and Pringle maneuver in liver resection. Hepatogastroenterology 49:225–230PubMedGoogle Scholar
  15. 15.
    Abdalla EK, Noun R, Belghiti J (2004) Hepatic vascular occlusion: which technique? Surg Clin North Am 84:563–585CrossRefPubMedGoogle Scholar
  16. 16.
    Reed DN Jr, Vitale GC, Wrightson WR et al (2003) Decreasing mortality of bile leaks after elective hepatic surgery. Am J Surg 185:316–318CrossRefPubMedGoogle Scholar

Copyright information

© Société Internationale de Chirurgie 2009

Authors and Affiliations

  • P. Jagannath
    • 1
    Email author
  • D. G. Chhabra
    • 1
  • K. R. Sutariya
    • 1
  • R. C. Shah
    • 1
  1. 1.Department of Surgical OncologyLilavati Hospital and Research CentreMumbaiIndia

Personalised recommendations