The use of the ultrasonically activated scalpel was found to reduce the incidence of pancreatic fistula in distal pancreatectomy. Furthermore, the use of this device without any clamping or parenchymal suturing may reduce the damage to the remnant pancreas.

We describe herein our technique of performing extensive resection of the liver by blunt dissection in combination with excision using a harmonic scalpel. A ball coagulator was inserted at 3-cm intervals along the proposed cutting line in the liver, and the liver parenchyma between these holes was then cut using coagulation shears. Regardless of the condition of the liver, good coagulation and cutting were achieved using the harmonic scalpel without vascular occlusion when dividing the shallow layer of the liver, and no complications in association with the harmonic scalpel, such as postoperative bleeding, bile leakage, or abscess formation at the cut margins, occurred. In the deep layer below the main trunk of the hepatic vein, blunt dissection was used, since it was difficult to achieve sufficient control of bleeding from large vessels using the harmonic scalpel alone. Therefore, when used in combination with other techniques, the harmonic scalpel appears to be an effective device for liver surgery that minimizes bleeding and decreases the vascular clamping time.

No abstract

Leiomyosarcomas with a cartilaginous matrix are extremely rare. A 72-year-old man presented with a mass approximately the size of a hen's egg, on the posterior wall of the lesser curvature of the stomach, near the esophagogastric junction. On endoscopic ultrasonography, the size of the tumor was estimated to be 30x20 mm. On histopathological exmination of sections of the lesion stained with hematoxylin and eosin, the tumor was found to be composed of densely packed spindle cells with mitotic figures. A hyaline-like matrix was seen at the center of the tumor. This matrix contained cells with vacuoles around the nuclei. On immunohistochemical staining, the tumor cells stained positively for vimentin and desmin. The cartilaginous portion of the tumor was positive for S-100 protein. We describe herein our experience and discuss similar cases reported in the literature. (Dig Endosc 1997 ; 9 : 1 4 1 -146)