Metzenbaum-Assisted Liver Resection: A Safe and Effective Liver Resection Technique

Abstract

Aim: We hereby present and evaluate a technique for hepatic parenchymal transection based on the application of Metzenbaum scissors and clips during liver ischemia. Methods: Our technique was retrospectively evaluated in 32 noncirrhotic, noncholestatic patients with intrahepatic cholangiocarcinoma and 32 patients with hepatocellular carcinoma (23 of whom cirrhotic, 71.9%). Patient data were retrieved from our Hepatobiliary Surgery Database. Type and duration of vascular clamping, blood transfusion requirements, marginal status and immediate postoperative complications were analyzed. Results: Twenty-seven extended (>4 liver segments; 42.2%) and 37 nonextended (≤4 liver segments; 57.8%) liver resections were analyzed. Warm liver ischemia duration was 14 (interquartile range: 11-17.8) min. Thirty-three patients (51.6%) were transfused with a median of 2 (1.5-3) units of packed red blood cells. Tumor-free margins were achieved in 90.6% of cases (n = 58). The overall morbidity rate was 18.8% with a 4.7% mortality rate. Our technique allowed for excellent identification and safe dissection and preservation, or ligation of major liver vessels. Conclusions: The proposed technique is simple, fast, safe and with low cost. It is associated with limited postoperative complications while from an oncologic standpoint it enables the surgeon to achieve a high percentage of tumor-free margins while protecting major vascular structures. i 2014 S. Karger AG, Basel

Feasibility and safety of liver transplantation or resection after transarterial radioembolization with Yttrium-90 for unresectable hepatocellular carcinoma

“…TARE was performed using glass microspheres (TheraSphere ® , BTG, United Kingdom). 10 Post-TARE delivery Bremsstrahlung SPET-CT was performed routinely for all patients. Per Institutional protocol, patients were discharged home 2-4 h after the procedure.…”

“…Parenchymal transection was performed using CUSA (Integra ® , CUSA ® ) or Metzenbaum-assisted liver resection (MALR) as previously described. 10 Minor structures (<5 mm) were clipped; larger intrahepatic vascular or ductal structures were dissected, exposed and suture ligated preventing devascularization of the surrounding liver tissue. Argon beam coagulation was employed to obtain hemostasis along the cut edge of the liver when needed.…”