New Simple Technique for Hepatic Parenchymal Resection Using a Cavitron Ultrasonic Surgical Aspirator® and Bipolar Cautery Equipped with a Channel for Water Dripping

Abstract

We have developed a new technique to resect hepatic parenchyma without inflow occlusion by using the Cavitron Ultrasonic Surgical Aspirator (CUSA) and bipolar cautery with a saline irrigation system. The significance of this method in hepatectomy was analyzed in comparison with historical control of hepatectomy using Pringle's maneuver. An ordinary bipolar cautery was remodeled with an infusion line to bring saline droplets down the inner surface of one arm of the tweezers through an opening about 1.5 cm proximal to its tip. The optimal flow rate of saline was approximately one drop per second. The power of bipolar cautery was adjusted to 50 watts. When the tweezer blades were approximated to 1 or 2 mm, saline droplets were directed to the tip of tweezers and could be immediately evaporated. After sonicating parenchymal cells, the tissue of small branches of Glisson's tree or small tributaries of the hepatic vein were coagulated by bipolar cautery. The coagulated cords were then easily cut by scissors. The impact of this technique on ordinary liver resections was evaluated by analyzing the postoperative clinical course in relation to the hepatic functional reserve necessary for major hepatectomy, duration of hepatectomy, and intraoperative blood loss. Hepatic resection without vascular occlusion using this technique could decrease the morbidity in patients who have less hepatic functional reserve. It could also decrease intraoperative blood loss. This new technique effectively decreased the surgical load of the remnant liver during parenchymal resection by avoiding ischemic stress. Consequently it extends the safety limits of major hepatectomy.

ICG Clearance Test and 99mTc-GSA SPECT/CT Fusion Images

“…Takasaki et al [32] proposed that rem K ICG > 0.062 is a safety threshold for postoperative mortality [32]. Other investigators also reported that postoperative morbidity was low in patients with rem K ICG > 0.06 after a major hepatectomy [46], or that rem K ICG 0.05 was a threshold for survival in patients with bile duct cancer who underwent preoperative PVE [47]. More recently, on the basis of statistical analysis, a rem K ICG of 0.05 has been again reported as a useful cut-off value for predicting mortality and morbidity in patients with biliary cancer [48,49].…”

Hepatic Resection for Hepatocellular Carcinoma with Tumor Thrombus in the Major Portal Vein

“…Hepatic parenchymal dissection was performed using an ultrasonic surgical aspirator and bipolar irrigation forceps [16] . Tumor thrombi confined to the first branch of the portal vein were resected with the liver.…”

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

“…Advances in technology have elaborated the techniques for parenchymal transection during hepatectomy from the classic clamp crushing technique [18] to a combination of various sophisticated devices [19,20,21]. …”