Segmental Hepatic Resection Utilizing the Ultrasonic Dissector

Andrus, Charles H.

doi:10.1001/archsurg.1986.01400050025003

Cited by 49 publications

(15 citation statements)

References 6 publications

(3 reference statements)

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“…None of the instruments developed for transection is completely adequate for division and hemostasis, and most liver transections are performed using a combination of instruments and techniques [9][10][11][12][13][14]17,18].…”

Section: Discussionmentioning

confidence: 99%

“…Intraoperative ischemia following inflow occlusion may add another risk factor for postoperative liver failure. Therefore any technique that avoids the routine use of inflow occlusion is recommended in these not uncommon circumstances; this has led to the development of several devices for liver transection that precludes inflow occlusion [10][11][12][13][14]. However, these instruments are expensive and not always available, especially in centers with low economic resources.…”

Section: Discussionmentioning

confidence: 99%

“…The most popular devices that can facilitate liver transection include: ultrasonic dissector [10], water jet [11], radiofrequency devices [12], salinelinked cautery [13], bipolar cautery [3], and harmonic scalpel [14]. These devices are often expensive and therefore not available worldwide, especially in centers with low economic resources.…”

Section: Introductionmentioning

confidence: 99%

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Silkclasy: A simple way for liver transection during anatomic hepatectomies

Herman

Machado

2006

Journal of Surgical Oncology

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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Silkclasy: A simple way for liver transection during anatomic hepatectomies

Herman

Machado

2006

Journal of Surgical Oncology

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“…In Europe and Japan the nomenclature most commonly used by surgeons and radiologists is based on the description introduced by Couinaud [30] and Bismuth [31]. In American and British publications the terminology proposed by Goldsmith and Woodburne [32] was generally employed; however, Couinaud's classification has recently also permeated the English North American radiology and surgery literature [6,33,34,35]. Couinaud's system distinguishes two lobes and four segments (Fig.…”

Section: Descriptive Liver Anatomymentioning

confidence: 99%

Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging

et al. 2003

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The segmental anatomy of the human liver has become a matter of increasing interest to the radiologist, especially in view of the need for an accurate preoperative localization of focal hepatic lesions. In this review article first an overview of the different classical concepts for delineating segmental and subsegmental anatomy on US, transaxial CT, and MR images is given. Essentially, these procedures are based on Couinaud's concept of three vertical planes that divide the liver into four segments and of a transverse scissura that further subdivides the segments into two subsegments each. In a second part, the limitations of these methods are delineated and discussed with the conclusion that if exact preoperative localization of hepatic lesions is needed, tumor must be located relative to the avascular planes between the different portal territories.

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“…Advances in hepatic surgery have in creased the possibilities for segmental hepatic resection [1][2][3][4], and the importance of the hepatic vein in liver surgery is now more widely recognized [5]. However, in some cases, segmental hepatic resection cannot be done without combined resection of the ma jor hepatic vein, as when a tumor is located near the confluence of the hepatic vein.…”

Section: Introductionmentioning

confidence: 99%

Changes in Hepatic Hemodynamics and Oxygen Consumption after Partial Hepatic Congestion in Dogs

Yamamoto

Nimura²,

Yasui³

et al. 1992

Eur Surg Res

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The effects of 66 % hepatic congestion (group 2, n = 6) on liver blood flow and hepatic oxygen metabolism were investigated in anesthetized dogs using an ultrasonic transit time flowmeter. The results were compared with those for control dogs (group 1, n = 6) and for 60% hepatectomized dogs (group 3, n = 6) wherein almost the same amount of hepatic parenchyma was removed as was congested in group 2. Portal blood flow (PVF) in group 2 and group 3 decreased similarly to 60 and 63 % of the baseline values, respectively (p < 0.05). Cardiac output (CO) in group 2 and group 3 also decreased significantly in proportion to the decrease in PVF. Among the dogs in group 2, hepatic arterial blood flow (HAF) was fairly well maintained at 86% of the baseline value, despite the decrease of cardiac output, whereas the HAF in group 3 decreased to 49 % of the baseline value at 1 h after hepatectomy. The calculated hepatic arterial resistance (HAR) in group 3 increased significantly due to the 60 % loss of the hepatic arterial vascular bed. The HAR in group 2, by contrast, became lower than that in group 1, suggesting a compensatory decrease of HAR for the obstructed portal flow to the congested area. These results were well consistent with our angiographic findings (n = 3) that the portal flow to the congested segments was completely obstructed and the congested segments received only an arterial blood supply. The centrilobular hepatocytes of the congested segments showed marked vacuolar degeneration and the total hepatic oxygen consumption in group 2 was reduced (p < 0.05). However, the decrease in oxygen consumption in group 2 was not so severe as in group 3 (p < 0.05). These data suggest that some parts of the preserved congested segments were still viable and had the capacity of aerobic metabolism even 4 h after the ligation of the drainage vein of those segments. In this study, the importance of the hepatic arterial flow to the congested segment has been demonstrated. When the congested hepatic segment is to be preserved intraoperatively, care must be taken to maintain the hepatic arterial blood flow during the perioperative period.

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Segmental Hepatic Resection Utilizing the Ultrasonic Dissector

Cited by 49 publications

References 6 publications

Silkclasy: A simple way for liver transection during anatomic hepatectomies

Silkclasy: A simple way for liver transection during anatomic hepatectomies

Limitations and pitfalls of Couinaud's segmentation of the liver in transaxial Imaging

Changes in Hepatic Hemodynamics and Oxygen Consumption after Partial Hepatic Congestion in Dogs

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