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New Simple Technique for Hepatic Parenchymal Resection Using a Cavitron Ultrasonic Surgical Aspirator® and Bipolar Cautery Equipped with a Channel for Water Dripping
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New Simple Technique for Hepatic Parenchymal Resection Using a Cavitron Ultrasonic Surgical Aspirator® and Bipolar Cautery
Equipped with a Channel for Water Dripping
Yuzo Yamamoto1, Iwao Ikai1, Makoto Kume1, Yoshiharu Sakai1, Akira Yamauchi1, Hisashi Shinohara1, Taisuke Morimoto1, Yasuyuki Shimahara1, Masayuki Yamamoto1 and Yoshio Yamaoka1
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Department of Gastroenterological Surgery, Kyoto University, Graduate School of Medicine, 54 Kawahara-cho, Shogoin, Sakyo-ku,
Kyoto 606-8507, Japan, JP |
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.
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