Techniques of liver resection

Techniques of liver resection

Techniques of Liver Resection

1.Finger Fracture/Clamp Crush

  1. CUSA
    3. Harmonic Scalpel
  2. Water Jet
  3. Ligasure
  4. Tissue Sealant Device
  5. Radio frequency Probes
  6. Vascular Staplers

Finger Fracture

Crushing of liver parenchyma with fingers  under inflow vascular occlusion to isolate vessels and bile ducts for ligation

CUSA (Cavitron Ultrasonic Surgical Aspirator)

Liver Parenchyma is fragmented with Ultrasonic energy and aspirated exposing vascular and biliary structures.

Advantages

Decreased blood loss and lower morbidity and mortality

More precise dissection plane allows wider tumor free margins

Water Jet

It uses a pressurized jet of water to fragment the liver parenchyma and isolate the vascular and biliary structures

Disadvantage

Long transection time

Increased risk of venous air embolism

Advantage

Better transection of tumor in proximity to the veins

 

 

Harmonic Scalpel

It uses Ultrasonically activated shears to seal small vessels between vibrating blades.

The blade's longitudinal vibration with a frequency of 55.5 kHz can dissect liver parenchyma easily.

The coagulation effect is caused by protein denaturation, which occurs as a result of destruction

of the hydrogen bonds in proteins and generation of heat in the vibrating tissue Blood vessels up to

2–3 mm in diameter are coagulated on contact with the vibrating blade. The tissue-cutting

effect derives from a saw mechanism in the direction of the vibrating blade.

Advantages

Useful in laparoscopic Surgery

DisAdvantage

Associated with higher rates of biliary leakage

Limited use in transection of liver parenchyma near a main hepatic vein

 

Tissue link sealant systems
 
In this instrument, saline runs to the tip of the electrode to couple RF energy to the liver surface and achieve coagulation
 
 
Radiofrequency
In this technique, a Cool-tip RF electrode (Radionics Inc., Burlington, MA, USA) is inserted along the transection plane serially 1–2 cm apart, and RF energy is applied for 1–2 min to create overlapping cylinders of coagulated tissue, followed by transection of the coagulated liver using a simple scalpel. In a preliminary study of 15 cases of mainly segmental or wedge resection reported by Weber et al. , the mean blood loss was only 30±10 ml, and no complications such as bile leakage were observed
 
Advantage
Simple
Minimal Blood Loss
 
Disadvantages
Loss of wide area of liver parenchyma
Thermal injury to viatal structures in porta or hepatic veins
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