Techniques of Liver Resection
1.Finger Fracture/Clamp Crush
3. Harmonic Scalpel
- Water Jet
- Tissue Sealant Device
- Radio frequency Probes
- Vascular Staplers
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.
Decreased blood loss and lower morbidity and mortality
More precise dissection plane allows wider tumor free margins
It uses a pressurized jet of water to fragment the liver parenchyma and isolate the vascular and biliary structures
Long transection time
Increased risk of venous air embolism
Better transection of tumor in proximity to the veins
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.
Useful in laparoscopic Surgery
Associated with higher rates of biliary leakage
Limited use in transection of liver parenchyma near a main hepatic vein