Liver segmentectomy as anatomically precise resections. An experimental study in sheep.
OBJECTIVE
To assess a new technique of anatomically precise hepatic segmental resection and to compare the degree of precision and biochemical profiles with results after traditional segmental resection and a sham operation.


METHODS
Experimental study.


METHODS
University hospital, Germany.


METHODS
50 sheep (10 each had segments II, III, and IV removed by the new technique, and 10 each were studied in the traditional resection and sham operated groups).


METHODS
Operative ultrasonography and injection of methylene blue to identify segmental boundaries. In traditional operations boundaries were identified only from knowledge of the surface structure of the liver.


METHODS
Degree of precision, duration of operation, blood loss, mortality, transaminase activities and liver function tests.


RESULTS
Anatomically precise segmentectomies were achieved in 6/9 (67%) for segment II, 6/9 (67%) for segment III, and 4/8 (50%) for segment IV. Using the traditional technique (segment III only) there was only 1/10 anatomically precise resections, together with 5 perisegmentectomies and 4 incomplete resections (p < 0.02). The operations for anatomically precise resection lasted significantly longer, but resection time was similar. Blood loss, survival, and transaminase activities were similar for the two groups, but the margin of necrosis at the cut edge was significantly less in anatomically precise resections.


CONCLUSIONS
Anatomically precise hepatic resections are technically feasible with the use of intraoperative ultrasonography and selective staining of the segment(s) to be removed with methylene blue. Although it takes longer, there are no detrimental consequences compared with the considerably less accurate traditional technique.
Department of Surgery, Hannover Medical School, Germany.
H
H
Lang
A
A
Junge
H
H
Sitter
H J
HJ
Klotter
W
W
Lorenz
M
M
Rothmund
D000818:Animals; D004396:Coloring Agents; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D008099:Liver / Q000000981:diagnostic imaging / Q000473:pathology; D008297:Male; D009336:Necrosis; D012756:Sheep; D014463:Ultrasonography
D004396:Coloring Agents