Initial experience with the harmonic scalpel in liver surgery.
OBJECTIVE
Hepatectomies are generally performed using a crushing clamp or by finger fracture. New instruments such as ultrasonic aspirators or water jet dissectors are increasingly used for precise dissection of intrahepatic structures. An ultrasonically activated scalpel has been introduced, mainly for laparoscopic procedures. The potential of this instrument in liver surgery remains to be defined.


METHODS
In a prospective study, we have tested the harmonic scalpel (Ultracision, Ethicon Endo-surgery) in 16 consecutive patients undergoing liver surgery. The ease of parenchymal dissection and the hemostatic effect of the ultrasonically vibrating blade was assessed in each operation. Blood loss and transfusions were recorded.


RESULTS
One patient underwent excision of a liver cyst and 15 patients 16 hepatectomies for colorectal metastases (7 cases), hepatocarcinoma (5 cases) and other benign or malignant conditions (4 cases). The liver was cirrhotic in 4 cases. The performance of the harmonic scalpel for dissection, cutting and hemostasis was good or excellent in 16 operations, and poor in 1 hepatectomy in a cirrhotic liver. Median blood loss was 400 mL (range: 0-1200 mL) and 4 patients received blood transfusions.


CONCLUSIONS
The harmonic scalpel allows efficient section of liver parenchyma, precise dissection of intrahepatic structures, good hemostasis and section of small intrahepatic vessels.
Department of Surgery, Ospedale San Giovanni, Bellinzona, Switzerland.
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Gertsch
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Pelloni
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Guerra
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Krpo
D000328:Adult; D000368:Aged; D003560:Cysts / Q000601:surgery; D004210:Dissection / Q000295:instrumentation; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D008107:Liver Diseases / Q000601:surgery; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies