title: Sharp liver transection versus clamp crushing technique in liver resections: a prospective study.
abstract: BACKGROUND
  Parenchymal liver transection constitutes an important phase of liver resection. Serious intraoperative bleeding, together with injuries to vital structures of the liver remnant, can occur during this stage. A method of sharp liver parenchymal transection with scalpel is compared in a prospective randomized manner with the widely used clamp crushing technique.
  
  
  METHODS
  Patients scheduled for hepatectomy under selective hepatic vascular exclusion (N = 82) were allocated randomly to either the sharp transection group (n = 41) or the clamp crushing group (n = 41). Warm ischemic time, blood loss and transfusions, postoperative morbidity and mortality, and tumor-free margins were recorded in both groups and analyzed.
  
  
  RESULTS
  When the sharp transection group was compared with the clamp crushing group, the two groups were similar in warm ischemic time (median 36 vs 34 minutes), total operative time (median 205 vs 211 minutes), intraoperative blood loss (median 500 vs 460 mL), blood transfusion requirements (median value 0 in both groups), and overall complication rate (44% vs 39%). However, sharp transection yielded better tumor-free margins compared with the clamp crushing technique (12 +/- 1.4 mm vs 8 +/- 1.5 mm, mean +/- SD, P < .05).
  
  
  CONCLUSIONS
  Sharp liver parenchymal transection with a scalpel is equally safe in terms of blood loss and mortality compared with the clamp crushing method. Although it is a technically demanding method, requiring selective hepatic vascular occlusion, it may be recommended when the tumor-free margins are anticipated to be narrow.
authors.affiliation: Second Department of Surgery,Athens University Medical School, Aretaieion Hospital, Greece.
authors.forename: Vassilios
authors.initials: V
authors.lastname: Smyrniotis
authors.forename: Nikolaos
authors.initials: N
authors.lastname: Arkadopoulos
authors.forename: Georgia
authors.initials: G
authors.lastname: Kostopanagiotou
authors.forename: Charalampos
authors.initials: C
authors.lastname: Farantos
authors.forename: John
authors.initials: J
authors.lastname: Vassiliou
authors.forename: John
authors.initials: J
authors.lastname: Contis
authors.forename: Eleni
authors.initials: E
authors.lastname: Karvouni
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality; D002648:Child; D002675:Child, Preschool; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D007223:Infant; D007511:Ischemia / Q000401:mortality; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000401:mortality; D011446:Prospective Studies; D013525:Surgical Instruments; D013696:Temperature; D016896:Treatment Outcome