title: Improvements in hepatic parenchymal transection for living related liver donor.
abstract: BACKGROUND
  To eliminate mortality and morbidity risk in living related liver donors, we developed a new surgical technique to resect hepatic parenchyma using an ultrasonic surgical aspirator in association with a monopolar floating ball cautery.
  
  
  METHODS
  We performed 17 right hepatectomies and 2 left hepatectomies using this technique. We performed a retrospective analysis of perioperative mortality, length of hospitalization (LOS), blood transfused during surgery (IBT), intraoperative blood lost (IBL), biliary complications (BC), and aspartate aminotransferase (AST)/alanine aminotransferase (ALT) peak in the first postoperative week. This group of patients (Group A) was compared, using the analysis of variance (ANOVA) test (P < .05) with 2 different groups of 19 patients: Group B with liver neoplasms that had the same technique as Group A, and Group C wherein a crushing clamp technique was used.
  
  
  RESULTS
  All of the analyzed variables showed significative statistical differences, especially between Group A and Group C (IBL, P < .000; IBT, P < .006; LOS, P < .028; BC, P < .000; AST peak, P < .041; and ALT peak, P < .023).
  
  
  CONCLUSIONS
  The association of these 2 techniques seems to reduce the LOS, and the need for intraoperative blood transfusions. Moreover, the surgical complications (biliary leaks) and the postoperative parenchymal cytonecrosis seem to be less using this technique.
authors.affiliation: Department of Surgery, Istituto Mediterraneo per i Trapianti e Terapie ad Alta Specializzazione IsMeTT-UPMC Italy, Palermo, Italy. sgruttadauria@ismett.edu
authors.forename: S
authors.initials: S
authors.lastname: Gruttadauria
authors.forename: L
authors.initials: L
authors.lastname: Mandalà
authors.forename: F
authors.initials: F
authors.lastname: Vasta
authors.forename: D
authors.initials: D
authors.lastname: Cintorino
authors.forename: A
authors.initials: A
authors.lastname: Musumeci
authors.forename: W
authors.initials: W
authors.lastname: Marsh
authors.forename: A
authors.initials: A
authors.lastname: Marcos
authors.forename: B
authors.initials: B
authors.lastname: Gridelli
mesh_terms: D000328:Adult; D000704:Analysis of Variance; D016063:Blood Loss, Surgical; D001803:Blood Transfusion; D005190:Family; D005705:Gallbladder Diseases / Q000453:epidemiology; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality; D006801:Humans; D007431:Intraoperative Complications; D007902:Length of Stay; D008111:Liver Function Tests; D016031:Liver Transplantation / Q000379:methods / Q000401:mortality; D019520:Living Donors; D008875:Middle Aged; D012189:Retrospective Studies; D020858:Tissue and Organ Harvesting / Q000379:methods / Q000401:mortality