title: Silkclasy: a simple way for liver transection during anatomic hepatectomies.
abstract: BACKGROUND
  Parenchymal transection is the most important step of liver resection, and during this phase, blood loss may lead to morbidity and mortality. Liver parenchyma can be transected by different ways such as finger fracture, clamp crushing, or instrument-based techniques.
  
  
  METHODS
  A simple and cost-efficient method has been developed for liver transection using a technique based on silk crushing of the liver substance.
  
  
  RESULTS
  We have successfully employed this technique in 278 consecutive liver resections from July 2001 to March 2006. The average duration of hepatic transection varied according to the type of liver resection: 22 min (range 15-42), 19 min (range 11-37), and 12 min (range 7-21) for right hepatectomy, left hepatectomy, and bisegmentectomy 2-3, respectively. The mean transection speed was 6.9 +/- 2.3 cm(2)/min. Blood transfusions were necessary in 42 patients (15.1%), and there were three operative deaths (1.1%). Morbidity rate was 20.9% (58 patients).
  
  
  CONCLUSIONS
  This technique allows a safe and quick liver transection without the use of expensive hemostatic devices, and also precludes the use of inflow occlusion maneuvers. We recommend the use of this technique in centers with low economic resources.
authors.affiliation: Department of Gastroenterology, University of São Paulo, São Paulo, Brazil.
authors.forename: Paulo
authors.initials: P
authors.lastname: Herman
authors.forename: Marcel Autran C
authors.initials: MA
authors.lastname: Machado
authors.forename: Marcel C C
authors.initials: MC
authors.lastname: Machado
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015179:Colorectal Neoplasms / Q000556:secondary; D003362:Cost-Benefit Analysis; D005260:Female; D006489:Hemostatic Techniques; D006498:Hepatectomy / Q000191:economics* / Q000379:methods*; D006801:Humans; D008099:Liver / Q000033:anatomy & histology*; D008113:Liver Neoplasms / Q000556:secondary / Q000601:surgery; D008297:Male; D008875:Middle Aged; D047011:Silk
chemical_list: D047011:Silk