title: Fusion technique for liver transection with Kelly-clysis and harmonic technology.
abstract: BACKGROUND
  Various devices are available for liver transection and comparative data on transection techniques are limited by the diversity of operative procedures. Clamp crushing (Kelly-clysis) with a Cavitron ultrasonic surgical aspirator (CUSA-Integra Radionics) is widely used for splitting the liver parenchyma. Hemostasis is achieved by bipolar coagulation, ligatures, or hemoclips. We introduce a fusion technique (Focus-clysis) for liver transection using a combination of Kelly-clysis and harmonic technology.
  
  
  METHODS
  A fusion technique (FT) was performed using FOCUS, a Kelly clamp like instrument attached to a Harmonic generator. Hepatic resections (nine major, nine minor) were performed with the fusion technique in 18 non-cirrhotic patients. Variables evaluated were blood loss, transection time, biliary leak, postoperative liver function, morbidity, and cost-effectiveness. The results were compared with 18 hepatic resections (nine major, nine minor) that were performed with our earlier technique, i.e., CUSA with bipolar cautery, ligatures, and hemoclips.
  
  
  RESULTS
  The mean blood loss was 416 ml in the FT group, compared to 833 ml in the CUSA group. Two patients in the FT group needed blood transfusion in the first 48 h, whereas eight patients in the CUSA group had transfusions. No major postoperative liver dysfunction was noted with the new technique, and postoperative morbidity was lower in the FT group. Liver transection with the fusion technique was faster.
  
  
  CONCLUSIONS
  The fusion technique (Focus-clysis) using Kelly-clysis and harmonic technology is promising, easy, and effective for liver transection. Our initial results show advantages over the routinely used CUSA/bipolar combination. The fusion technique could be a new option for liver transection, especially in non-cirrhotic patients.
authors.affiliation: Department of Surgical Oncology, Lilavati Hospital and Research Centre, Bandra Reclamation, Bandra (West), Mumbai, India. drjagannath@gmail.com
authors.forename: P
authors.initials: P
authors.lastname: Jagannath
authors.forename: D G
authors.initials: DG
authors.lastname: Chhabra
authors.forename: K R
authors.initials: KR
authors.lastname: Sutariya
authors.forename: R C
authors.initials: RC
authors.lastname: Shah
mesh_terms: D000328:Adult; D000368:Aged; D004564:Electrocoagulation / Q000295:instrumentation; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation*; D006498:Hepatectomy / Q000295:instrumentation*; D006801:Humans; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D016896:Treatment Outcome; D014464:Ultrasonic Therapy / Q000295:instrumentation*