title: Combined blunt-clamp dissection and LigaSure ligation for hepatic parenchyma dissection: postcoagulation technique.
abstract: BACKGROUND
  Blunt-clamp dissection allows for visualization of intrahepatic vessels and individual ligation of major blood or bile vessels. Recently, many instruments have been developed for "precoagulation" of liver parenchyma before sharp transection, but suffer from the possibility of injuring major blood and biliary vessels that are not well-visualized, along with high cost. In this article, we describe a "postcoagulation" technique combining clamp dissection and sealing of vessels under direct vision using a tissue-sealing device.
  
  
  METHODS
  Clinical evaluation of 400 patients from 2 centers subjected to liver resection using this technique.
  
  
  RESULTS
  There were no cases complicated by hemorrhage. There was an incidence of 1.8% for bile leaks. This low incidence of biloma formation was seen even with the high incidence (49%) of abnormal parenchyma encountered in this cohort.
  
  
  CONCLUSIONS
  Combining the clamp-crushing method with use of the LigaSure device (Valleylab) allows identification of intraparenchymal vessels followed by sealing. This method of parenchymal transaction optimizes ease of use with confidence in vessel ligation.
authors.affiliation: University Hospital Dubrava Zagreb, Zagreb, Croatia.
authors.forename: Leonardo
authors.initials: L
authors.lastname: Patrlj
authors.forename: Scott
authors.initials: S
authors.lastname: Tuorto
authors.forename: Yuman
authors.initials: Y
authors.lastname: Fong
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D004066:Digestive System Diseases / Q000601:surgery; D004210:Dissection / Q000379:methods; D005260:Female; D006488:Hemostasis, Surgical / Q000379:methods; D006498:Hepatectomy / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D008026:Ligation / Q000379:methods*; D008297:Male; D008875:Middle Aged; D013525:Surgical Instruments; D013536:Suture Techniques / Q000295:instrumentation*; D016896:Treatment Outcome