Tissue damage with different surgical techniques in a porcine model of liver resection: implications for living-donor liver transplantation?
OBJECTIVE
For living-donor liver transplantation (LDLT) it is of paramount importance to preserve as much viable liver tissue as possible to avoid postoperative complications in the donor and recipient. The depth of tissue damage caused by common surgical techniques for liver resection has not been studied so far.


METHODS
Here we compared the depth of tissue damage and the immunohistochemical expression of heat shock protein (HSP) 70, a marker for tissue damage, in a porcine model of liver resection, to assess the effect of different surgical techniques, i.e., blunt dissection (BD), and dissection with an ultrasound aspirator (UA), an ultrasound scalpel (US), or a water-jet (WJ).


RESULTS
Analysis with linear mixed effects models (LME) showed significantly less tissue damage with BD and UA than with US and WJ (joint p value <0.001). Damage also increased within 6 h after surgery (p value = 0.004). Semiquantitative evaluation of HSP 70 showed increased expression after resection with US compared to all other resection methods (p value <0.001), indicating increased tissue damage with this method.


CONCLUSIONS
We suggest that in cases of liver resection for LDLT surgeons should reevaluate using US and WJ because of possible excessive tissue damage compared to BD and UA. Overall we advocate the use of BD as it requires no special equipment and, hence, has considerably higher cost-effectiveness without compromising tissue preservation and clinical outcome and is readily available even in low-tech environments.
Department of General and Visceral Surgery, University Medical Center Göttingen, Robert-Koch-Strasse 40, 37075, Göttingen, Germany. agoralczyk@med.uni-goettingen.de
Armin Dietmar
AD
Goralczyk
Aiman
A
Obed
Angelika Grosse
AG
Beilage
Burckhardt
B
Sattler
Laszlo
L
Füzesi
Thomas
T
Lorf
D000818:Animals; D004195:Disease Models, Animal; D005260:Female; D018840:HSP70 Heat-Shock Proteins / Q000096:biosynthesis*; D006498:Hepatectomy / Q000009:adverse effects / Q000379:methods*; D008099:Liver / Q000378:metabolism / Q000473:pathology*; D016031:Liver Transplantation / Q000379:methods*; D019520:Living Donors; D011183:Postoperative Complications / Q000378:metabolism / Q000473:pathology*; D013552:Swine
D018840:HSP70 Heat-Shock Proteins