title: High-intensity focused ultrasound (HIFU)-assisted hepatic resection in an animal model.
abstract: BACKGROUND
  Bleeding is the main cause of postoperative complications of hepatic surgery. To minimize intraoperative bleeding during hepatectomy, resections are generally carried out under hepatic vascular control despite the risk of liver dysfunction in patients with chronic liver disease. This study evaluates the feasibility and safety of high-intensity focused ultrasound (HIFU)-assisted hepatic resection during an open procedure in an animal model.
  
  
  METHODS
  Three groups of 12-14-week-old Landrace pigs (n = 7/group) were used to evaluate HIFU-assisted liver resection (group A) vs liver resection with or without portal triad clamping (groups B and C). In each pig, liver resection was performed on the right and left paramedian lobes. The following were evaluated and compared in the 3 groups: total blood loss, blood loss/cm(2) of resection area, clip density, procedure duration, morbidity, and mortality.
  
  
  RESULTS
  Median blood loss was significantly lower in group A than in group B (P = .02), and group C (P = .007). Median blood loss/cm(2) of resection area was 4.77 mL/cm² in group A, 11.35 mL/cm² in group B, 12.22 mL/cm² in Group C. Precoagulation resulted in sealing blood vessels <5 mm; therefore, median clip density during liver transection was 0.78 clip/cm² in group A, 1.61 clip/cm(2) in group B, and 1.57 clip/cm(2) in group C. Median duration of the surgical procedure was 12 min in group A, 21 min in group B, and 19 min in group C.
  
  
  CONCLUSIONS
  HIFU-assisted hepatic resection during an open procedure in an animal model is safe, reduces bleeding, and allows real-time ultrasound guidance.
authors.affiliation: Institut de chirurgie expérimentale, CRLCC Léon Bérard, Lyon, France. alessandro_gandini@fastwebnet.it
authors.forename: Alessandro
authors.initials: A
authors.lastname: Gandini
authors.forename: David
authors.initials: D
authors.lastname: Melodelima
authors.forename: Francesco
authors.initials: F
authors.lastname: Schenone
authors.forename: Apoutou William
authors.initials: AW
authors.lastname: N'Djin
authors.forename: Jean Yves
authors.initials: JY
authors.lastname: Chapelon
authors.forename: Michel
authors.initials: M
authors.lastname: Rivoire
mesh_terms: D000818:Animals; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001810:Blood Volume; D003250:Constriction; D006488:Hemostasis, Surgical / Q000295:instrumentation / Q000379:methods*; D006498:Hepatectomy / Q000295:instrumentation / Q000379:methods*; D057086:High-Intensity Focused Ultrasound Ablation / Q000009:adverse effects; D008099:Liver / Q000033:anatomy & histology / Q000601:surgery*; D061646:Operative Time; D018709:Statistics, Nonparametric; D013552:Swine