title: Surgical outcome of liver transection by the crush-clamping technique combined with Harmonic FOCUS™.
abstract: BACKGROUND
  New energy devices are constantly being introduced for all types of surgery, including liver surgery. These devices help surgeons perform operations. Meanwhile, intraoperative blood loss is a concern of liver surgeons. Various methods to reduce intraoperative bleeding during liver resection have been reported. There are some reports that the use of energy devices was effective for liver transection. Recently, the Harmonic FOCUS™ (HF), an ultrasonically activated device, was developed. The shape of the HF is similar to that of Kelly forceps. Hepatectomy can be performed by the clamp-crushing method using the HF instead of Kelly forceps. We obtained good results of liver resection with the HF, and report these outcomes in this study.
  
  
  METHODS
  From November 2009 to March 2011, a total of 51 patients underwent hepatectomy with the use of the HF. The control group consisted of 59 patients who underwent hepatectomy without the HF from February 2009 to September 2009. The surgical outcomes were evaluated and compared retrospectively.
  
  
  RESULTS
  Mean blood loss was 640 mL in the HF group compared to 1,176 mL in the control group. The number of patients needing a blood transfusion was smaller in the HF group (p = 0.02). Mean operative time was shorter in the HF group (171 vs. 235 min, p < 0.001). All these surgical outcomes were significantly better in the HF group. Postoperative morbidity was not increased in the HF group, and we could perform liver transection safely.
  
  
  CONCLUSIONS
  The crush-clamping method combined with the HF is effective for liver transection. Liver resection can be performed quickly using this method.
authors.affiliation: Department of Surgical Oncology, National Cancer Center Hospital East, 6-5-1 Kashiwanoha, Kashiwa, Chiba 277-8577, Japan. ngotohda@east.ncc.go.jp
authors.forename: Naoto
authors.initials: N
authors.lastname: Gotohda
authors.forename: Masaru
authors.initials: M
authors.lastname: Konishi
authors.forename: Shinichiro
authors.initials: S
authors.lastname: Takahashi
authors.forename: Takahiro
authors.initials: T
authors.lastname: Kinoshita
authors.forename: Yuichiro
authors.initials: Y
authors.lastname: Kato
authors.forename: Taira
authors.initials: T
authors.lastname: Kinoshita
mesh_terms: D000368:Aged; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D003250:Constriction; D005260:Female; D006488:Hemostasis, Surgical / Q000295:instrumentation; D006498:Hepatectomy / Q000295:instrumentation* / Q000379:methods; D006801:Humans; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D012189:Retrospective Studies; D013525:Surgical Instruments; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*