title: The three-surgeon technique for liver tissue dissection: towards real bloodless hepatectomy.
abstract: OBJECTIVE
  Bleeding during hepatectomy remains a major cause of mortality despite recent developments in surgical and anaesthetic techniques. To date there is no single surgical device that combines speed, efficient haemostasis and safety for the adjacent vital structures during parenchymal division. This article presents the Three Surgeon Technique (3ST), a novel method of parenchymal dissection for major hepatectomies and compare it with our standard radiofrequency ablation (RFA) - assisted technique.
  
  
  METHODS
  77 patients who underwent major liver resection were divided into two groups: 38 of them (group A) underwent 41 RFA-assisted liver resections and 39 (group B) underwent 41 hepatectomies with the 3ST. The data for the 3ST were prospectively collected and compared to the already collated RFA patient group.
  
  
  RESULTS
  Blood transfusion was necessary in 28 and 13 patients in group A and B respectively (p=0.016), with an average of 1.7 and 0.6 units of red blood cells (p<0.001). The Pringle maneuver was not required with the 3ST. The mean time of parenchymal dissection was 90.49 and 77.52 min in group A and B, respectively (p=0.007).
  
  
  CONCLUSIONS
  The 3ST is a novel, reliable and safe alternative to the stand alone RFA-assisted technique. It is a faster procedure, and requires less blood units transfusion.
authors: Hepatobiliary and Pancreatic Surgical Department, Oxford Radcliffe Hospitals NHS Foundation Trust, UK. thpetrou@gmail.com
authors: A
authors: A
authors: Petrou
authors: M
authors: M
authors: Kontos
authors: E
authors: E
authors: Prassas
authors: K
authors: K
authors: Bramis
authors: A
authors: A
authors: Papalambros
authors: N
authors: N
authors: Brennan
authors: C
authors: C
authors: Mihas
authors: E
authors: E
authors: Felekouras
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion / Q000706:statistics & numerical data*; D017115:Catheter Ablation; D004210:Dissection; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods* / Q000401:mortality*; D006801:Humans; D008113:Liver Neoplasms / Q000401:mortality / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate