title: Liver resection using cavitron ultrasonic surgical aspirator (CUSA) versus harmonic scalpel: a retrospective cohort study.
abstract: BACKGROUND
  The aim of this study was to evaluate the safety and efficacy of two device combinations used in parenchymal division during hepatic resections in non-cirrhotic patients and without inflow vascular occlusion.
  
  
  METHODS
  We retrospectively analyzed 47 patients who underwent liver resection at our Institution from 2004 to 2010 using the TissueLink with either the Cavitron Ultrasonic Surgical Aspirator (CUSA) or the Harmonic Scalpel. The TissueLink was used with the CUSA in 27 patients and with the Harmonic Scalpel in 20 patients.
  
  
  RESULTS
  Median estimated blood loss (EBL) in the Harmonic Scalpel and CUSA groups was 250 and 1035 mL respectively (p < 0.05). Three patients were transfused banked blood perioperatively in the Harmonic Scalpel group and 11 in the CUSA group (p < 0.05). Median operative time in the Harmonic Scalpel and CUSA groups was 185 and 290 min respectively. Length of stay (LOS) was shorter in the Harmonic Scalpel group at 6 days compared to 7 days in the CUSA group (p < 0.05). Perioperative complications were documented in 20% and 26% in the Harmonic Scalpel and CUSA groups, respectively.
  
  
  CONCLUSIONS
  Our results show the Harmonic Scalpel with TissueLink to be a safe, effective method of parenchymal division with significantly less EBL and LOS when compared to CUSA with TissueLink.
authors.affiliation: University of California Los Angeles, Division of Transplantation, Los Angeles, CA, USA.
authors.forename: Adam S
authors.initials: AS
authors.lastname: Bodzin
authors.affiliation: Thomas Jefferson University, Division of Biostatistics, Philadelphia, PA 19107, USA.
authors.forename: Benjamin E
authors.initials: BE
authors.lastname: Leiby
authors.affiliation: Thomas Jefferson University Hospital, Division of Transplantation, Philadelphia, PA 19107, USA.
authors.forename: Carlo G
authors.initials: CG
authors.lastname: Ramirez
authors.affiliation: Thomas Jefferson University Hospital, Division of Transplantation, Philadelphia, PA 19107, USA.
authors.forename: Adam M
authors.initials: AM
authors.lastname: Frank
authors.affiliation: Thomas Jefferson University Hospital, Division of Transplantation, Philadelphia, PA 19107, USA. Electronic address: cataldo.doria@jefferson.edu.
authors.forename: Cataldo
authors.initials: C
authors.lastname: Doria
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001803:Blood Transfusion; D015331:Cohort Studies; D006498:Hepatectomy / Q000009:adverse effects / Q000295:instrumentation / Q000379:methods*; D006801:Humans; D053208:Kaplan-Meier Estimate; D008099:Liver / Q000601:surgery*; D008107:Liver Diseases / Q000601:surgery; D008875:Middle Aged; D012189:Retrospective Studies; D014464:Ultrasonic Therapy; D055815:Young Adult
keywords: Hepatocellular carcinoma; Liver; Resection