title: Combined ultrasonic aspiration and saline-linked radiofrequency precoagulation: a step toward bloodless liver resection without the need of liver inflow occlusion: analysis of 313 consecutive patients.
abstract: BACKGROUND
  Hemorrhage is undoubtedly one of the main factors contributing to morbidity and mortality in liver resections. Vascular occlusion techniques are effective in controlling intraoperative bleeding, but they cause liver damage due to ischemia. We evaluated the effectiveness and safety of using a combined technique for hepatic parenchymal transection without liver inflow occlusion.
  
  
  METHODS
  Three hundred and thirteen consecutive patients who underwent liver resection in four hepato-pancreato-biliary units. Hepatic parenchymal transection was carried out using a combined technique of saline-linked radiofrequency precoagulation and ultrasonic aspiration without liver inflow occlusion.
  
  
  RESULTS
  During the study period 114 minor and 199 major hepatic resections were performed. The mean amount of intraoperative blood loss was 377 ml (SD 335 ml, range 50 to 2,400 ml) and the blood transfusion rate was 10.5%. The median amount of blood loss during parenchymal transection and parenchymal transection time was 222 ml (SD 224 ml, range 40 to 2,100 ml) and 61 minutes (range 12 to 150 minutes) respectively. There were two postoperative deaths (0.6%). Complications occurred in 84 patients (26.8%) and most complications were minor.
  
  
  CONCLUSIONS
  Combined technique of saline-linked radiofrequency ablation and ultrasonic aspiration for liver resection is a safe method for both major and minor liver resections. The method is associated with decreased blood loss, reduced postoperative morbidity, and minimal mortality rates. We believe that this combined technique is comparable to other techniques and should be considered as an alternative.
authors.forename: Evangelos
authors.initials: E
authors.lastname: Felekouras
authors.forename: Athanasios
authors.initials: A
authors.lastname: Petrou
authors.affiliation: Department of Academic Surgery, Upper GI/HPB Unit, Royal Marsden Hospital, Fulham Road, London SW3 6JJ, UK. kneophy2@gmail.com.
authors.forename: Kyriakos
authors.initials: K
authors.lastname: Neofytou
authors.forename: Alexandros
authors.initials: A
authors.lastname: Giakoustidis
authors.forename: Jessamy
authors.initials: J
authors.lastname: Bagenal
authors.forename: Ferdinando
authors.initials: F
authors.lastname: Cananzi
authors.forename: Emmanouel
authors.initials: E
authors.lastname: Pikoulis
authors.forename: Satvinder
authors.initials: S
authors.lastname: Mudan
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D017115:Catheter Ablation / Q000379:methods*; D003131:Combined Modality Therapy; D005260:Female; D005500:Follow-Up Studies; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008113:Liver Neoplasms / Q000098:blood supply* / Q000401:mortality / Q000556:secondary / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011379:Prognosis; D012189:Retrospective Studies; D012965:Sodium Chloride / Q000008:administration & dosage*; D015996:Survival Rate; D014465:Ultrasonics / Q000379:methods*
chemical_list: D012965:Sodium Chloride