title: A prospective randomized controlled trial: comparison of two different methods of hepatectomy.
abstract: BACKGROUND
  Hemorrhage and liver failure are the two major complications in partial hepatectomy. The finger fracture or clamp crushing technique has been a standard technique used for transection of liver parenchyma. Hepatic vascular Inflow occlusion (Pringle maneuver, PM) is often used to minimize blood loss, but hepatic ischemia-reperfusion may result with an increased risk of post-operative liver failure. The Harmonic scalpel (HS) has been shown to be effective in reducing blood loss during liver parenchymal transection without any hepatic vascular inflow occlusion.
  
  
  METHODS
  A randomized controlled trial was carried out to evaluate the impact of the two different hepatic transection techniques. The post-operative short-term results were compared.
  
  
  RESULTS
  During the study period, 160 of 212 patients who received partial hepatectomy in our hospital were randomized into 2 groups: the PM group (n = 80) and the HS group (n = 80). The numbers of patient who had a poor liver function on post-operative day 5 (ISLGS Grade B) were 30, and 18, respectively (p < 0.05). The post-operative complication rate was significantly higher in the PM group (41.3% versus 22.5%, p < 0.05). The HS group had significantly less blood loss and blood transfusion requirements than the PM group (p < 0.05).
  
  
  CONCLUSIONS
  In conclusion, liver resection carried out using HS without hepatic vascular occlusion was better than using finger fracture or clamp crushing technique with Pringle maneuver. The use of HS allowed liver resection to be safely performed, with earlier recovery of liver function, and less surgical complication.
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China.
authors.forename: Sun
authors.initials: S
authors.lastname: Hanyong
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China; Faculty of Medicine, The Chinese University of Hong Kong, Shatin, Hong Kong Special Administrative Region.
authors.forename: Lau
authors.initials: L
authors.lastname: Wanyee
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China.
authors.forename: Fu
authors.initials: F
authors.lastname: Siyuan
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China.
authors.forename: Liu
authors.initials: L
authors.lastname: Hui
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China.
authors.forename: Yang
authors.initials: Y
authors.lastname: Yuan
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China. Electronic address: linch68@sina.com.
authors.forename: Lin
authors.initials: L
authors.lastname: Chuan
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China; National Innovation Alliance for Hepatitis & Liver Cancer, Shanghai, PR China. Electronic address: ehphwp@126.com.
authors.forename: Zhou
authors.initials: Z
authors.lastname: Weiping
authors.affiliation: Department of Hepatic Surgery III, Eastern Hepatobiliary Surgery Hospital, Second Military Medical University, Shanghai, PR China.
authors.forename: Wu
authors.initials: W
authors.lastname: Mengchao
mesh_terms: D000328:Adult; D016063:Blood Loss, Surgical / Q000517:prevention & control*; D001803:Blood Transfusion; D001810:Blood Volume; D006528:Carcinoma, Hepatocellular / Q000601:surgery*; D005260:Female; D006498:Hepatectomy / Q000009:adverse effects* / Q000379:methods* / Q000401:mortality; D006801:Humans; D008099:Liver / Q000098:blood supply / Q000503:physiopathology*; D008111:Liver Function Tests; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011446:Prospective Studies
keywords: Blood loss; Complication; Harmonic scalpel; Liver function; Liver resection; Pringle maneuver