title: Skeletonization and Isolation of the Glissonean and Venous Branches in Liver Surgery With an Ultrasonic Scalpel Technology.
abstract: This study describes a novel technique for skeletonization and isolation of Glissonean and venous branches during liver surgery using a harmonic scalpel (HS). Hepatic resections with HS were performed with the skeletonization and isolation technique in 50 patients (HS group). Variables evaluated were blood loss, operative time, biliary leak, and morbidity. The results were compared with 50 hepatic resections that were performed using a previously established technique: Cavitron ultrasonic surgical aspirator with electric cautery, ligatures, and hemoclips (NHS group). The HS group had shorter total operative times (285 versus 358 minutes; P = 0.01), less blood loss (389 versus 871 mL; P = 0.034), and less crystalloid infusion (2744 versus 3299 mL; P = 0.027) compared with the NHS group. Postoperative liver function and complication rates were similar when comparing the two groups. These data demonstrate that HS is a simple, easy, and effective instrument for the skeletonization and isolation of vessels during liver transection.
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Takeshi
authors.initials: T
authors.lastname: Aoki
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Masahiko
authors.initials: M
authors.lastname: Murakami
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Tomotake
authors.initials: T
authors.lastname: Koizumi
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Yuta
authors.initials: Y
authors.lastname: Enami
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Reiko
authors.initials: R
authors.lastname: Koike
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Fujimori
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Tomokazu
authors.initials: T
authors.lastname: Kusano
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Kazuhiro
authors.initials: K
authors.lastname: Matsuda
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Kosuke
authors.initials: K
authors.lastname: Yamada
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Nogaki
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Makoto
authors.initials: M
authors.lastname: Watanabe
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Otsuka
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Haytham
authors.initials: H
authors.lastname: Gareer
authors.affiliation: Department of Gastroenterological & General Surgery, School of Medicine, Showa University, Tokyo, Japan.
authors.forename: Takashi
authors.initials: T
authors.lastname: Kato
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016063:Blood Loss, Surgical / Q000706:statistics & numerical data; D005260:Female; D006498:Hepatectomy / Q000379:methods*; D006801:Humans; D008099:Liver / Q000098:blood supply*; D008113:Liver Neoplasms / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D011183:Postoperative Complications / Q000453:epidemiology; D016896:Treatment Outcome; D059708:Ultrasonic Surgical Procedures / Q000295:instrumentation*
keywords: Cavitation effect; Liver resection; Skeletonization; Ultrasonic scalpel