title: Secure, low-cost technique for laparoscopic hepatic resection using the crush-clamp method with a bipolar sealer.
abstract: BACKGROUND
  Laparoscopic hepatectomy is difficult because surgeons must perform the transection using many (four and more) energy devices and without direct manual maneuvers. Here we introduce hepatic transection by the classical method with a few (two or three) energy devices.
  
  
  METHODS
  We performed laparoscopic hepatectomy for 40 patients with hepatic tumor and liver dysfunction. For parenchymal transection, we used bipolar radiofrequency coagulation forceps connected to a voltage-controlled electrosurgical generator and ultrasonic dissector. The demarcation of the liver surface was made by an ultrasonic dissector. Along the demarcation line, the blades of a BiClamp were opened slightly and inserted into the hepatic parenchyma. We clamped slowly, softly, and gradually, and a small amount of hepatic parenchyma was consequently coagulated and fractured. After the crush, the small vessels and intrahepatic bile duct that were sealed were left as atrophic strings, and the strings were divided by an ultrasonic dissector. Large vessels and Glisson's sheaths were left because of the small clamp. Large Glisson's sheaths and hepatic veins were ligated with a titanium clip or autosutures, and cut without bile leakage or bleeding. The mean operation time of the procedure was 196.9 min, mean blood loss was 69.9 mL, and mean postoperative hospitalization was 9.5 days. No blood transfusions were needed. Two cases had perioperative complications-one involving right shoulder pain and the other involving ascites due to liver dysfunction-but there were no serious postoperative complications.
  
  
  CONCLUSIONS
  The present results appear to demonstrate that this simple and safe method helps decrease intraoperative bleeding and shorten hospital stay.
authors.affiliation: Department of Surgery, Ishikiri Seiki Hospital, Higashiosaka, Japan.
authors.forename: Takatsugu
authors.initials: T
authors.lastname: Yamamoto
authors.affiliation: Department of Surgery, Ishikiri Seiki Hospital, Higashiosaka, Japan.
authors.forename: Takahiro
authors.initials: T
authors.lastname: Uenishi
authors.affiliation: Department of Surgery, Ishikiri Seiki Hospital, Higashiosaka, Japan.
authors.forename: Kazuhisa
authors.initials: K
authors.lastname: Kaneda
authors.affiliation: Department of Surgery, Ishikiri Seiki Hospital, Higashiosaka, Japan.
authors.forename: Masato
authors.initials: M
authors.lastname: Okawa
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan.
authors.forename: Shogo
authors.initials: S
authors.lastname: Tanaka
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Osaka City University Graduate School of Medicine, Osaka City, Osaka, Japan.
authors.forename: Shoji
authors.initials: S
authors.lastname: Kubo
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D001650:Bile Duct Neoplasms / Q000191:economics / Q000601:surgery; D001653:Bile Ducts, Intrahepatic; D016063:Blood Loss, Surgical / Q000517:prevention & control / Q000706:statistics & numerical data; D006528:Carcinoma, Hepatocellular / Q000191:economics / Q000601:surgery; D018281:Cholangiocarcinoma / Q000191:economics / Q000601:surgery; D005260:Female; D006498:Hepatectomy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D017721:Hospital Costs; D006801:Humans; D007564:Japan; D010535:Laparoscopy / Q000191:economics / Q000295:instrumentation / Q000379:methods*; D007902:Length of Stay / Q000706:statistics & numerical data; D008113:Liver Neoplasms / Q000191:economics / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D061646:Operative Time; D016896:Treatment Outcome
keywords: Bipolar sealer; crush-clamp method; laparoscopic hepatic resection