A prospective randomized controlled trial: Comparison of two different methods of hepatectomy
Introduction
Partial hepatectomy remains the most commonly used curative treatment for malignant liver tumor. The finger fracture or clamp crushing technique has been a standard technique used in transection of liver parenchyma.1 Hepatic vascular inflow occlusion in the form of Pringle maneuver is commonly used in partial hepatectomy to reduce intraoperative blood loss during parenchymal transection.2 The major concern in the use of hepatic vascular inflow occlusion is ischemia-reperfusion injury.
Harmonic scalpel (HS) allows sealing of small vessels during transection of liver parenchyma with resultant reduced blood loss and transection time.3, 4, 5 The ultrasonically activated shears seal small vessels between the vibrating blades. The coagulation effect is caused by protein denaturation, which occurs as a result of destruction of hydrogen bonds in proteins and generation of heat in vibrating tissue.6 Blood vessels up to 3–4 mm in diameter are coagulated.7, 8 The tissue-cutting effect derives from a saw mechanism in the direction of the vibrating blades. The benefit of Harmonic scalpel without hepatic vascular inflow occlusion in open liver resection remains uncertain, and there is no randomized trial in the medical literature.
This randomized controlled study was carried out to compare the perioperative outcomes of partial hepatectomy using either finger fracture or clamp crushing technique with PM or HS without hepatic vascular inflow occlusion.
Section snippets
Trial design
From January 2012 to September 2012, 160 patients who underwent partial hepatectomy for liver tumors at the Third Department of Hepatic Surgery, Eastern Hepatobiliary Surgery Hospital were considered to be included into the study. The inclusion criteria were: (1) elective liver resection; (2) inflow occlusion was needed if the finger fracture and clamp crushing technique was used for transection of liver parenchyma; (3) inflow occlusion was not needed if the Harmonic Scalpel was used for
Results
During the study period, 212 patients received partial liver resection in our hospital. 52 patients were excluded from this study because:- tumors were combined with tumor thrombosis of portal vein branch or bile duct (n = 21), metastatic tumors were resected together with colorectal primary (n = 3), tumors had invaded the hepatic vessel or were located at special sites such as the caudate lobe that required total hepatic vascular occlusion or hepatic vein occlusion (n = 28). No patients
Discussion
Intraoperative factors that affect patients' outcome, including bleeding, bile leakage, abdominal collection, and infections, are often related to the surgeon's techniques.17, 18, 19, 20, 21 Control of bleeding is crucial in good liver surgery as blood loss is an independent factor which increases post-operative morbidity and mortality.22, 23, 24 There are different vascular occlusion techniques which can be used to reduce blood loss during liver parenchymal transection,25 such as total hepatic
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