Two different methods for donor hepatic transection: cavitron ultrasonic surgical aspirator with bipolar cautery versus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-A randomized controlled trial.
ABSTRACT The aim of this study was to compare the Cavitron ultrasonic surgical aspirator (CUSA) with bipolar cautery (BP) to CUSA with a radiofrequency coagulator [TissueLink (TL)] in terms of efficacy and safety for hepatic transection in living donor liver transplantation. Twenty-four living liver donors (n = 12 for each group) were randomized to undergo hepatic transection using CUSA with BP or CUSA with TL. Blood loss during parenchymal transection and speed of transection were the primary endpoints, whereas the degree of postoperative liver injury and morbidity were secondary endpoints. Median blood loss during liver transection was significantly lower in the TL group than in the BP group (195.2 +/- 84.5 versus 343.3 +/- 198.4 mL; P = 0.023), and liver transection was significantly faster in the TL group than in the BP group (0.7 +/- 0.2 versus 0.5 +/- 0.2 cm(2)/minute; P = 0.048). Significantly fewer ties were required during liver transection in the TL group than in the BP group (15.8 +/- 4.8 versus 22.8 +/- 7.9 ties; P = 0.023). The morbidity rates were similar for the 2 groups. In conclusion, CUSA with TL is superior to CUSA with BP for donor hepatectomy in terms of blood loss and speed of transection with no increase in morbidity.
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ABSTRACT: Nomenclature describing liver anatomy and liver resection has been standardized with the Brisbane 2000 terminology. When performing liver resection, blood loss should be minimized by using low central venous pressure (CVP) anesthesia and vascular occlusion as appropriate. There are many options for transection of the liver parenchyma, and although no technique has been shown to be superior to clamp-crushing, hepatic surgeons should be familiar with the techniques available.Surgical Clinics of North America 08/2010; 90(4):737-48. · 2.14 Impact Factor
Article: Tissue damage with different surgical techniques in a porcine model of liver resection: implications for living-donor liver transplantation?[show abstract] [hide abstract]
ABSTRACT: For living-donor liver transplantation (LDLT) it is of paramount importance to preserve as much viable liver tissue as possible to avoid postoperative complications in the donor and recipient. The depth of tissue damage caused by common surgical techniques for liver resection has not been studied so far. Here we compared the depth of tissue damage and the immunohistochemical expression of heat shock protein (HSP) 70, a marker for tissue damage, in a porcine model of liver resection, to assess the effect of different surgical techniques, i.e., blunt dissection (BD), and dissection with an ultrasound aspirator (UA), an ultrasound scalpel (US), or a water-jet (WJ). Analysis with linear mixed effects models (LME) showed significantly less tissue damage with BD and UA than with US and WJ (joint p value <0.001). Damage also increased within 6 h after surgery (p value = 0.004). Semiquantitative evaluation of HSP 70 showed increased expression after resection with US compared to all other resection methods (p value <0.001), indicating increased tissue damage with this method. We suggest that in cases of liver resection for LDLT surgeons should reevaluate using US and WJ because of possible excessive tissue damage compared to BD and UA. Overall we advocate the use of BD as it requires no special equipment and, hence, has considerably higher cost-effectiveness without compromising tissue preservation and clinical outcome and is readily available even in low-tech environments.Journal of hepato-biliary-pancreatic sciences. 12/2010; 18(3):436-42.
Article: Multiple cerebral infarction and paradoxical air embolism during hepatectomy using the Cavitron Ultrasonic Surgical Aspirator -A case report-.[show abstract] [hide abstract]
ABSTRACT: A venous air embolism and paradoxical air embolism (PAE) are serious complications in patients undergoing a hepatectomy. We report a case of PAE and cerebral infarctions in a patient undergoing a hepatic resection using a Cavitron Ultrasonic Surgical Aspirator (CUSA®). A 65-year-old woman underwent a left lobe hepatectomy. During the middle phase of the liver resection with CUSA®, there was a sudden decrease in arterial blood pressure, end-tidal carbon dioxide and SpO(2). With resuscitation, intraoperative ultrasonography revealed massive air emboli in both her left and right heart, which lasted for 40 min. The hepatectomy was completed after the disappearance of the air emboli from her heart. After surgery, her mental status was stuporous. The brain CT and MRI revealed multiple acute cerebral infarctions. Finally, she died from septic shock. This case highlights the need for anesthetists and surgeons to be aware of the potential for CUSA®-related massive PAE.Korean journal of anesthesiology 12/2010; 59 Suppl:S133-6.