The Efficacy of Three Transection Techniques of the Liver Resection: A Randomized Clinical Trial

Abstract

The Clump Crushing Technique, CUSA and Liga Sure are equally safe for resection of non-cirrhotic liver. Liver resections can be performed safely if the entire concept is well designed and the choice of dissection device does not affect the outcome of hepatectomy.

Lebertranssektion: moderne Verfahren

“…Die mittlere Dauer der Parenchymphase lag bei der Clamp-crush-Technik zwischen 28 und 118,7 min, bei den HF/ RF-basierten Verfahren zwischen 34 und 85 min und bei den ultraschallbasierten Verfahren zwischen 37,5 und 139,7 min [15,33,39,56,57]. In mehreren Studien zeigte sich eine signifikant kürzere Parenchymphase bzw.…”

“…In mehreren Studien zeigte sich eine signifikant kürzere Parenchymphase bzw. höhere Transsektionsgeschwindigkeit bei den Clamp-crush-Resektionen [15,37,39,57]. Lesurtel et al…”

The Aim of Technology During Liver Resection — A Strategy to Minimize Blood Loss During Liver Surgery

“…This might have resulted in bias in favor of clamp crushing. An other recent comparative study between clamp crushing technique (CRUSH), ultrasonic dissection (CUSA) or bipolar device (LigaSure), failed to show any difference between the three techniques in terms of intraoperative blood loss, blood transfusion, postoperative complications and mortality [72]. Further prospective randomized studies are needed to determine which transection technique is the best.…”

“…BVSD is capable to obliterate the lumen of veins and arteries up to 7 mm in diameter by the fusion of elastin and collagen proteins of the vessel walls; that makes BVSB the only safe and real alternative to sutures and clips for sealing vessel [68], [69], [70]. A: BVSD coagulates sealing vessels up to 7 mm in diameter with minimal charring, thermal spread or smoke, it's capable to reduce blood loss and the need for vessel occlusion techniques if compared to traditional techniques [8], [71], [72], A recently published randomized controlled trial demonstrated that the use of Ligasure in combination with a clamp crushing technique resulted in lower blood loss and faster transaction speed in minor liver resections compared with the conventional technique of electric cautery or ligature for controlling vessels in the transection plane [73]. Otherwise a more recent randomized trial from the same team was not able to show a real difference between the traditional techniques and the Ligasure vessel sealing system [74].…”

Methods to Reduce Liver Ischemia/Reperfusion Injury

“…Unfortunately, none of these studies included a sufficient number of patients to draw firm conclusions regarding the superior technique (62,(64)(65)(66)(67). In one study, the crushing method was accompanied by pedicle clamping, whereas the other methods (CUSA, radiofrequency, water jet) were not, making comparisons even more complicated (66 (71,72). However, this device has become increasingly popular with the increase in laparoscopic liver surgery (73).…”