Combined blunt-clamp dissection and LigaSure ligation for hepatic parenchyma dissection: Postcoagulation technique Journal Article
| Authors: | Patrlj, L.; Tuorto, S.; Fong, Y. |
| Article Title: | Combined blunt-clamp dissection and LigaSure ligation for hepatic parenchyma dissection: Postcoagulation technique |
| Abstract: | Background: Blunt-clamp dissection allows for visualization of intrahepatic vessels and individual ligation of major blood or bile vessels. Recently, many instruments have been developed for "precoagulation" of liver parenchyma before sharp transection, but suffer from the possibility of injuring major blood and biliary vessels that are not well-visualized, along with high cost. In this article, we describe a "postcoagulation" technique combining clamp dissection and sealing of vessels under direct vision using a tissue-sealing device. Study Design: Clinical evaluation of 400 patients from 2 centers subjected to liver resection using this technique. Results: There were no cases complicated by hemorrhage. There was an incidence of 1.8% for bile leaks. This low incidence of biloma formation was seen even with the high incidence (49%) of abnormal parenchyma encountered in this cohort. Conclusions: Combining the clamp-crushing method with use of the LigaSure device (Valleylab) allows identification of intraparenchymal vessels followed by sealing. This method of parenchymal transaction optimizes ease of use with confidence in vessel ligation. © 2010 American College of Surgeons. |
| Keywords: | adult; treatment outcome; aged; aged, 80 and over; middle aged; major clinical study; incidence; dissection; bile leakage; blood vessel; liver resection; hepatectomy; liver cancer; anticoagulation; liver parenchyma; postoperative hemorrhage; suture techniques; ligation; surgical equipment; sealant; tissue adhesive; biloma; blunt clamp dissection; hepatic artery ligation; digestive system diseases; hemostasis, surgical; surgical instruments |
| Journal Title: | Journal of the American College of Surgeons |
| Volume: | 210 |
| Issue: | 1 |
| ISSN: | 1072-7515 |
| Publisher: | Elsevier Science, Inc. |
| Date Published: | 2010-01-01 |
| Start Page: | 39 |
| End Page: | 44 |
| Language: | English |
| DOI: | 10.1016/j.jamcollsurg.2009.09.035 |
| PUBMED: | 20123330 |
| PROVIDER: | scopus |
| DOI/URL: | |
| Notes: | --- - "Cited By (since 1996): 3" - "Export Date: 20 April 2011" - "CODEN: JACSE" - "Source: Scopus" |
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