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Randomized Comparison of Ultrasonic vs Clamp Transection of the Liver—Invited Critique
William C. Chapman, MD
Nashville, Tenn
Arch Surg. 2001;136:928.
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Few surgical procedures pose a greater risk of major hemorrhage than hepatic resection, a risk due to the extensive network of thin-walled portal and hepatic venous branches throughout the liver. Whereas ligation and division of inflow and outflow vessels can occasionally present a challenge in patients with large liver tumors, hemorrhage more frequently becomes problematic during parenchymal transection, when there is difficulty defining, ligating, and transecting vascular structures. Several techniques have been developed to improve parenchymal transection, most notably ultrasonic dissection. Despite the popular acclaim of this and other new methods, few studies compare them objectively with finger fracture techniques.
Takayama et al report a prospective randomized trial judging ultrasonic dissection against conventional finger fracture techniques, and assess 6 outcome measures. A hepatectomy grading score consisting of weighted variables was developed to score the resection procedure objectively, from which the authors conclude that finger fracture is . . . [Full Text of this Article]
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Arch Surg. 2001;136(8):922-928.
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