Abstract
Introduction and Objective. Bleeding is an important complication in liver transections. To determine the safety and efficacy of Debakey forceps for liver parenchymal transection and its ergonomic advantages over clamp crushing method we analysed our data. Methods. We used Debakey crushing technique in 100 liver resections and analysed data for transection time, transfusion rate, morbidity, mortality, hospital stay, influence of different types of liver conditions, and ergonomi features of Debakey forceps. Results. Mean age, transection time and hospital stay of 100 patients were 52.38 ± 17.44 years, 63.36 ± 33.4 minutes, and 10.27 ± 5.7 days. Transection time, and hospital stay in patients with cirrhotic liver (130.4 ± 44.4 mins, 14.6 ± 5.5 days) and cholestatic liver (75.8 ± 19.7 mins, 16.5 ± 5.1 days) were significantly greater than in patients with normal liver (48.1 ± 20.1 mins, 6.7 ± 1.8 days) (P < 0.01). Transection time improved significantly with experience (first fifty versus second fifty cases—70.2 ± 31.1 mins versus 56.5 ± 34.5 mins, P < 0.04). Qualitative evaluation revealed that Debakey forceps had ergonomic advantages over Kelly clamp. Conclusions. Debakey forceps crushing technique is safe and effective for liver parenchymal transection in all kinds of liver. Transection time improves with surgeon's experience. It has ergonomic advantages over Kelly clamp and is a better choice for liver transection.
Highlights
Introduction and ObjectiveBleeding is an important complication in liver transections
During the study period of January 2006 to October 2013 a total of 100 elective liver resections were performed for various indications using Debakey thumb forceps for the liver parenchymal transection
Indications and the type of liver resections performed are mentioned in Tables 1 and 2
Summary
Introduction and ObjectiveBleeding is an important complication in liver transections. It has ergonomic advantages over Kelly clamp and is a better choice for liver transection. In 1958 Lin et al introduced the finger fracture technique which involves crushing of liver parenchyma by surgeon’s finger under inflow occlusion so as to isolate vessels and bile ducts for ligation [4]. This technique was subsequently improved through the use of small Kelly clamp for blunt dissection which gives better control, namely, clamp crushing or Kellyclasia [5,6,7]. People have used finer versions of clamps similar to Kelly like Pean, Halstead, Heiss, or Bengolea clamps [6, 8]
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