Abstract
The mortality and morbidity in major hepatic resection is often related to hemorrhage. A high pressure, high velocity water jet has been developed and has been utilized to assist in hepatic parenchymal transection. Sixty-seven major hepatic resections were performed for solid hepatic tumors. The tissue fracture technique was used in 51 patients (76%), and the water jet dissector was used predominantly in 16 patients (24%). The extent of hepatic resection using each technique was similar. The results showed no difference in operative duration (p = .499). The mean estimated blood loss using the water jet was 1386 ml, and tissue fracture technique 2450 ml (p = .217). Transfusion requirements were less in the water jet group (mean 2.0 units) compared to the tissue fracture group (mean 5.2 units); (p = .023). Results obtained with the new water dissector are encouraging. The preliminary results suggest that blood loss may be diminished.
Highlights
Major hepatic resection can be performed with low operative mortality and postoperative morbidity
The duration of operation using the water jet dissector was a mean of 285 minutes, and with the tissue fracture technique a mean of 272 minutes
Operative mortality and morbidity has been related to blood loss and operative duration8’9
Summary
Major hepatic resection can be performed with low operative mortality and postoperative morbidity. Mortality is often related to operative hemorrhage, and the most common complications after operation are postoperative bleeding, biliary fistula, or intraabdominal abscess. Various methods have been developed to assist the hepatic parenchymal dissection by the exposure of the intact vascular elements and bile ducts for secure ligation. Tissue fracture using either the fingers and/or a. Clamp are the most common methods[1]. A new approach for parenchymal dissection was reported by Papachristou in 1982 using a jet of water to disrupt the liver tissue and display the blood vessels and bile ducts[2]. Other investigators have introduced various models of water jet apparatus3’4
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