Abstract
Objectives: Perioperative hemorrhage and postoperative bile leakage are important complications of hepatectomy. Various methods have been reported to reduce intraoperative bleeding during liver transection. We designed a randomized clinical trial to compare the outcomes and complications between Crush Clamp (CC) and ultrasound dissection methods (the Cavitron Ultrasonic Surgical Aspirator, CUSA) in liver transection.
Methods: Twenty patients underwent hepatectomy with the crush clamp method, and 20 underwent ultrasonic dissection. The surgical outcome and complications, including duration of the surgery, bleeding, packed cells requirement after the operation, bile leakage, hospital stay, and hepatic failure, were evaluated and compared.
Results: Mean blood loss during the operation in the CUSA group was less than CC group, but this loss was not significant (247±77.1 in CC vs 232.2±84.3 mL in CUSA, P=0.769). The operation time in the CC group was longer than in the CUSA group, but this difference was not significant (171.3±55.1 min in CC vs 163.1±74.2 min in CUSA; P=0.72). The duration of transection in patients of the CC group was significantly less than that in the CUSA group (47.5±21.1 min for CC vs 77.6±30.4 min for CUSA, P=0.06), and the length of hospitalization in the CC group was significantly less than CUSA group (1.9±0.7 day for CC vs 2.8±1.1 day for CUSA, P=0.016). There were no cases of infection and bile leakage in the two groups.
Discussion: Postoperative complications did not differ in the two groups, but the duration of transection in crush clamp was shorter than the ultrasonic dissection method, and blood loss was almost identical. Because ultrasonic dissection is an equipmentdependent procedure and more expensive, we tend to perform liver transection with the crush clamp method.
Methods: Twenty patients underwent hepatectomy with the crush clamp method, and 20 underwent ultrasonic dissection. The surgical outcome and complications, including duration of the surgery, bleeding, packed cells requirement after the operation, bile leakage, hospital stay, and hepatic failure, were evaluated and compared.
Results: Mean blood loss during the operation in the CUSA group was less than CC group, but this loss was not significant (247±77.1 in CC vs 232.2±84.3 mL in CUSA, P=0.769). The operation time in the CC group was longer than in the CUSA group, but this difference was not significant (171.3±55.1 min in CC vs 163.1±74.2 min in CUSA; P=0.72). The duration of transection in patients of the CC group was significantly less than that in the CUSA group (47.5±21.1 min for CC vs 77.6±30.4 min for CUSA, P=0.06), and the length of hospitalization in the CC group was significantly less than CUSA group (1.9±0.7 day for CC vs 2.8±1.1 day for CUSA, P=0.016). There were no cases of infection and bile leakage in the two groups.
Discussion: Postoperative complications did not differ in the two groups, but the duration of transection in crush clamp was shorter than the ultrasonic dissection method, and blood loss was almost identical. Because ultrasonic dissection is an equipmentdependent procedure and more expensive, we tend to perform liver transection with the crush clamp method.
Keywords
Hepatectomy Crush clamp method Ultrasonic dissection Hepatic mass Hepatobiliary surgery
Copyright
© 2016, Jundishapur Journal of Oncology. This open-access article is available under the Creative Commons Attribution-NonCommercial 4.0 (CC BY-NC 4.0) International License (https://creativecommons.org/licenses/by-nc/4.0/), which allows for the copying and redistribution of the material only for noncommercial purposes, provided that the original work is properly cited.