![]() 3d), easy-flow drains were placed in the subphrenic and subhepatic space. Following the resection procedure, argon beam coagulation was applied to abort minor oozing. Where the necessity was given, intraoperative ultrasound was used to guide the dissection. 2a, b, 3a) and subsequently divided with endo-GIA vascular staplers (fig. To allow subsequent dissection of the hepatic parenchyma, the liver tissue was fractured stepwise with a clamp (fig. The transectional line is then made afterwards and the liver capsule then divided with diathermy. Subsequently, the appropriate hepatic vein(s) are divided with the endo-GIA vascular stapler (fig. In performing hemihepatectomy or extended hemihepatectomy, the adequate hepatic arterial branch is divided between ligation with sutures followed by division of the portal venous branch with the vascular stapler or via suture. To enable the complete liver mobilization the short hepatic and caudate veins from the inferior vena cava (IVC) are clipped or ligated. Following an incipient abdominal exploration in search of extrahepatic disease, the falciform triangular ligament is then mobilized, thereafter dissection is conducted, exposing the hepatic veins and the porta hepatis. ![]() Ī reversed L-shaped incision from the xiphoid to the tip of the twelfth right rib or a standard transverse abdominal incision (with or without extension in the midline to the xiphoid) is mostly made use of. Recent publications observing a number of techniques using stapling devices in liver surgery showed it to be extraordinarily helpful in the safe ligation of inflow and outflow vessels. Vascular staplers have increased the speed and safety of lobar resections of the lung. Rectal, colonic, and esophageal anastomotic instruments allow safe and rapid anastomosis of the gastrointestinal tract, even when surgical exposure is compromised. Today, staplers have become a vital instrument in the practice of many surgical specialties. Despite tremendous improvements in both surgical technique and perioperative patient management (especially for hemorrhage, bile leakage, hematoma, infections and postoperative liver function, all associated with high morbidity and mortality), there are still major concerns after liver resection which require a high level of training leaving it still a demanding surgical procedure. The introduction of these surgical instruments has permitted large, non-anatomical wedge resections and liver resections to be performed with improved operative morbidity and mortality rates typically being less than 30 and 5%, respectively, in high-volume centers. These methods represent selective dissection techniques, whereas non-selective methods include the scalpel, scissors, high-frequency coagulation and the laser technique. The blunt dissection has been widely replaced by various time-consuming methods, such as the Cavitron Ultrasonic Surgical Aspirator® (CUSA) technique and the jet cutter for major liver resections. Since surgical technique is a major factor to prevent complications, various methods and instruments have been developed for safe tissue-preserving dissection of the liver parenchyma.
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