Sorting through methods of dividing the liver
Background: No doubt, liver surgery has become safer over the past two decades. Many people jump to the conclusion that this increase in safety is due primarily to new methods of dissecting through the liver. Methods: We did a literature search over the period 1992-2004 and then considered the data within the articles on the basis of device design and our own personal experiences. Results: For resection of malignancies, we rank the Cavitron ultrasonic surgical aspirator (CUSA) number one because of its utility in staying within tissue planes during resections while preserving vessels for ligature. We find the water jet the most useful instrument for living-donor resections because of the minimal necrotic margin. The floating ball has a particular utility in removing tumors from cirrhotic livers. The harmonic scalpel tops the instruments for laparoscopic surgery, primarily because the instrument is designed specifically for laparoscopic surgery and most tumors being removed via the laparoscope are small, benign ones. Conclusions: Technological innovations have definitely made their mark on liver surgery. However, the skill and experience of the surgeon but not the instruments determine the outcomes of patients after liver resections.
Meyers, WC; Shekherdimian, S; Owen, SM; Ringe, BH; Brooks, AD
European Surgery Acta Chirurgica Austriaca
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