Prospective Evaluation of Ultrasonic Surgical Dissectors in Hepatic Resection: A Cooperative Multicenter Study

摘要

Blood loss is the major cause of postoperative mortality and morbidity associated with hepatic resection.A prospective multicenter study was conducted to determine if ultrasonic dissectors (USD) were usefulin hepatic resection and could reduce this hemorrhagic risk. Forty-seven hepatic resections wereperformed in 42 consecutive patients during a two month period in 11 public, surgical centers.Twenty-one patients had primary or secondary malignancies, six had benign tumors, two had biliarycysts, one had cholangiocarcinoma, one had Caroli’s disease, and 11 had hydatid cysts of the liver. Twodifferent USD devices were evaluated (CUSA System-Lasersonics and NIIC-DX 101 T). The hepaticresections tested included a wide range of procedures. Each surgeon had the possibility of choosingbetween the USD and his own usual technique for each operative step and according to local conditions.The average volume of blood infused, irrespective of the underlying pathology or the procedureperformed, was 1.0 L (range 0-4.8 L). Fourteen patients required no transfusions. No operative orimmediate postoperative deaths were recorded. Five major complications, all unrelated to the use of theUSD, developed in three patients. Access to intra and extraparenchymal arterial and venous tributariesand particularly the control of the hepatic veins were facilitated by USD. While transection of hepaticparenchyma was neither easier nor faster than with conventional techniques, it was found to be lesshemorrhagic. Overall appraisal was expressed on an analog scale; the USD was found to be helpful orvery helpful in 75 percent of all resections. With regard to the pathology being treated, total or partialexcision of hydatid cysts was greatly enhanced by the use of the USD while this benefit was not found forwedge resections of other hepatic lesions. With regard to user friendliness and maintenance, theNIIC-DX 101 T device was preferred. We conclude that the USD facilitates formal hepatic resections.Converging opinions emerging from various surgical centers reinforce this conclusion.