[Liver resection with the water dissector; preliminary experience of 8 cases]

New methods for the resection of liver parenchyma was developed in order to simplify liver surgery. The object of our study was to test a method using the water dissector, a rather new equipment. Eight patients, four men end four women, have been operated, from March to September 1997, using the water dissector. Age of the patients ranged from 42 to 83 years (mean age 67 years). Indication for surgery was liver metastasis from colon cancer (6 patients), and gallbladder cancer (2 patients). 1 right lobectomy, 1 left side segmentectomy, 2 V and IV segments resection, 1 unitectomy of the VII segment and 2 III and IV segment resections was performed. In the first four patients we used the Pringle manoeuvre (clamping of the liver stalk), while we did not do it in the last four so we could compare both the operation time and the loss of blood with or without this manoeuvre. One patient died of ARDS in the seventh post-operative day, another patient, who underwent a right lobectomy, developed a biliary fistula which healed in the 10 degrees postoperative day. All the seven surviving patients was in good health, with normal liver ultrasonography when checked on the 31/12/1997. Our results show that the water dissector offers the possibility to isolate vascular stalks very easily, both with a posterior ilar approach and with an intraparenchymal approach, making possible a very accurate haemostasis, in such minimizing blood and biliary losses. This method allows the performing of oncologically correct dissections and in the meanwhile the saving of as much healthy parenchyma as possible.