Initial experience with the harmonic scalpel in liver surgery.

Area of Science:

• Hepatobiliary Surgery
• Surgical Oncology
• Minimally Invasive Surgery

Background:

• Traditional hepatectomy techniques involve crushing clamps or finger fracture.
• Advanced instruments like ultrasonic aspirators and water jet dissectors are gaining traction for precise intrahepatic dissection.
• The ultrasonically activated scalpel, primarily used in laparoscopy, has an undefined role in open liver surgery.

Purpose of the Study:

• To evaluate the efficacy and safety of the harmonic scalpel in liver surgery.
• To assess the instrument's performance in parenchymal dissection and hemostasis during hepatectomy.

Main Methods:

• A prospective study involving 16 consecutive patients undergoing liver surgery.
• The harmonic scalpel (Ultracision) was used for parenchymal dissection.
• Ease of dissection, hemostatic effect, blood loss, and transfusion requirements were recorded.

Main Results:

• The harmonic scalpel demonstrated good or excellent performance in 16 out of 17 operations.
• Effective parenchymal dissection, cutting, and hemostasis were noted.
• Median blood loss was 400 mL, with 4 patients requiring transfusions; one cirrhotic liver case showed poor performance.

Conclusions:

• The harmonic scalpel enables efficient liver parenchyma section.
• It provides precise dissection of intrahepatic structures.
• The instrument achieves good hemostasis and transects small intrahepatic vessels effectively.