Parenchymal compression and new devices for hepatic resections: re-visitation of an old technique

This reports on the modification of a technique of parenchymal compression ideated to reduce blood loss during liver transection, favorably affecting patient's outcome by reducing the need of Pringle maneuver and operative time through the active role of the second surgeon.

After echographic examination a water-cooled, high-density, monopolar dissecting sealer is introduced into the hepatic parenchyma allowing pre-coagulation of liver tissue. After coagulation of the traced line, a small Kelly forceps is used to fracture the liver parenchyma. As the transection proceeds, the hemostatic efficacy of the dissecting sealer reduces. At this step, where the Pringle maneuver is usually requested to stop bleeding, bimanual compression determines the occlusion of all the afferent vessels, bleeding is effectively stopped with a limited amount of residual backflow arising from the opposite plane.

During a three-year period this approach was used in 9 patients affected by HCC. The Pringle maneuver was not necessary in any patient. The median blood loss was 200mL. The median transection time was 120 min, with a median operative time of 180 min. No mortality occurred.

Compression during the transection represents a valid support not only for the dissecting sealer, but also in all cases in which similar devices are used, and by avoiding the need of further devices there is an unquestionable reduction of costs.