Application value of cavitron ultrasonic surgical aspirator combined with high-frequency electrosurgical scalpel in liver graft procurement for living donor liver transplantation

doi:10.3877/cma.j.issn.2095-3232.2016.03.004

Abstract

Abstract:

Objective

To explore the application value of cavitron ultrasonic surgical aspirator (CUSA) combined with high-frequency electrosurgical scalpel in liver graft procurement for living donor liver transplantation (LDLT).

Methods

Clinical data of 8 donors who underwent LDLT in Zhengzhou People's Hospital between May 2012 and July 2015 were retrospectively analyzed. CUSA combined with high frequency electrosurgical scalpel were used in the liver graft procurement of all the donors. Among the donors, 4 were males and 4 were females with the age ranging from 30 to 56 years old and the median of 45 years old. The informed consents of all donors were obtained and the local ethical committee approval was received. During the graft procurement, the liver was fully dissociated, and the first porta hepatis was dissected without blood occlusion. Blood vessel distribution and liver resection line were determined by intraoperative ultrasound examination. Liver capsule was incised with high frequency electrosurgical scalpel and liver parenchyma was seperated with CUSA. The length of operation, intraoperative blood loss, changes of liver function and length of stay after operation, incidence of complications and perioperative mortality of the donors were observed. All the donors were followed up after operation.

Results

All donors completed the operations successfully. Six cases underwent right hemihepatectomy and one of them had middle hepatic vein resected. Two cases underwent left hemihepatectomy without resecting the middle hepatic vein. The average length of operation was (437±96) min and the intraoperative blood loss was (467±216) ml. No blood transfusion during operation was observed. The serum alanine aminotransferase (ALT) level was respectively (221±56) and (77±25) U/L, and the serum total bilirubin (TB) level at 1, 7 d after operation was respectively (34±11) and (16±6) μmol/L. The length of stay after operation was (18±5) d. Fat liquefaction of wound after operation was observed in 1 case and was cured after conservative treatment. No death was observed.

Conclusions

CUSA combined with high frequency electrosurgical scalpel has certain clinical application value in the liver graft procurement for LDLT. It is a safe and effective method for liver graft procurement.

Key words: Liver transplantation, Living donors, Cavitron ultrasonic surgical aspirator, High frequency electrosurgical equipment

Meng Liu, Guoyong Chen, Jianjun Sun, Gaofeng Tang, Sidong Wei. Application value of cavitron ultrasonic surgical aspirator combined with high-frequency electrosurgical scalpel in liver graft procurement for living donor liver transplantation[J]. Chinese Journal of Hepatic Surgery(Electronic Edition), 2016, 05(03): 141-143.

/ / Recommend

Add to citation manager EndNote|Ris|BibTeX

URL: https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/10.3877/cma.j.issn.2095-3232.2016.03.004

https://zhgzwkssxdzzz.cma-cmc.com.cn/EN/Y2016/V05/I03/141

References 20

[1]	Tanoglu A, Artis T, Donmez R, et al. Liver transplantation from living donors with Gilbert's syndrome is a safe procedure for both donors and recipients[J]. Clin Transplant, 2015, 29(11):965-970.
[2]	Benini BB, Salzedas-Netto AA, de Azevedo RA, et al. Clinical evaluation of hepatic transection on pediatric liver transplantation[J]. Transplant Proc, 2014, 46(6): 1778-1780.
[3]	Dayangac M, Taner CB, Balci D, et al. Use of middle hepatic vein in right lobe living donor liver transplantation[J]. Transpl Int, 2010, 23(3): 285-291.
[4]	Shiba H, Wakiyama S, Futagawa Y, et al. Assessment of graft selection criteria in living-donor liver transplantation: the Jikei experience[J]. Int Surg, 2015, 100(7/8): 1229-1232.
[5]	Liu B, Yan LN, Wang WT, et al. Clinical study on safety of adult-to-adult living donor liver transplantation in both donors and recipients[J]. World J Gastroenterol, 2007, 13(6):955-959.
[6]	Nadalin S, Capobianco I, Königsrainer I, et al. Living liver donor: indications and technical aspects[J]. Chirurg, 2015, 86(6): 609-621.
[7]	Brown RS Jr, Smith AR, Dew MA, et al. Predictors of donor follow-up after living donor liver transplantation[J]. Liver Transpl, 2014, 20(8): 967-976.
[8]	Adcock L, Macleod C, Dubay D, et al. Adult living liver donors have excellent long-term medical outcomes: the University of Toronto liver transplant experience[J]. Am J Transplant, 2010, 10(2): 364-371.
[9]	Roll GR, Parekh JR, Parker WF, et al. Left hepatectomy versus right hepatectomy for living donor liver transplantation: shifting the risk from the donor to the recipient[J]. Liver Transpl, 2013, 19(5): 472-481.
[10]	Guler N, Yaprak O, Gunay Y, et al. Major complications of adult right lobe living liver donors[J]. Hepatobiliary Pancreat Dis Int, 2015, 14(2):150-156.
[11]	Hori T, Oike F, Ogura Y, et al. Graft harvest of right posterior segment for living-donor liver transplantation[J]. Int J Surg Case Rep, 2014, 5(8):516-522.
[12]	Rauchfuss F, Bauschke A, Bärthel E, et al. Living donor liver transplantation-past and present[J]. Zentralbl Chir, 2013, DOI: 10.1055/s-0032-1328347[Epub ahead of print].
[13]	Schemmer P, Mehrabi A, Friess H, et al. Living related liver transplantation: the ultimate technique to expand the donor pool?[J]. Transplantation, 2005, 80(1 Suppl): S138-141.
[14]	范上达，任祖海．成人活体肝移植的现状和争议[J]．临床外科杂志，2005，13(1): 8-9.
[15]	杭化莲，张祺琪，张建军，等．精准肝脏外科理念在儿童活体肝移植供肝切取术中的临床价值[J]．中华消化外科杂志，2014，13(10): 806-810.
[16]	Lochan R, Ansari I, Coates R, et al. Methods of haemostasis during liver resection--a UK national survey[J]. Dig Surg, 2013, 30(4/5/6): 375-382.
[17]	S Hammond J, Muirhead W, Zaitoun AM, et al. Comparison of liver parenchymal ablation and tissue necrosis in a cadaveric bovine model using the Harmonic Scalpel, the LigaSure, the Cavitron Ultrasonic Surgical Aspirator and the Aquamantys devices[J]. HPB, 2012, 14(12):828-832.
[18]	El Moghazy WM, Hedaya MS, Kaido T, et al. Two different methods for donor hepatic transection: cavitron ultrasonic surgical aspirator with bipolar cauteryversus cavitron ultrasonic surgical aspirator with radiofrequency coagulator-a randomized controlled trial[J]. Liver Transpl, 2009, 15(1): 102-105.
[19]	Yamada N, Amano R, Kimura K, et al. Two-surgeon technique for liver transection using precoagulation by a soft-coagulation system and ultrasonicdissection[J]. Hepatogastroenterology, 2015, 62(138): 389-392.
[20]	文天夫，米凯，李川，等．活体肝移植右半供肝切取的临床经验总结(附157例报告)[J]．器官移植，2013，4(1): 28-32.

Please choose a citation manager

Content to export