Standards of Surgical Techniques in Liver Metastases The first posttraumatic liver resection was performed in the 17th century. Since then almost 200 years have passed until the first elective liver resection was performed in 1888 and the first hemihepatectomy was achieved in 1911 by Wendell. It was quickly evident that almost 70% of the time required for a successful liver resection was needed for the anatomical preparation and only 20% of the time for parenchymal resection. Since this time a wide variety of dissection techniques have been introduced. The blunt dissection was replaced by novel methods, i.e. CUSA® technique, and the Jet-Cutter for major liver resections. These methods represent selective dissection techniques, whereas nonselective methods include the scalpel, scissors, linear stapling cutter, high-frequency coagulation, and the laser technique. The aim of this review is to compare the different resection techniques in liver surgery, focusing on blood loss and resection time. A clinical study compared blood loss, resection time, and Pringle time between the different dissection techniques (blunt dissection n = 279, CUSA, n = 175 and Jet-Cutter n = 137). Parenchymal resection performed via Jet-Cutter showed a significant lower blood loss and shorter resection and Pringle time in comparison to the other resection techniques. Moreover, extrahepatic control of liver perfusion and of the liver veins and the surgeon’s experience are important for lowering blood loss during liver resection. The aim of this review is the comparison of the different resection techniques in liver surgery focusing on blood loss and resection time.

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© 2003 S. Karger GmbH, Freiburg
2004
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