Metzenbaum-Assisted Liver Resection: A Safe and Effective Liver Resection Technique.

[cholangiocarcinoma]

Aim : We hereby present and evaluate a technique for hepatic parenchymal transection based on the application of Metzenbaum scissors and clips during liver ischemia . Methods : Our technique was retrospectively evaluated in 32 noncirrhotic , noncholestatic patients with intrahepatic cholangiocarcinoma and 32 patients with hepatocellular carcinoma (23 of whom cirrhotic , 71 .9 %). Patient data were retrieved from our Hepatobiliary Surgery Database . Type and duration of vascular clamping , blood transfusion requirements , marginal status and immediate postoperative complications were analyzed . Results : Twenty -seven extended (>4 liver segments ; 42 .2 %) and 37 nonextended (≤4 liver segments ; 57 .8 %) liver resections were analyzed . Warm liver ischemia duration was 14 (interquartile range : 11 -17 .8 ) min . Thirty -three patients (51 .6 %) were transfused with a median of 2 (1 .5 -3 ) units of packed red blood cells . Tumor -free margins were achieved in 90 .6 % of cases (n = 58 ). The overall morbidity rate was 18 .8 % with a 4 .7 % mortality rate . Our technique allowed for excellent identification and safe dissection and preservation , or ligation of major liver vessels . Conclusions : The proposed technique is simple , fast , safe and with low cost . It is associated with limited postoperative complications while from an oncologic standpoint it enables the surgeon to achieve a high percentage of tumor -free margins while protecting major vascular structures . © 2014 S . Karger AG , Basel .