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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
.
Diseases
Validation
Diseases presenting
"low cost"
symptom
acute rheumatic fever
cholangiocarcinoma
dracunculiasis
esophageal adenocarcinoma
neuralgic amyotrophy
oral submucous fibrosis
waldenström macroglobulinemia
zellweger syndrome
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