Laparoscopic Liver Resection and the Use of Torsional Ultrasound Dissectors for Parenchymal Liver Dissection

Recent advances in laparoscopic surgical equipment is one of the most significant factors in the expansion of laparoscopic liver resections (LLR) by increasing its feasibility, safety and efficiency.
Ultrasonic dissectors are the main instrument used for the parenchymal dissection part of a laparoscopic liver resection. Most of the commercially available brands of ultrasonic dissectors use a longitudinal mode of ultrasound vibration. Choice of which particular brand and model is largely down to surgeon preference.
In the UK a new device called LOTUS® (SRA Developments Ltd, Devon, UK) has been developed, using a torsional mode of ultrasonic vibration.
As the largest centre for laparoscopic liver surgery in the UK, we report our series of five years experience of LLRs and during the presentation will show edited video footage to illustrate the efficacy of torsional ultrasound in LLRs.
Patients and methods:
Since January 2004 to August 2008, 103 LLRs were performed in our Unit. Torsional ultrasound was the main dissector used in 63 cases. (5 major hepatectomies (MH), 35 left lateral secienectomies, 10 bisegmentectomies, and 13 segmentectomies) and was one of the principle instruments used in 20 cases (15 MH and 5 LLS).
Median blood loss was 250ml (50-600). Mean operating time was 180mins (120-242.5) and median hospital stay was 3 days (2-4). There were two major complications, one bile leak and one haemorrhage requiring return to theatre and nine minor complications.
Advancements in surgical equipment have contributed significantly to a safe and efficient expansion of LLRs. A reliable ultrasonic dissector is essential in this type of surgery and the torsional mode of ultrasonic vibration has been shown to be an excellent instrument for dissecting liver parenchyma haemostatically.

Session: Poster

Program Number: P431

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