Experience with ultrasound scissors and blades (UltraCision) in open and laparoscopic liver resection.

Despite standardized techniques for liver resection, the surgical death rate ranges from 4% to 20%. 1–4 Dissection of the parenchyma of the liver may cause considerable blood loss. Further complications include liver failure, hematoma, infections, and bile leakage as a result of inadequate closure of the resection area of the liver. Surgical techniques are an important factor for preventing intraoperative and postoperative complications. 3 Various techniques have been developed for safe and careful dissection of the liver parenchyma. In addition to blunt dissection using the “finger fracture” technique, 1 various ultrasonic dissectors, water jet dissectors, laser systems, and specially prepared suction devices have been used. 2–8 None of these techniques can achieve complete hemostasis during dissection. Consequently, blood vessels and biliary tract branches need to be clipped or sutured. In laparoscopic surgery dissection of parenchyma is performed using an electric hook or scissors to achieve a bloodless operating field. However, the use of electric coagulation may cause severe complications by damaging nearby organs (i.e., the common bile duct during cholecystectomy or the small bowel). 9 The UltraCision scissors discussed in this article were originally developed for laparoscopic surgery. They meet the requirement for a safe instrument for laparoscopic preparation. 10–15 In this article we will present our experiences with the new technique of ultrasound dissection. In our clinic this cutting device is mainly used in laparoscopic surgery for dissection of tissue, but we consider it an appropriate instrument for liver dissection. Because of its simultaneous hemostatic and coagulating effect, it might theoretically offer a considerable advantage over the suction knife technique used in our clinic for liver resection. The aim of our study was to prove the suitability of the ultrasound scissors (Harmonic Scalpel, UltraCision, Ethicon Endosurgery) for the dissection of liver parenchyma in laparoscopic and open surgery in routine clinical practice; in addition, we wanted to see whether there are advantages over other techniques.