Laparoscopic Hepatic Transection Using an Ultrasonically Activated Device

The introduction of new technological devices for efficient and fast hemostatic control during parenchymal transection has greatly enhanced the diffusion and safety of the laparoscopic approach in the field of liver surgery. In this chapter we review the usefulness of the ultrasonically activated device (USAD) for dissection of liver parenchyma during laparoscopic liver resection. Among the wide panorama of available devices, the USAD technology in our experience of 69 laparoscopic liver resections was revealed to be a useful tool in both the dissection and parenchymal transection phases. For instance, the Pringle maneuver was rarely needed to achieve a safe coagulating effect, even when prepared in case of major bleedings. USAD was demonstrated to be extremely efficient in mobilizing the liver by rapid and blood-less dissection of all suspending ligaments. Though there is a lack of data based on well-conducted controlled studies and further studies on a greater number of patients are needed, according to our experience, utilization of USAD may help to minimize blood loss during liver resection regardless of the condition of the liver, even in case of cirrhosis.