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Usefulness of Kelly clamp crushing technique during hepatic resection.

ABSTRACT: INTRODUCTION: Recently, there are various kinds of parenchymal transection methods. The aim of this study is to evaluate the usefulness of the Kelly clamp crushing technique compared to ultrasonic dissector during hepatic resection. MATERIALS AND METHODS: Comparisons between 10 ultrasonic dissector group and 10 Kelly clamp crushing technique group were performed by using nine items (transaction time, right lobe volume, perioperative transfusion, total bilirubin (TB), aspartate aminotransferase (AST), alanine aminotransferase (ALT), hospital stay, postoperative morbidity, in-hospital mortality). RESULTS: The mean transection time in the Kelly clamp crushing technique group was 27+/-15.5 mins (range 15-60) and was 48+/-7.1 mins (range 35-60) in the ultrasonic dissector group (p<0.05), and no patients received transfusion in both groups. CONCLUSIONS: Since the Kelly clamp crushing technique shortens operative time and there is no significant difference in blood loss and in results of liver function tests compared to using the ultrasonic dissector, we propose that the Kelly clamp crushing technique should be considered as a standard method of liver resection.

SUBMITTER: Kim KH

PROVIDER: S-EPMC2518298 | biostudies-other | 2008

REPOSITORIES: biostudies-other

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Snip-electrocoagulation technique versus clamp-crashing technique for parenchyma transection in liver resection: a pilot study.

Project description:BackgroundNowadays, much effort has been made to optimize the technique for liver parenchyma transection to reduce intrasurgical hemorrhage and complications. Here we intent to introduce a novel method for sharp liver parenchyma transection using scissors and bipolar electrocoagulator (named the snip-electrocoagulation technique, SET) and compare it with the classical clamp-crushing technique (CCT).MethodsIn this retrospective study, 98 patients were divided into either the SET group or the CCT group. The total inflow occlusion time, total surgery time, intrasurgical blood loss and transfusion, morbidity, mortality, hospital stay, and the narrowest tumor-free margins were compared.ResultsBackground characteristics in the two groups were comparable, and the differences of total inflow occlusion time (median 25 vs. 27 minutes), total surgery time (median 182.5 vs. 190 minutes), blood transfusion amount (median value 0 in both groups), postoperative hospital stay (median 7 vs. 8 days), and overall complication rate (16% vs. 31.2%, P>0.05) were not statistically significant. However, the SET group yielded less intrasurgical blood loss (median 200 vs. 300 mL), and better tumor-free margins (13.69±2.99 vs. 10.76±3.31 mm; mean ± SD; P<0.05).ConclusionsSET is a safe method for sharp parenchyma transection in liver resection when compared with the classical CCT, considering the similar morbidity and mortality, along with the decreased intrasurgical blood loss. More importantly, SET can be adopted when the tumors are located close to the intrahepatic vessels and the tumor-free margins are expected to be limited.

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BiClamp® forcep liver transection versus clamp crushing technique for liver resection: study protocol for a randomized controlled trial.

Project description:Blood loss and the requirement of blood transfusions during liver transection have been shown to correlate well with higher morbidity and mortality rates and a worse prognosis. Various devices for liver parenchymal transection have been developed to reduce intraoperative blood loss. The goal of this study is to evaluate the safety and effectiveness of BiClamp® forcep transection compared to a clamp crushing technique in patients undergoing liver resection.This study will include patients 18 years and older scheduled for hepatectomy with hepatic vascular exclusion who give informed consent. A sample size of 48 patients in each randomization arm will be calculated to detect a difference in the reduction of blood loss of approximately 200 ml (90% power and ??=?0.05 (two-tailed)). The primary efficacy endpoint of the trial will be the total intraoperative blood loss based on the randomized dissection technique. The statistical analysis is based on the intention-to-treat population. Patients will be followed up on for three months for complications and adverse events.This prospective, single-center, randomized controlled, single-blinded, two-group parallel trial is designed to assess the efficacy and safety of BiClamp forcep hepatectomy versus clamp crushing for parenchymal transection during elective hepatic resection.This trial was registered with Clinicaltrials.gov (identifier: NCT02197481 ) on 15 July 2014.

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Use of a collagen-sealing device in hepatic resection: a comparative analysis to standard resection technique.

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Fibular Intra-articular Resection During Arthroscopic Ankle Arthrodesis: The Surgical Technique.

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Clamp-crushing versus stapler hepatectomy for transection of the parenchyma in elective hepatic resection (CRUNSH)--a randomized controlled trial (NCT01049607).

Project description:BackgroundHepatic resection is still associated with significant morbidity. Although the period of parenchymal transection presents a crucial step during the operation, uncertainty persists regarding the optimal technique of transection. It was the aim of the present randomized controlled trial to evaluate the efficacy and safety of hepatic resection using the technique of stapler hepatectomy compared to the simple clamp-crushing technique.Methods/designThe CRUNSH Trial is a prospective randomized controlled single-center trial with a two-group parallel design. Patients scheduled for elective hepatic resection without extrahepatic resection at the Department of General-, Visceral- and Transplantation Surgery, University of Heidelberg are enrolled into the trial and randomized intraoperatively to hepatic resection by the clamp-crushing technique and stapler hepatectomy, respectively. The primary endpoint is total intraoperative blood loss. A set of general and surgical variables are documented as secondary endpoints. Patients and outcome-assessors are blinded for the treatment intervention.DiscussionThe CRUNSH Trial is the first randomized controlled trial to evaluate efficacy and safety of stapler hepatectomy compared to the clamp-crushing technique for parenchymal transection during elective hepatic resection.Trial registrationClinicalTrials.gov: NCT01049607.

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Project description: Not available

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Experimental and histological evaluation of different clamp technique for pulmonary artery.

Project description:ObjectivesThe double-loop technique has been used in our clinical settings for pulmonary arterioplasty and/or injured artery repair during thoracoscopic anatomical lung resection. We evaluated the pressure resistance capacity and intimal load to determine the effectiveness and safety of the double-loop technique.MethodsThe double-loop technique, DeBakey clamp, Fogarty clamp, endovascular clips and vessel loop technique were evaluated. During an experimental study, a polyvinyl alcohol main pulmonary artery model, manometer and in-deflation device were used to measure the burst pressure. The maximum clamp pressure was measured using a pressure-measuring film. Each measurement was performed 10 times. During the histological study, we measured the burst pressure and evaluated the intimal damage of the human pulmonary artery associated with the double-loop technique and DeBakey clamp.ResultsThe experimental burst pressure (mmHg) and maximum clamp pressure (MPa) between the double-loop technique and DeBakey at the third notch were not significantly different (24.6 ± 2.8 and 21.8 ± 2.8, P = 0.094; 1.54 ± 0.12 and 1.49 ± 0.12, P = 0.954). During the histological study, the burst pressures of the double-loop technique and DeBakey at the third notch were also not significantly different (P = 0.754). Furthermore, the double-loop technique resulted in only intimal deformation in each five samples.ConclusionsThe double-loop technique is feasible for thoracoscopic anatomical lung resection because it has similar pressure resistance capacity and intimal load as DeBakey at the 3rd notch.

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HERG channel (dys)function revealed by dynamic action potential clamp technique.

Project description:The human ether-a-go-go-related gene (HERG) encodes the rapid component of the cardiac delayed rectifier potassium current (I(Kr)). Per-Arnt-Sim domain mutations of the HERG channel are linked to type 2 long-QT syndrome. We studied wild-type and/or type 2 long-QT syndrome-associated mutant (R56Q) HERG current (I(HERG)) in HEK-293 cells, at both 23 and 36 degrees C. Conventional voltage-clamp analysis revealed mutation-induced changes in channel kinetics. To assess functional implication(s) of the mutation, we introduce the dynamic action potential clamp technique. In this study, we effectively replace the native I(Kr) of a ventricular cell (either a human model cell or an isolated rabbit myocyte) with I(HERG) generated in a HEK-293 cell that is voltage-clamped by the free-running action potential of the ventricular cell. Action potential characteristics of the ventricular cells were effectively reproduced with wild-type I(HERG), whereas the R56Q mutation caused a frequency-dependent increase of the action potential duration in accordance with the clinical phenotype. The dynamic action potential clamp approach also revealed a frequency-dependent transient wild-type I(HERG) component, which is absent with R56Q channels. This novel electrophysiological technique allows rapid and unambiguous determination of the effects of an ion channel mutation on the ventricular action potential and can serve as a new tool for investigating cardiac channelopathies.

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The usefulness of the totally intra-corporeal pringle maneuver with Penrose drain tube during laparoscopic left side liver resection.

Project description:Backgrounds/Aims:The Pringle maneuver is generally performed to reduce the amount of blood loss during hepatic resection. During laparoscopic liver resection, the Pringle maneuver can be used in several ways. We have developed a new Pringle maneuver (PM) with Penrose drain tube to sufficiently control blood loss during laparoscopic liver resection. This study was performed to determine the safety and outcome during laparoscopic left-sided hepatectomy performed using this new method. Methods:We describe the technique and results of the left-sided liver resection with totally intracorporeal PM with Penrose drain tube. We performed 37 laparoscopic left-sided hepatic resections with (PM group) or without the Penrose PM (No PM group). We retrospectively compared the short-term operative outcome between the No PM group (n=12) and the PM group (n=25) during laparoscopic left-sided liver resection. Results:Median PM duration was 34.3 min. The median duration of the surgery using the totally intracorporeal PM with Penrose drain tube was 174 min, while the surgical duration required for resection without the PM was 156 min. The median volume of operative blood loss was lower in the PM group than in the No PM group (No PM group (341 ml) vs. PM group (165 ml)). There was no postoperative mortality and no open conversion. Conclusions:The totally intracorporeal PM with Penrose drain tube for laparoscopic hepatectomy is safe, reproducible, and can facilitate liver dissection during left-sided liver resection.

| S-EPMC7452809 | biostudies-literature

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