Comparative Study on Liver Resection Between Harmonic Scalpel Versus Crush-clamping Method
Comparative Study on Liver Resection Between Harmonic Scalpel Versus Crush-clamping Method
Blood loss during liver resection significantly associates with short term operative outcome.
 The median blood loss during partial liver resection is 700-1200ml in high-volume centers.
 Conventional method (crush-clamp) has been a standard technique for liver transection.
 Technique advances related to liver transection have contributed to reduction in blood loss.
 Several studies have showed that Harmonic Scalpel in liver resection is safe and easy to use.
 A nonrandomized study showed use of the Harmonic Scalpel was associated with decreased
 operative time, blood loss and transfusion requirement, and an increased incidence of
 postoperative bile leakage. However, no randomized study has compared the difference between
 liver resection using traditional technology and harmonic Scalpel. The objective of this
 prospective randomized study is to compare the safety and efficacy of liver resection using
 the harmonic scalpel device with the "crush-clamp" technique in respect to blood loss, liver
 transection time, hepatic hilum clamping time, hospital stay and postoperative complications.
Blood loss during liver resection significantly associates with short term operative outcome.
 The median blood loss during partial liver resection is 700-1200ml in high-volume centers.
 Conventional method (crush-clamp) has been a standard technique for liver transection.
 Technique advances related to liver transection have contributed to reduction in blood loss.
 Several studies have showed that Harmonic Scalpel in liver resection is safe and easy to use.
 A nonrandomized study showed use of the Harmonic Scalpel was associated with decreased
 operative time, blood loss and transfusion requirement, and an increased incidence of
 postoperative bile leakage. However, no randomized study has compared the difference between
 liver resection using traditional technology and harmonic Scalpel. The objective of this
 prospective randomized study is to compare the safety and efficacy of liver resection using
 the harmonic scalpel device with the "crush-clamp" technique in respect to blood loss, liver
 transection time, hepatic hilum clamping time, hospital stay and postoperative complications.
 All patients submitted to liver resection are randomized into two groups: those submitted to
 liver resection with the use of "crush-clamp" technique. (group Α) and those with the use of
 the Harmonic Scalpel device (group Β).

 Crush-clamping Method (group A) :Patients submitted to liver resection with the use of
 "crush-clamping" technique.

 Device: Liver parenchymal is crushed by surgeon's fingers or basic surgical clamps to isolate
 small vessels and biliary radicals, and then divided by suture ligation, electrocautery, or
 vascular clips.

 Harmonic Scalpel (group B) :Patients submitted to liver resection with the use of the
 Harmonic Scalpel device.Device: liver parenchymal transection is transected by harmonic
 scalpel, and small vessels and biliary radicals (<3mm) is also divided by harmonic scalpel.
 Vessels and biliary radicals (≥ 3mm) were divided by suture ligation, electrocautery, or
 vascular clips.

 Primary Outcome Measures:

 Blood loss during operation [an expected average of 3 hours] operation][Designated as safety
 issue: Yes] Postoperative complications including bile leakage, bleeding, morbidity, injured
 Liver function [Time Frame: participants will be followed for the duration of hospital stay,
 an expected average of 8 days] [Designated as safety issue: Yes]

 Secondary Outcome Measures:

 Transection time from Mark of the cutting edge to finish disposed of the cutting edge
 [Designated as safety issue: No] Hepatic hilar clamping time (Pringle's method) [the duration
 of clamping of hepatic hilar] [Designated as safety issue: No] Hospital stay [participants
 will be followed for the duration of hospital stay, an expected average of 8 days]
 [Designated as safety issue: No] Enrollment: 128 Study Start Date: June 2014 Study Completion
 Date: May 2015 Primary Completion Date: May 2015 (Final data collection date for primary
 outcome measure)

 Eligibility:

 Genders Eligible for Study: Both Accepts Healthy Volunteers: No

 Criteria:

 Inclusion Criteria:

 1. Age ≥18y, and ≤80y;

 2. No history of liver resection and radiotherapy

 3. Liver function: Child A with a normal prothrombin time (<13 seconds) and international
 normalized ratio (INR )(<1.15);

 4. Extent of resection ≥2 segment or diameter of tumor (single nodule) ≥ 8cm or cumulative
 diameter of tumor (multiple nodule) ≥ 8cm; Eligible patients will be stratified by
 resection in left lobe or right lobe.

 5. No tumor thrombosis in main trunk or right and left branch of portal vein or major
 hepatic vein.

 Exclusion Criteria:

 1. Recurrent liver tumor; or simultaneous resection of other organs except gallbladder

 2. Prothrombin time > 13seconds;

 3. Blood platelets count (BPC) < 60*109

 4. Moderate and severe of esophageal varices detected by CT or MRI

 5. Diameter of portal vein > 14mm (color ultrasound)
Inclusion Criteria:

 1. Age ≥18y, and ≤80y;

 2. No history of liver resection and radiotherapy

 3. Liver function: Child A with a normal prothrombin time (<13 seconds) and INR (1.15);

 4. Extent of resection ≥2 segment or diameter of tumor (single nodule) ≥ 8cm or
 cumulative diameter of tumor (multiple nodule) ≥ 8cm; Eligible patients will be
 stratified by resection in left lobe or right lobe.

 5. No tumor thrombosis in main trunk or right and left branch of portal vein or major
 hepatic vein.

 Exclusion Criteria:

 1. Recurrent liver tumor; or simultaneous resection of other organs except gallbladder

 2. Prothrombin time > 13S;

 3. Blood platelets count (BPC) < 60x109

 4. Moderate and severe of esophageal varices detected by CT or MRI

 5. Diameter of portal vein > 14mm (color ultrasound)