Hanaki T, Tsuda A, Sunaguchi T, Goto K, Morimoto M, Murakami Y, Kihara K, Matsunaga T, Yamamoto M, Tokuyasu N, Sakamoto T, Hasegawa T, Fujiwara Y. Influence of the water jet system vs cavitron ultrasonic surgical aspirator for liver resection on the remnant liver. World J Clin Cases 2022; 10(20): 6855-6864 [PMID: 36051129 DOI: 10.12998/wjcc.v10.i20.6855]
Corresponding Author of This Article
Takehiko Hanaki, MD, PhD, Assistant Professor, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishi-Cho, Yonago 683-8504, Tottori, Japan. hanaki-ttr@umin.ac.jp
Research Domain of This Article
Surgery
Article-Type of This Article
Observational Study
Open-Access Policy of This Article
This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Takehiko Hanaki, Ayumi Tsuda, Teppei Sunaguchi, Keisuke Goto, Masaki Morimoto, Yuki Murakami, Kyoichi Kihara, Tomoyuki Matsunaga, Manabu Yamamoto, Naruo Tokuyasu, Teruhisa Sakamoto, Toshimichi Hasegawa, Yoshiyuki Fujiwara, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, Yonago 683-8504, Tottori, Japan
Author contributions: Hanaki T designed the study and drafted the initial manuscript; Tsuda A performed the all statistical analysis; Sunaguchi T, Goto K, Morimoto M, Murakami Y, Kihara K, Matsunaga T, Yamamoto M and Tokuyasu N participated in the acquisition and analysis of data; Hanaki T and Sakamoto T performed the surgery; Hasegawa T and Fujiwara Y revised the article critically for important intellectual content.
Institutional review board statement: The study was reviewed and approved by the institutional review board of Tottori University, Faculty of Medicine (approval No. 21A081).
Informed consent statement: The need for patients’ informed written consent was waived due to the retrospective nature of the study.
Conflict-of-interest statement: All the authors report no relevant conflicts of interest for this article.
Data sharing statement: No additional data are available.
STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Takehiko Hanaki, MD, PhD, Assistant Professor, Division of Gastrointestinal and Pediatric Surgery, Department of Surgery, Tottori University Faculty of Medicine, 36-1, Nishi-Cho, Yonago 683-8504, Tottori, Japan. hanaki-ttr@umin.ac.jp
Received: November 8, 2021 Peer-review started: November 8, 2021 First decision: April 19, 2022 Revised: April 23, 2022 Accepted: May 27, 2022 Article in press: May 27, 2022 Published online: July 16, 2022 Processing time: 238 Days and 21.3 Hours
Abstract
BACKGROUND
Several methods, such as finger fracture, Pean crush, cavitron ultrasonic surgical aspirator (CUSA), and water jet (WJ), are used for hepatic parenchymal dissection in liver surgery. CUSA is the conventional method in Japan. WJ is a relatively novel method for parenchymal dissection. Although it has several advantages, such as lower volume of blood loss and shorter operative time, the effect of the WJ system for hepatic dissection on the remnant liver has not yet been investigated.
AIM
To investigate and compare the effect of the WJ method vs CUSA on the remnant liver cut surface.
METHODS
This observational study compared the two types of parenchymal transection methods (WJ vs CUSA) in liver surgery. In total, 24 and 40 patients who underwent hepatectomy using the WJ method and CUSA, respectively, were included in the analysis. Accordingly, the clinicopathological characteristics and clinical outcomes of 24 and 40 patients were compared. Furthermore, postoperative contrast-enhanced computed tomography (CT) scan was performed to assess the cut surface length of the remnant liver and the degenerative thickness of the areas with a reduced contrast effect in the dissected plane. Then, the two groups were compared.
RESULTS
On CT scan, the median areas of denaturation in the liver dissection planes were 522 (range: 109.5-1242) mm2 in the CUSA group and 324 (range: 93.6-1529) mm2 in the WJ group. The area did not significantly differ between the two groups; however, the denaturation thickness of the WJ group was significantly lower than that of the CUSA group [5.8 (range: 0.7-11.1) mm vs 3.3 (range: 1.7-10.4) mm, P < 0.001].
CONCLUSION
The WJ group had significantly thinner contrast-enhanced areas in the post hepatectomy detached section than the CUSA group.
Core Tip: We evaluated the denaturation degree of the liver dissection plane on computed tomography (CT) scan and compared the cavitron ultrasonic surgical aspirator and water jet (WJ) method. The perioperative outcomes were almost similar. However, the WJ method had a lower loss of contrast effect on the liver dissection plane. Moreover, we found a positive correlation between the denaturation degree on CT scans and the postoperative peak of hepatic enzymes. The reduced contrast effect on CT scan reflects thermal degeneration during hepatectomy, and the WJ method may be more advantageous in preserving the remnant functioning liver volume during hepatectomy.
