Influence of the water jet system vs cavitron ultrasonic surgical aspirator for liver resection on the remnant liver

Figure 1 Images of liver section plane. A: Close-up image of the liver plane dissected using the water jet method. The fine Glissonian pedicles and veins were exposed without bleeding. There was no thermal damage to the resected surface; B: Image of the liver surface dissected with cavitron ultrasonic surgical aspirator (CUSA); C: Image of the liver surface dissected with the water jet. Thermal denaturation of the liver parenchyma with the water jet might be less than that with CUSA.

Figure 2 Measurement of computed tomography scan values. A: Case 64 — water jet dissection: Computed tomography section of the portal venous phase with the maximum liver dissection length; B: Measurement of liver dissection length; C: Measurement of denaturation area of the cut surface.

Figure 3 Comparison of computed tomography values between the two groups. A: Length of the liver cut surface; B: Area of denaturation; C: Denaturation index (Mann-Whitney U test). CUSA: Cavitron ultrasonic surgical aspirator.

Figure 4 Correlation between the highest postoperative aspartate aminotransferase and alanine aminotransferase levels and computed tomography values. A: Dissection length; B: Denaturation area; C: Denaturation index. There was a significant positive correlation between the highest aspartate aminotransferase/alanine aminotransferase levels and denaturation area. AST: Aspartate aminotransferase; ALT: Alanine aminotransferase.

Figure 5 Example of the liver specimen (cut surface). A thermal denaturation on a dissected plane of the liver; 5-8 mm of thermal denaturation (arrowhead) could be observed in the hepatic resection margin (dashed line) due to electrocauteries.