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1. Liver Resection Using Heat Coagulative Desiccation - preliminary experience with 30 operated patients Prof. M. Milićević MD, Ph D., FACS and P. Bulaji ć MD . The First Surgical Clinic, University of Belgrade Clinical Center IASG Meeting, Buc h arest 2003.
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4. The crucial issue is: Can a simple technique achieve minimal blood loss and safe, tissue sparing liver, parenchyma transsection even in non-anatomical planes ?
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6. The effect of monopolar diathermy … Cushing H, Bovie WT. Electro-surgery as an aid to the removal of intracranial tumors. Surg Gynecol Obstet 1928;47:751-784.
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8. Radionics Cool-tip ™ RF System Coagulative necrosis – tissue dessication 100° C 50° C Denatura tion of collagen Thermal lesion starts 60° C 70° C 80° C 90° C Cool Tip minimal goal Temp. RF induced ionic agitation produces heat
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12. CAN RF BE USED FOR LIVER RESECTION AND NOT ONLY FOR TUMOR ABLATION – THAT IS THE QUESTION?
13. “ ZERO BLOOD LOSS” HEPATECTOMY The Nagy Habib RF hepate ctomy
14. How does RF work on liver tissue ? Current Diameter of coagulation 3 x 1 cm tumor = 20 min. 3 x 1 cm liver = 40 sec.
30. THE SEQUENTIAL CONTINUOUS COAGULATE-CUT TECHNIQUE min. blood loss liver transection technique without occlusion 2.8 kg (the CUSA like technique)
31. Modification of the operative technique Computer monitoring of output parameters ( average - last 24 patients ) Total emission time = 41.08 min. Total current integral = 1892.39 Coulombs Maximal delivered current = 1735.89 mA
40. rf resected area following sequential continuous coagulate-cut technique HE 40x – cell shrinkage, granular hyperesonophylic cytoplasm small dark picnotic nucleus – desication evident
41. SOLITARY NECROTIC LIVER NODULE rf resection in rare entity K. Iwase et al, J Hepato-Biliary- Pancreatic Surgery, 9;1 (120-124), 2002 untill today only 22 cases published
42. OPERATED PATIENTS 01.1 2 .2001 – 01.11.200 2 38 pts. – 40 operations (18 to 76 yrs . – mod. 60) liver lesion pts. operated CRC metastases 20 liver primary Ca 9 recurrent liver abscess 1 actynomicosis 1 ovarii Ca meetastasis 1 hydatid cyst 2 GB cancer 2 Giant liver haemangioma Pulmonary metastasis unknown primary solitary necrotic liver nodule 1 1 1 1 t o t a l 40
43. type of liver resection TYPE HEPATECTOMY (20%) NO. PTS. right 5 left 3 TOTAL 8 TYPE OF RESECTION NO. PTS three segments two segments two segments + subsegmen. segmentectomy + subsegmen. segmentectomy sub-segmentectomy metastasectomy TOTAL 3 7 ( 3 leve) 6 6 1 6 3 32
44. * reoperated † died ( 3 pts. -7.5%) Morbidity and mortality Type of complication No. pts. sequestrated desiccated tissue * pleural empyema † op. site infection wound dehiscience* thrombosis of portal vein enteralna fistula* † pseudomembranous colitis † 2 2 1 1 1 1 1 U k u p n o 9
45. BLOOD TRANSUSION ? NO TRANSFUSION 26 pts. 65.0 % TRANSFUSION 1 4 pts. 3 5.0 % 12 of 1 4 pts. (8 5 %) avg . preop. Hb 9.33 g/L - difficult adhaesiolysis - resection of other organs AVERAGE TRANSFUSION 457.27 mL ( min 240 – max. 1160 ) BLOOD LOSS NOT RELATED TO PROCEDURE ON LIVER
46. instead of a conclusion for those who doubt RF coagulation works …. Transsegment al rese ction of s p l een – no additional hemostasis ... Scintigraphy 2 months po. HE stain