Fusion Technique for Liver Transection: A New Technique Combining Kelly-Clysis and Harmonic Technology

Abstract

Liver transection is performed by multiple techniques. Finger fracture (digitoclasia), clamp–crushing (Kelly-clysis), Cavitron ultrasonic surgical aspirator (CUSA), and Hydro-jet need additional coagulation devices for hemostasis. Precoagulation techniques include RF-HABIB 4x, TissueLink, LigaSure, and Gyrus forceps. Lateral parenchymal damage and biliary leak are the disadvantages. None of these are ideal, and there are no convincing data for superiority of a single technique. The choice is often based on individual surgeon preference. An ideal transection technique should be easy to assemble, ergonomically convenient, and cost-effective, replacing multiple expensive devices in the operating room. The fusion technique uses a single instrument providing both precise parenchymal dissection and hemostasis at the same time. Focus® is a 14-inch-long Kelly-like instrument attached to a Harmonic generator. The curved tapered tips of the instrument allow precise dissection with a gentle clamp–crush technique that splits the parenchyma to expose vascular structures. The blood vessels (up to 5 mm) are sealed by coaptive coagulation at low temperatures (50–100 °C). It can be used to seal vessels up to 5 mm, and along with a long curved tip can be used as a dissecting instrument. In high-speed mode, the liver capsule and superficial parenchyma can be split with ease. No instrument exchange for coagulation is a selective advantage of the fusion technique. Focus® with its Kelly-clysis ability provides an easy and rapid parenchymal split, while the Harmonic technology ensures simultaneous adequate coagulation. We have used this technique in all types of hepatic resection and have found it particularly useful in noncirrhotic livers.