LIVER SEGMENTECTOMY AS ANATOMICALLY PRECISE RESECTIONS

Objective: To assess a new technique of anatomically precise hepatic s egmental resection and to compare the degree of precision and biochemi cal profiles with results after traditional segmental resection and a sham operation. Design: Experimental study. Setting: University hospit al, Germany Material: 50 sheep (10 each had segments II, III, and IV r emoved by the new technique, and 10 each were studied in the tradition al resection and sham operated groups). Intervention: Operative ultras onography and injection of methylene blue to identify segmental bounda ries. In traditional operations boundaries were identified only from k nowledge of the surface structure of the liver. Main outcome measures: Degree of precision, duration of operation, blood loss, mortality, tr ansaminase activities and liver function tests. Results: Anatomically precise segmentectomies were achieved in 6/9 (67%) for segment II, 6/9 (67%) for segment III, and 4/8 (50%) for segment IV. Using the tradit ional technique (segment III only) there was only 1/10 anatomically pr ecise resections, together with 5 perisegmentectomies and 4 incomplete resections (p < 0.02). The operations for anatomically precise resect ion lasted significantly longer, but resection time was similar. Blood loss, survival, and transaminase activities were similar for the two groups, but the margin of necrosis at the cut edge was significantly l ess in anatomically precise resections. Conclusion: Anatomically preci se hepatic resections are technically feasible with the use of intraop erative ultrasonography and selective staining of the segment(s) to be removed with methylene blue. Although it takes longer, there are no d etrimental consequences compared with the considerably less accurate t raditional technique.