Ultrasonically activated device for parenchymal division during open liver resection

Over the past decades, liver surgery has gained wide acceptance as a main therapeutic option for patients with both benign and malignant lesions. The introduction of new technological devices has gained popularity among liver surgeons with the aim of improving safety of resection and reducing procedure-related complications such as bile leakage, hematoma, and infections. In this chapter, we review the usefulness of the ultrasonic activated device (USAD) for dissection of liver parenchyma during open liver resection. In open surgery, this device can be used for blunt preparation, cutting, and coagulation, which are achieved by local thermal denaturation resulting from longitudinal vibration of the blade. Both thermal spreading and conduction have been shown to be significantly lower when compared with electrocoagulation and laser. Though there is a lack of data based on well-conducted controlled studies and further studies on a greater number of patients are needed, according to our experience, utilization of USAD may help to minimize blood loss during liver resection regardless of the condition of the liver, even in case of cirrhosis.