Preliminary experience in liver surgery using the ultrasonic scalpel.

We will describe the development of new resectional techniques with the use of the ultrasonic scalpel in 33 patients with liver disease. Our experience is presented in the performance of anatomic and nonanatomic liver resections by use of this device. Its saline-cooled tip vibrated at ultrasonic frequencies and selectively fragmented target tissue, then suspended and aspirated the fragments, thus removing the mesenchyma from the blood vessels. Tactile feedback enhanced this dissection so that all but the smallest blood vessels could be divided between clamps or clips. This resulted in improved control and hemostasis in hepatic resections. Only six patients had complications and there was only one operative death. We now use this technique routinely as we believe it is a major advance over existing methods.