Laparoscopic liver resection in the Large White pig--a comparison between waterjet dissector and ultrasound dissector.

Resection of 16 liver lobes was successfully undertaken laparoscopically in anaesthetised Large White pigs. These animals proved to be suitable for the instruments used in human laparoscopic procedures. It was planned to undertake a comparison between the waterjet and ultrasound dissectors, but this proved impossible because of the development of a thick intraabdominal mist during dissection with the waterjet dissector. The ultrasound dissector was effective in dissecting the intraparenchymal hepatic structures, especially the portal vein and the hepatic vein. These blood vessels were safely secured with endoclips, while bleeding points on the resection surface were coagulated with an argon beam coagulator. The liver specimens removed were approximately 75 g in weight. All ultrasound-dissected animals survived for 10 days. Post-mortem evaluation showed two cases of wound infection, one case of subphrenic abscess and two cases of biloma. Our results emphasise the potential of laparoscopic resection techniques for formal or at least peripheral liver resections in humans.