Abstract：
BACKGROUND:Blunt-clamp dissection allows for visualization of intrahepatic vessels and individual ligation of major blood or bile vessels. Recently, many instruments have been developed for "precoagulation" of liver parenchyma before sharp transection, but suffer from the possibility of injuring major blood and biliary vessels that are not well-visualized, along with high cost. In this article, we describe a "postcoagulation" technique combining clamp dissection and sealing of vessels under direct vision using a tissue-sealing device. STUDY DESIGN:Clinical evaluation of 400 patients from 2 centers subjected to liver resection using this technique. RESULTS:There were no cases complicated by hemorrhage. There was an incidence of 1.8% for bile leaks. This low incidence of biloma formation was seen even with the high incidence (49%) of abnormal parenchyma encountered in this cohort. CONCLUSIONS:Combining the clamp-crushing method with use of the LigaSure device (Valleylab) allows identification of intraparenchymal vessels followed by sealing. This method of parenchymal transaction optimizes ease of use with confidence in vessel ligation.
journal_name
J Am Coll Surgjournal_title
Journal of the American College of Surgeonsauthors
Patrlj L,Tuorto S,Fong Ydoi
10.1016/j.jamcollsurg.2009.09.035subject
Has Abstractpub_date
2010-01-01 00:00:00pages
39-44issue
1eissn
1072-7515issn
1879-1190pii
S1072-7515(09)01451-3journal_volume
210pub_type
杂志文章abstract：BACKGROUND:With the general acceptance of lumpectomy, axillary staging, and radiotherapy as local treatment for infiltrating breast cancer, an appreciation is evolving for the spectrum of vascular lesions that occur in the mammary skin after this treatment. Most of these lesions develop within the prior radiation field...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
doi：10.1016/s1072-7515(01)00863-8
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abstract：BACKGROUND:Patient comprehension during surgical informed consent remains problematic. Using data from our randomized trial of methods to improve informed consent comprehension, we performed an additional analysis to define independent factors associated with improved patient understanding. STUDY DESIGN:Patients sched...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章,多中心研究,随机对照试验
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abstract：BACKGROUND:The complications and long-term follow-up results of internal hemipelvectomy are not well documented. STUDY DESIGN:We reviewed 32 internal hemipelvectomies performed between 1976 and 1994. RESULTS:The pathologic diagnoses were soft tissue sarcoma in 15 cases, bone tumor in 14 cases, melanoma in two cases, ...
journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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abstract：BACKGROUND:Although the procedure is generally safe, significant morbidity and even mortality have occurred after laparoscopic donor nephrectomy (LDN). The learning curves for both surgeons and institutions with LDN have not been well delineated, and longterm donor data are not well reported. STUDY DESIGN:A retrospect...
journal_title：Journal of the American College of Surgeons
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abstract：BACKGROUND:Preprocedural briefings have been adopted in many high consequence environments, but have not been widely accepted in medicine. We sought to develop, implement, and evaluate a preoperative briefing for cardiovascular surgery. STUDY DESIGN:The briefing was developed by using a combined questionnaire and semi...
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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doi：
更新日期：1996-01-01 00:00:00
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
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更新日期：1995-11-01 00:00:00
abstract：BACKGROUND:One of the most important criteria indicative of the longterm success of vaginal enlargement is the absence of postoperative contracture. Numerous procedures have been developed for reconstruction of an inadequate vagina. Some are technically complex techniques (myo- and fasciocutaneous flaps) with few posto...
journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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doi：
更新日期：1997-10-01 00:00:00
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journal_title：Journal of the American College of Surgeons
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更新日期：1994-01-01 00:00:00
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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journal_title：Journal of the American College of Surgeons
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abstract：BACKGROUND:Single-site laparoscopy (SSL) attempts to further reduce the surgical impact of minimally invasive surgery. However, crossed instruments and the proximity of the endoscope to the operating instruments placed through one single site leads to inevitable instrument or trocar collision. We hypothesized that a no...
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abstract：BACKGROUND:The American College of Surgeons National Surgical Quality Improvement Program (ACS NSQIP) has become an important surgical quality program in the United States, yet few studies describe their methods for handling missing data. Our study examines the impact of missing data on predictive models for short-term...
journal_title：Journal of the American College of Surgeons
pub_type： 杂志文章
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journal_title：Journal of the American College of Surgeons
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