Hepatic resections using a water-cooled, high-density, monopolar device: a new technology for safer surgery.

Several techniques and devices have recently been developed in an effort to allow safer liver resections and avoid intraoperative blood loss. The aim of this study was to analyze our initial experience with hepatic resections using a new water-cooled, high-density, monopolar device--the Tissuelink Monopolar Floating Ball (Tissuelink Medical, Inc., Dover, NH)--in order to avoid bleeding during hepatic surgery. We analyzed patients who underwent hepatic surgery between January and June 2003. Sex, age, type of disease, and type of surgical procedure, in association with the duration of the surgical procedure, blood loss, use of vascular clamping of the liver, length of hospital stay, morbidity, and mortality were analyzed. Seven minor liver resections, two major liver resections, and one total cystopericystectomy were performed with the use of this new device. Average blood loss was 150 ml (range 50 to 300 ml). No vascular clamping was used with the exception of one patient. No deaths were recorded. Morbidity included ascites in one case and pleural effusion in another. In conclusion, the Tissuelink Monopolar Floating Ball permitted excellent coagulation of the cut liver surface, thus avoiding bleeding and vascular clamping. As a result, postoperative morbidity and mortality were low.

Biliary squamous cell carcinoma.

Squamous cell carcinoma of the liver, bile ducts and gallbladder is extremely rare. We report a case of squamous cell carcinoma of the common bile duct manifesting atypically without jaundice, despite its large size and proximal bile duct dilation. A review of the literature concerning all other squamous carcinoma of the biliary tract is presented including 3 other bile duct cancers, 17 intrahepatic and 30 gallbladder cancers. Compared to the more common adenocarcinoma these rare biliary cancers seem to present particular clinical features and prognostic differences which may be important for planning treatment.

Liver metastases from lung cancer: is surgical resection justified?

Resection of the liver for metastatic lesions has largely been done for secondary colorectal or neuroendocrine tumors, and there is little information of its value for other lesions. Recent improvements in hepatic surgery have made resection of metastases a safe procedure and it should certainly be considered whenever there is an isolated lesion. We report the case of a successful resection of an isolated secondary hepatic lesion from a lung primary tumor, which was resected approximately 4 years beforehand. A review of the literature demonstrates that although early reports of similar procedures were not favorable, more recent reports reinforce the value of an aggressive approach in favorable cases.

Simultaneous occurrence of adenoma, focal nodular hyperplasia, and hemangioma of the liver: are they derived from a common origin?

The association between hepatic hemangioma (HH) and focal nodular hyperplasia (FNH) or the association between FNH and hepatic adenoma (HA) has been reported. The authors report a case in which FNH, HH, and HA simultaneously appear in the liver. A 25-year-old woman was admitted to the Department of Surgery of the University of Catania (Italy), after presenting pain in the right hypocondrium. No therapy with oral contraceptives, no pregnancy and no abnormalities of the laboratory tests were found. Ultrasonography and computed tomography scans revealed four masses with the characteristics of HH, HA, FNH, and a hydatid cyst located, respectively, in segments II, IV, IV, and V of the liver. The surgical procedures performed were hemangioma and adenoma enucleation and en bloc resection of the FNH, hydatid cyst and gallbladder. No complications were recorded in the postoperative period and the patient was discharged from the hospital after 1 week. A pathological examination confirmed the preoperative diagnosis. To the best of our knowledge, the association of HH, FNH, and HA has never been reported. A common pathogenesis has clearly been demonstrated for hepatocytes and other cell types. The simultaneous presence of these three different kinds of tumor suggest that HH, FNH and HA could be the different expression of the same malformative anomaly.

Isolated agenesis of the gallbladder: report of a case.

We report the rare case of an isolated gallbladder with cystic duct agenesis that was misdiagnosed as acute alithiasic cholecystitis. We underline the inaccuracy of currently used diagnostic tests and the importance of making a correct preoperative diagnosis to avoid a needless surgical procedure. Based on the rare and incidental nature of this congenital anomaly, we discourage an extensive routine diagnostic workup, but rather, suggest a careful clinical and diagnostic evaluation of the patient who has symptoms suggestive of biliary tract disease. We conclude that in patients with gallbladder and cystic duct agenesis surgery might be useless and risky when performed by the laparoscopic approach. On the other hand, the awareness of the laparoscopic surgeon of the problems posed by this anomaly and a careful review of currently available diagnostic tests can prevent unnecessary laparotomy and minimize the risk of complications.